eMedicine Specialties > Pediatrics: General Medicine > Gastroenterology

Rectal Prolapse: Follow-up

Author: Joel A Friedlander, DO, MBe, Instructor, Department of Pediatrics, University of Pennsylvania School of Medicine; Fellow, Pediatric Gastroenterology, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia
Coauthor(s): Maria Rebello Mascarenhas, MBBS, Associate Professor of Pediatrics, University of Pennsylvania School of Medicine; Section Chief, Division of Gastroenterology and Nutrition, Director, Nutrition Support Service, Children's Hospital of Philadelphia; Leon M Garner, DO, MPH, Staff Physician, Department of Emergency Medicine, North Broward Medical Center; Frank Cunningham, Jr, MD, FAAP, FACEP, Director, Division of Emergency Pediatrics, Assistant Professor, Department of Pediatrics, University of Medicine and Dentistry of New Jersey
Contributor Information and Disclosures

Updated: Dec 1, 2008

Follow-up

Further Inpatient Care

  • Inpatient management of rectal prolapse is usually reserved for patients in whom surgical therapy is necessary.

Further Outpatient Care

  • All pediatric rectal prolapses should be approached as possible symptoms of another underlying disease process or disorder.
    • Evaluate the child for cystic fibrosis.
    • Evaluate whether or not the child has exhibited signs of constipation or diarrhea.
    • If sweat test results are negative and bowel regimen has been normal, consider proctosigmoidoscopy to rule out rectal polyps or lesions.

Complications

  • Ulceration of mucosa
  • Frequent recurrence despite surgical correction
  • Complications of surgical repair procedures such as nerve damage, infection, or incontinence

Prognosis

  • Approximately 10% of patients who experience rectal prolapse as children continue to experience it in their adult lives.
  • Approximately 90% of children aged 9 months to 3 years who experience rectal prolapse respond to conservative management by age 6 years.
  • Spontaneous resolution is much less likely in children who first experience prolapse when they are older than 4 years.

Patient Education

  • Instruct parents how to manually reduce a prolapse and to seek immediate help from a health care provider if reduction fails.
  • For excellent patient education resources, visit eMedicine's Esophagus, Stomach, and Intestine Center. Also, see eMedicine's patient education article Rectal Prolapse.

Miscellaneous

Medicolegal Pitfalls

  • Rectal prolapse must be differentiated from prolapse of an intussusception or rectal polyp.
  • Pediatric patients with rectal prolapse must be evaluated to rule out cystic fibrosis.
 


More on Rectal Prolapse

Overview: Rectal Prolapse
Differential Diagnoses & Workup: Rectal Prolapse
Treatment & Medication: Rectal Prolapse
Follow-up: Rectal Prolapse
References
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References

  1. Corman ML. Rectal prolapse in children. Dis Colon Rectum. Jul 1985;DA - 19850830(7):535-9. [Medline].

  2. Tou S, Brown SR, Malik AI, Nelson RL. Surgery for complete rectal prolapse in adults. Cochrane Database System Reviews [serial online]. 4:CD001758. [Medline]. Available at http://proxy.library.upenn.edu:2206/cochrane/clsysrev/articles/CD001758/frame.html.

  3. Antao B, Bradley V, Roberts JP, Shawis R. Management of rectal prolapse in children. Dis Colon Rectum. Aug 2005;48(8):1620-5. [Medline].

  4. El-Sibai O, Shafik A. Cauterization-plication operation in the treatment of complete rectal prolapse. Techniques in Coloproctology. 2002;6(1):51-54. [Medline].

  5. Behrman R, Kleigman R, Jenson H. Rectal prolapse. In: Nelson Textbook of Pediatrics. 16th ed. Philadelphia, Pa: WB Saunders and Co; 2000:1182.

  6. Chan WK, Kay SM, Laberge JM, et al. Injection sclerotherapy in the treatment of rectal prolapse in infants and children. J Pediatr Surg. Feb 1998;33(2):255-8. [Medline].

  7. Koivusalo A, Pakarinen M, Rintala R. Laparoscopic suture rectopexy in the treatment of persisting rectal prolapse in children: a preliminary report. Surg Endosc. Jun 2006;20(6):960-3. [Medline].

