Patient Preparation
Anesthesia
In the case of a relaxed cooperative patient, anesthesia may not be needed. In other cases, a local perianal anesthetic or procedural sedation can be used. Although the bowel itself has no pain receptors, apprehension and discomfort may lead to spasm of the anal sphincter, making reduction difficult or impossible until relaxation can be achieved.
No randomized trials have compared anesthetic techniques for this specific procedure. Perianal field block has been described as useful for various rectal procedures. Multiple injections of a local anesthetic are made into the ischiorectal fat immediately peripheral to the external sphincter, with good anesthesia occurring in just a few minutes. [8] The injections themselves are painful.
Positioning
The patient should be in either the dorsal lithotomy or the knee-chest position. Children may be less anxious if allowed to remain on the lap of a parent.
Monitoring & Follow-up
Patients should follow up with a primary care provider or a surgeon for further treatment. Patients (or family members) who are capable may be instructed to attempt reduction themselves in case of recurrence.
-
Diagram depicting clinical difference between true (full-thickness) prolapse (left), including all layers of rectum and with circular folds seen on prolapsed intestine, and procidentia, or mucosa-only prolapse (right), in which radial folds are seen in mucosa.
-
Photograph of severe rectal prolapse with clinically significant edema and mucosal ulceration.
-
Picture of infant with full-thickness rectal prolapse. Severe edema and abundant mucus are seen on mucosal surface.
-
Image demonstrates mucosal prolapse, with radial folds seen on mucosa.
