Medication Summary

There is no specific medical treatment for rectal prolapse, however, management of constipation, treatment of associated parasitic infections, and avoiding excessive strain are appropriate measures for the management of uncomplicated rectal prolapse.

Pancreatic enzyme replacement may be useful on CF patients with rectal prolapse with a 72% efficacy ^[1].

Class Summary

In addition to dietary modification, stool softeners help to decrease bowel movement straining secondary to constipation.

Polyethylene glycol solution (MiraLAX, Dulcolax Balance)

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Polyethylene glycol is an osmotic stool softener used for treatment of occasional constipation. In theory, there is less risk of dehydration or electrolyte imbalance with isotonic polyethylene glycol than with hypertonic sugar solutions. A laxative effect is generated because polyethylene glycol is not absorbed and continues to hold water by osmotic action through the small bowel and colon, resulting in mechanical cleansing.

Polyethylene glycol is supplied with a measuring cap marked to contain 17 g of laxative powder when filled to the indicated line. It may require 2-4 days (48-96 hours) to produce bowel movement.

Mineral oil (Fleet Mineral Oil Enema, Kondremul)

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Mineral oil lubricates the intestine and facilitates the passage of stool by decreasing water absorption from the intestine.

Lactulose (Enulose, Generlac, Kristalose, Constulose)

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Lactulose is an osmotic agent and ammonium detoxifying agent. It produces an osmotic effect in the colon that results in distention and promotes peristalsis.