  8. Nwako F. Rectal Prolapse in Nigerian Children. Internattional Surgery. 1975;60(5):284-285. [Medline].

  9. Reyes H, Block G, Moossa A, eds. Rectal prolapse. In: Operative Colorectal Surgery. Philadelphia, PA: WB Saunders and Co; 1994:573-8.

  10. Rowe M. Rectal prolapse. In: Essentials of Pediatric Surgery. St. Louis, MO: Mosby-Year Book; 1995:600-1.

  11. Severijnen R, Festen C, van der Staak F, Rieu P. Rectal prolapse in children. Neth J Surg. Dec 1989;41(6):149-51. [Medline].

  12. Siafakas C, Vottler TP, Andersen JM. Rectal prolapse in pediatrics. Clin Pediatr (Phila). Feb 1999;38(2):63-72. [Medline].

  13. Spiro H, Atterbury C. Rectal prolapse. In: Clinical Gastroenterology. 4th ed. New York, NY: McGraw-Hill Book Co; 1993:820-1.

  14. Steele SR, Goetz LH, Minami S, et al. Management of recurrent rectal prolapse: surgical approach influences outcome. Dis Colon Rectum. Apr 2006;49(4):440-5. [Medline].

  15. Walker W, Durie, PR, Hamilton JR, eds. Rectal prolapse. In: Pediatric Gastrointestinal Disease: Pathophysiology, Diagnosis, Management. 2nd ed. St. Louis, MO: Mosby-Year Book; 1996:581-2.

  16. Zempsky WT, Rosenstein BJ. The cause of rectal prolapse in children. Am J Dis Child. Mar 1988;142(3):338-9. [Medline].

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Further Reading

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Keywords

rectal prolapse, rectum prolapse, rectal mucosa prolapse, procidentia of rectum, Hirschsprung disease, Ehlers-Danlos syndrome, excessive straining, cystic fibrosis, intussusception, manual reduction, abdominal rectopexy, Ekehorn rectopexy, diarrhea, meningomyelocele, pertussis, rectal polyp, congenital megacolon, pneumonia, whipworm

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Contributor Information and Disclosures

Author

Joel A Friedlander, DO, MBe, Instructor, Department of Pediatrics, University of Pennsylvania School of Medicine; Fellow, Pediatric Gastroenterology, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia
Joel A Friedlander, DO, MBe is a member of the following medical societies: American Academy of Pediatrics, American Association for the Study of Liver Diseases, American College of Osteopathic Pediatricians, American Gastroenterological Association, American Medical Association, American Osteopathic Association, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

Coauthor(s)

Maria Rebello Mascarenhas, MBBS, Associate Professor of Pediatrics, University of Pennsylvania School of Medicine; Section Chief, Division of Gastroenterology and Nutrition, Director, Nutrition Support Service, Children's Hospital of Philadelphia
Maria Rebello Mascarenhas, MBBS is a member of the following medical societies: American Gastroenterological Association, American Society for Parenteral and Enteral Nutrition, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

Leon M Garner, DO, MPH, Staff Physician, Department of Emergency Medicine, North Broward Medical Center
Leon M Garner, DO, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American College of Osteopathic Emergency Physicians
Disclosure: Nothing to disclose.

Frank Cunningham, Jr, MD, FAAP, FACEP, Director, Division of Emergency Pediatrics, Assistant Professor, Department of Pediatrics, University of Medicine and Dentistry of New Jersey
Frank Cunningham, Jr, MD, FAAP, FACEP is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

Robert Baldassano, MD, Director, Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology and Nutrition, Associate Professor, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania
Robert Baldassano, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

B U K Li, MD, Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Director, Pediatric Fellowships and Gastroenterology Fellowship, Medical Director, Functional Gastrointestinal Disorders and Cyclic Vomiting Program, Medical College of Wisconsin; Attending Gastroenterologist, Children's Hospital of Wisconsin
B U K Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

CME Editor

Steven M Schwarz, MD, FAAP, FACN, AGAF, Professor of Pediatrics, State University of New York, Downstate Medical Center College of Medicine; Distinguished Lecturer, New York Medical College, School of Public Health
Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research
Disclosure: TAP Pharmaceuticals Honoraria Speaking and teaching; Curemark, LLC Consulting fee Board membership

Chief Editor

Carmen Cuffari, MD, Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine
Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

 
 
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