Questions

El-Chammas KI, Rumman N, Goh VL, Quintero D, Goday PS. Rectal Prolapse and Cystic Fibrosis. J Pediatr Gastroenterol Nutr. 2014 Aug 25. [QxMD MEDLINE Link].
Lockhart-Mummery JP. Surgical procedures in general practice. Br Med J. 1939. 1:345-7.
Williams JG, Rothenberger DA, Madoff RD, Goldberg SM. Treatment of rectal prolapse in the elderly by perineal rectosigmoidectomy. Dis Colon Rectum. 1992 Sep. 35(9):830-4. [QxMD MEDLINE Link].
Altemeier WA, Culbertson WR, Schowengerdt C, Hunt J. Nineteen years' experience with the one-stage perineal repair of rectal prolapse. Ann Surg. 1971 Jun. 173(6):993-1006. [QxMD MEDLINE Link]. [Full Text].
Rana Kronfol. Rectal prolapse in children. UpToDate. Available at https://www.uptodate.com/contents/rectal-prolapse-in-children?search=rectal%20prolapse&source=search_result&selectedTitle=2~49&usage_type=default&display_rank=2. Sep 2017.; Accessed: 30 Oct 2019.
Brisighelli G, Di Cesare A, Morandi A, Paraboschi I, Canazza L, Consonni D, et al. Classification and management of rectal prolapse after anorectoplasty for anorectal malformations. Pediatr Surg Int. 2014 Aug. 30 (8):783-9. [QxMD MEDLINE Link].
Rentea RM, St Peter SD. Pediatric Rectal Prolapse. Clin Colon Rectal Surg. 2018 Mar. 31 (2):108-116. [QxMD MEDLINE Link].
Porter NH. A physiological study of the pelvic floor in rectal prolapse. Ann R Coll Surg Engl. 1962 Dec. 31:379-404. [QxMD MEDLINE Link]. [Full Text].
Mann CV. Rectal prolapse. Morson BC, Heinemann W, eds. Diseases of the Colon, Rectum and Anus. London: Medical Books; 1969. 238.
Hinninghofen H, Enck P. Fecal incontinence: evaluation and treatment. Gastroenterol Clin North Am. 2003 Jun. 32(2):685-706. [QxMD MEDLINE Link].
Katz C, Drongowski RA, Coran AG. Long-term management of chronic constipation in children. J Pediatr Surg. 1987 Oct. 22(10):976-8. [QxMD MEDLINE Link].
Ponge T, Bruley des Varannes S. [Digestive involvement of scleroderma]. Rev Prat. 2002 Nov 1. 52(17):1896-900. [QxMD MEDLINE Link].
Candela G, Grillo M, Campione M, Casaburi V, Maschio A, Sciano D, et al. [Complete rectal prolapse in a patient with Hirschsprung disease: a clinical case]. G Chir. 2003 Aug-Sep. 24(8-9):289-94. [QxMD MEDLINE Link].
Sanaka MR, Ferguson DR, Ulrich S, Sargent R. Polyp associated with rectal prolapse. Gastrointest Endosc. 2004 Jun. 59(7):871-2. [QxMD MEDLINE Link].
Orenstein DM, Winnie GB, Altman H. Cystic fibrosis: a 2002 update. J Pediatr. 2002 Feb. 140(2):156-64. [QxMD MEDLINE Link].
Huskins WC, Griffiths JK, Faruque AS, Bennish ML. Shigellosis in neonates and young infants. J Pediatr. 1994 Jul. 125(1):14-22. [QxMD MEDLINE Link].
Rock MJ. Newborn screening for cystic fibrosis. Clin Chest Med. 2007 Jun. 28(2):297-305. [QxMD MEDLINE Link].
Adedayo O, Nasiiro R. Intestinal parasitoses. J Natl Med Assoc. 2004 Jan. 96(1):93-6. [QxMD MEDLINE Link]. [Full Text].
Brisighelli G, Di Cesare A, Morandi A, Paraboschi I, Canazza L, Consonni D, et al. Classification and management of rectal prolapse after anorectoplasty for anorectal malformations. Pediatr Surg Int. 2014 Aug. 30(8):783-9. [QxMD MEDLINE Link].
Bush A. Recurrent respiratory infections. Pediatr Clin North Am. 2009 Feb. 56(1):67-100, x. [QxMD MEDLINE Link].
Hill SR, Ehrlich PF, Felt B, Dore-Stites D, Erickson K, Teitelbaum DH. Rectal prolapse in older children associated with behavioral and psychiatric disorders. Pediatr Surg Int. 2015 Aug. 31 (8):719-24. [QxMD MEDLINE Link].
Huang SC, Yang YJ, Lee CT. Rectal prolapse in a child: an unusual presentation of Clostridium difficile-associated pseudomembranous colitis. Pediatr Neonatol. 2011 Apr. 52(2):110-2. [QxMD MEDLINE Link].
Brodén B, Snellman B. Procidentia of the rectum studied with cineradiography. A contribution to the discussion of causative mechanism. Dis Colon Rectum. 1968 Sep-Oct. 11(5):330-47. [QxMD MEDLINE Link].
Nwako F. Rectal Prolapse in Nigerian Children. Int Surg. 1975 May. 60(5):284-5. [QxMD MEDLINE Link].
Villarreal M, Brum P. [Rectal prolapse in a neonate with Shigella diarrhea]. Arch Argent Pediatr. 2010 Feb. 108(1):e17-9. [QxMD MEDLINE Link].
Bequet E, Stiennon L, Lhomme A, Piette C, Hoyoux C, Rausin L, et al. [Rectal prolapse revealing a tumor: The role of abdominal ultrasound]. Arch Pediatr. 2016 Jul. 23 (7):723-6. [QxMD MEDLINE Link].
Antao B, Bradley V, Roberts JP, Shawis R. Management of rectal prolapse in children. Dis Colon Rectum. 2005 Aug. 48(8):1620-5. [QxMD MEDLINE Link].
Hight DW, Hertzler JH, Philippart AI, Benson CD. Linear cauterization for the treatment of rectal prolapse in infants and children. Surg Gynecol Obstet. 1982 Mar. 154(3):400-2. [QxMD MEDLINE Link].
Sarmast MH, Askarpour S, Peyvasteh M, Javaherizadeh H, Mooghehi-Nezhad M. Rectal prolapse in children: a study of 71 cases. Prz Gastroenterol. 2015. 10 (2):105-7. [QxMD MEDLINE Link].
Khushbakht S, ul Haq A. Rectal Duplication Cyst: A Rare Cause of Rectal Prolapse in a Toddler. J Coll Physicians Surg Pak. 2015 Dec. 25 (12):909-10. [QxMD MEDLINE Link].
Felt-Bersma RJ, Tiersma ES, Cuesta MA. Rectal prolapse, rectal intussusception, rectocele, solitary rectal ulcer syndrome, and enterocele. Gastroenterol Clin North Am. 2008 Sep. 37(3):645-68, ix. [QxMD MEDLINE Link].
Jason S.Frischer, MD, Beth Rymeski, DO. Complications in colorectal surgery. Seminars in Pediatric Surgery. 2016. 25:380–387. [Full Text].
Rashid Z, Basson MD. Association of rectal prolapse with colorectal cancer. Surgery. 1996 Jan. 119(1):51-5. [QxMD MEDLINE Link].
Bennett W. Calder and Robert A. Cina. Perianal Disease - Rectal Prolapse. Peter Mattei. Fundamentals of Pediatric Surgery. Second Edition. ISBN 978-3-319-27441-6: Springer; 2017. 525-530.
Campbell AM, Murphy J, Charlesworth PB, Bhan C, Jarvi K, Power N, et al. Dynamic MRI (dMRI) as a guide to therapy in children and adolescents with persistent full thickness rectal prolapse: a single centre review. J Pediatr Surg. 2013 Mar. 48 (3):607-13. [QxMD MEDLINE Link].
Mäkelä-Kaikkonen J, Rautio T, Pääkkö E, Biancari F, Ohtonen P, Mäkelä J. Robot-assisted vs laparoscopic ventral rectopexy for external or internal rectal prolapse and enterocele: a randomized controlled trial. Colorectal Dis. 2016 Oct. 18 (10):1010-1015. [QxMD MEDLINE Link].
Mugie SM, Bates DG, Punati JB, Benninga MA, Di Lorenzo C, Mousa HM. The value of fluoroscopic defecography in the diagnostic and therapeutic management of defecation disorders in children. Pediatr Radiol. 2014 Sep 30. [QxMD MEDLINE Link].
Norton C. Fecal incontinence and biofeedback therapy. Gastroenterol Clin North Am. 2008 Sep. 37(3):587-604, viii. [QxMD MEDLINE Link].
Li M, Jiang T, Peng P, Yang X. MR Defecography in Assessing Functional Defecation Disorder: Diagnostic Value of the Defecation Phase in Detection of Dyssynergic Defecation and Pelvic Floor Prolapse in Females. Digestion. 2019. 100 (2):109-116. [QxMD MEDLINE Link].
Ramage L, Simillis C, Yen C, Lutterodt C, Qiu S, Tan E, et al. Magnetic resonance defecography versus clinical examination and fluoroscopy: a systematic review and meta-analysis. Tech Coloproctol. 2017 Dec. 21 (12):915-927. [QxMD MEDLINE Link].
Chan WK, Kay SM, Laberge JM, Gallucci JG, Bensoussan AL, Yazbeck S. Injection sclerotherapy in the treatment of rectal prolapse in infants and children. J Pediatr Surg. 1998 Feb. 33(2):255-8. [QxMD MEDLINE Link].
Festen S, van Geloven AA, D'Hoore A, Lindsey I, Gerhards MF. Controversy in the treatment of symptomatic internal rectal prolapse: suspension or resection?. Surg Endosc. 2011 Jun. 25(6):2000-3. [QxMD MEDLINE Link]. [Full Text].
Ramanujam PS, Venkatesh KS. Management of acute incarcerated rectal prolapse. Dis Colon Rectum. 1992 Dec. 35(12):1154-6. [QxMD MEDLINE Link].
Coburn WM 3rd, Russell MA, Hofstetter WL. Sucrose as an aid to manual reduction of incarcerated rectal prolapse. Ann Emerg Med. 1997 Sep. 30(3):347-9. [QxMD MEDLINE Link].
Wijffels NA, Collinson R, Cunningham C, Lindsey I. What is the natural history of internal rectal prolapse?. Colorectal Dis. 2010 Aug. 12(8):822-30. [QxMD MEDLINE Link].
Seenivasagam T, Gerald H, Ghassan N, Vivek T, Bedi AS, Suneet S. Irreducible rectal prolapse: emergency surgical management of eight cases and a review of the literature. Med J Malaysia. 2011 Jun. 66(2):105-7. [QxMD MEDLINE Link].
Tou S, Brown SR, Nelson RL. Surgery for complete (full-thickness) rectal prolapse in adults. Cochrane Database Syst Rev. 2015 Nov 24. CD001758. [QxMD MEDLINE Link].
Brown AJ, Anderson JH, McKee RF, Finlay IG. Strategy for selection of type of operation for rectal prolapse based on clinical criteria. Dis Colon Rectum. 2004 Jan. 47(1):103-7. [QxMD MEDLINE Link].
Ripstein CB, Lanter B. Etiology and surgical therapy of massive prolapse of the rectum. Ann Surg. 1963 Feb. 157:259-64. [QxMD MEDLINE Link]. [Full Text].
Dattani PG. 15th International Conference on AIDS. Bangkok, Thailand: Jul, 2004. 15: abstract no. B11748.
Ezer SS, Kayaselçuk F, Oguzkurt P, Temiz A, Ince E, Hicsonmez A. Comparative effects of different sclerosing agents used to treat rectal prolapse: an experimental study in rats. J Pediatr Surg. 2013 Aug. 48(8):1738-43. [QxMD MEDLINE Link].
Mugie SM, Bates DG, Punati JB, Benninga MA, Di Lorenzo C, Mousa HM. The value of fluoroscopic defecography in the diagnostic and therapeutic management of defecation disorders in children. Pediatr Radiol. 2015 Feb. 45 (2):173-80. [QxMD MEDLINE Link].
Yoon SG. Rectal prolapse: review according to the personal experience. J Korean Soc Coloproctol. 2011 Jun. 27(3):107-13. [QxMD MEDLINE Link]. [Full Text].
Ashcraft KW, Garred JL, Holder TM, Amoury RA, Sharp RJ, Murphy JP. Rectal prolapse: 17-year experience with the posterior repair and suspension. J Pediatr Surg. 1990 Sep. 25(9):992-4; discussion 994-5. [QxMD MEDLINE Link].
Chiang LW, Lee SY. Laparoscopic management for non-traumatic colon perforation in children. Pediatr Surg Int. 2013 Apr. 29 (4):353-6. [QxMD MEDLINE Link].
Ibáñez V, Gutiérrez C, García-Sala C, Lluna J, Barrios JE, Roca A, et al. [The prolapse of the rectum. Treatment with fibrin adhesive]. Cir Pediatr. 1997 Jan. 10(1):21-4. [QxMD MEDLINE Link].
Fahmy MA, Ezzelarab S. Outcome of submucosal injection of different sclerosing materials for rectal prolapse in children. Pediatr Surg Int. 2004 May. 20(5):353-6. [QxMD MEDLINE Link].
Abes M, Sarihan H. Injection sclerotherapy of rectal prolapse in children with 15 percent saline solution. Eur J Pediatr Surg. 2004 Apr. 14(2):100-2. [QxMD MEDLINE Link].
Zganjer M, Cizmic A, Cigit I, et a;. Treatment of rectal prolapse in children with cow milk injection sclerotherapy: 30-year experience. World J Gastroenterol. 2008 Feb 7. 14(5):737-40. [QxMD MEDLINE Link]. [Full Text].
Lomas MI, Cooperman H. Correction of rectal procidentia by use of polypropylene mesh (Marlex). Dis Colon Rectum. 1972 Nov-Dec. 15(6):416-9. [QxMD MEDLINE Link].
Saleem MM, Al-Momani H. Acute scrotum as a complication of Thiersch operation for rectal prolapse in a child. BMC Surg. 2006 Dec 28. 6:19. [QxMD MEDLINE Link]. [Full Text].
Chauhan K, Gan RW, Singh S. Successful treatment of recurrent rectal prolapse using three Thiersch sutures in children. BMJ Case Rep. 2015 Nov 25. 2015:[QxMD MEDLINE Link].
El-Sibai O, Shafik AA. Cauterization-plication operation in the treatment of complete rectal prolapse. Tech Coloproctol. 2002 Apr. 6(1):51-4; discussion 54. [QxMD MEDLINE Link].
Sander S, Vural O, Unal M. Management of rectal prolapse in children: Ekehorn's rectosacropexy. Pediatr Surg Int. 1999. 15(2):111-4. [QxMD MEDLINE Link].
Schepens MA, Verhelst AA. Reappraisal of Ekehorn's rectopexy in the management of rectal prolapse in children. J Pediatr Surg. 1993 Nov. 28(11):1494-7. [QxMD MEDLINE Link].
Joshi AA, Milanovic DM. Delorme’s procedure for rectal prolapse in a child refractory to conservative treatment and rectal suspension. Int J Colorectal Dis. 2006. 21:395-6.
De la Torre L, Zornoza-Moreno M, Cogley K, Calisto JL, Wehrli LA, Ruiz-Montañez A, et al. Transanal endorectal approach for the treatment of idiopathic rectal prolapse in children: Experience with the modified Delorme's procedure. J Pediatr Surg. 2018 Oct 12. 146 (1):87-93. [QxMD MEDLINE Link].
Lieberth M, Kondylis LA, Reilly JC, Kondylis PD. The Delorme repair for full-thickness rectal prolapse: a retrospective review. Am J Surg. 2009 Mar. 197(3):418-23. [QxMD MEDLINE Link].
Lee JI, Vogel AM, Suchar AM, Glynn L, Statter MB, Liu DC. Sequential linear stapling technique for perineal resection of intractable pediatric rectal prolapse. Am Surg. 2006 Dec. 72(12):1212-5. [QxMD MEDLINE Link].
Yamana T, Iwadare J. Mucosal plication (Gant-Miwa procedure) with anal encircling for rectal prolapse--a review of the Japanese experience. Dis Colon Rectum. 2003 Oct. 46(10 Suppl):S94-9. [QxMD MEDLINE Link].
Lasheen AE. Closed rectosacropexy for rectal prolapse in children. Surg Today. 2003. 33(8):642-4. [QxMD MEDLINE Link].
Gomes-Ferreira C, Schneider A, Philippe P, Lacreuse I, Becmeur F. Laparoscopic modified Orr-Loygue mesh rectopexy for rectal prolapse in children. J Pediatr Surg. 2015 Feb. 50 (2):353-5. [QxMD MEDLINE Link].
Ismail M, Gabr K, Shalaby R. Laparoscopic management of persistent complete rectal prolapse in children. J Pediatr Surg. 2010 Mar. 45(3):533-9. [QxMD MEDLINE Link].
Kairaluoma MV, Viljakka MT, Kellokumpu IH. Open vs. laparoscopic surgery for rectal prolapse: a case-controlled study assessing short-term outcome. Dis Colon Rectum. 2003 Mar. 46(3):353-60. [QxMD MEDLINE Link].
Delaney CP. Laparoscopic management of rectal prolapse. J Gastrointest Surg. 2007 Feb. 11(2):150-2. [QxMD MEDLINE Link].
Awad K, El Debeiky M, AbouZeid A, Albaghdady A, Hassan T, Abdelhay S. Laparoscopic Suture Rectopexy for Persistent Rectal Prolapse in Children: Is It a Safe and Effective First-Line Intervention?. J Laparoendosc Adv Surg Tech A. 2016 Apr. 26 (4):324-7. [QxMD MEDLINE Link].
Senagore AJ. Management of rectal prolapse: the role of laparoscopic approaches. Semin Laparosc Surg. 2003 Dec. 10(4):197-202. [QxMD MEDLINE Link].
D'Hoore A, Penninckx F. Laparoscopic ventral recto(colpo)pexy for rectal prolapse: surgical technique and outcome for 109 patients. Surg Endosc. 2006 Dec. 20(12):1919-23. [QxMD MEDLINE Link].
Saxena AK, Metzelder ML, Willital GH. Laparoscopic suture rectopexy for rectal prolapse in a 22-month-old child. Surg Laparosc Endosc Percutan Tech. 2004 Feb. 14(1):33-4. [QxMD MEDLINE Link].
Koivusalo AI, Pakarinen MP, Rintala RI, Seuri R. Dynamic defecography in the diagnosis of paediatric rectal prolapse and related disorders. Pediatr Surg Int. 2012 Aug. 28(8):815-20. [QxMD MEDLINE Link].
Stonelake S, Gee O, McArthur D, Jester I. Laparoscopic Protack™ rectopexy: Early experience of a novel technique for full thickness rectal prolapse in children. J Pediatr Surg. 2018 Oct. 53 (10):2077-2080. [QxMD MEDLINE Link].
Gupta PJ. Treatment of rectal prolapse with radiofrequency ablation and plication--a new surgical technique. Acta Chir Belg. 2007 Sep-Oct. 107(5):535-9. [QxMD MEDLINE Link].
Nyström PO, Qvist N, Raahave D, Lindsey I, Mortensen N. Randomized clinical trial of symptom control after stapled anopexy or diathermy excision for haemorrhoid prolapse. Br J Surg. 2010 Feb. 97(2):167-76. [QxMD MEDLINE Link].
Zhang M. Thirty-six cases of infantile proctoptosis treated by extremely shallow puncture. J Tradit Chin Med. 2002 Mar. 22(1):33-4. [QxMD MEDLINE Link].
Van Heest R, Jones S, Giacomantonio M. Rectal prolapse in autistic children. J Pediatr Surg. 2004 Apr. 39(4):643-4. [QxMD MEDLINE Link].
Pearl RH, Ein SH, Churchill B. Posterior sagittal anorectoplasty for pediatric recurrent rectal prolapse. J Pediatr Surg. 1989 Oct. 24(10):1100-2. [QxMD MEDLINE Link].
Godbole P, Botterill I, Newell SJ, Sagar PM, Stringer MD. Solitary rectal ulcer syndrome in children. J R Coll Surg Edinb. 2000 Dec. 45(6):411-4. [QxMD MEDLINE Link].
Savoye-Collet C, Koning E, Dacher JN. Radiologic evaluation of pelvic floor disorders. Gastroenterol Clin North Am. 2008 Sep. 37(3):553-67, viii. [QxMD MEDLINE Link].
Lesher AP, Hill JG, Schabel SI, Morgan KA, Hebra A. An unusual pediatric case of chronic constipation and rectosigmoid prolapse diagnosed by video defecography. J Pediatr Surg. 2010 May. 45(5):1050-2. [QxMD MEDLINE Link].
Shin T, Rafferty JF. Laparoscopy for benign colorectal diseases. Clin Colon Rectal Surg. 2010 Feb. 23(1):42-50. [QxMD MEDLINE Link]. [Full Text].
Potter DD, Bruny JL, Allshouse MJ, Narkewicz MR, Soden JS, Partrick DA. Laparoscopic suture rectopexy for full-thickness anorectal prolapse in children: an effective outpatient procedure. J Pediatr Surg. 2010 Oct. 45(10):2103-7. [QxMD MEDLINE Link].
Laituri CA, Garey CL, Fraser JD, Aguayo P, Ostlie DJ, St Peter SD. 15-Year experience in the treatment of rectal prolapse in children. J Pediatr Surg. 2010 Aug. 45(8):1607-9. [QxMD MEDLINE Link].
Shalaby R, Ismail M, Abdelaziz M, Ibrahem R, Hefny K, Yehya A. Laparoscopic mesh rectopexy for complete rectal prolapse in children: a new simplified technique. Pediatr Surg Int. 2010 Aug. 26(8):807-13. [QxMD MEDLINE Link].
Rittmeyer C, Nakayama D, Ulshen MH. Lymphoid hyperplasia causing recurrent rectal prolapse. J Pediatr. 1997 Sep. 131(3):487-8. [QxMD MEDLINE Link].
Hussein AM, Helal SF. Schistosomal pelvic floor myopathy contributes to the pathogenesis of rectal prolapse in young males. Dis Colon Rectum. 2000 May. 43(5):644-9. [QxMD MEDLINE Link].
Carrada-Bravo T. [Massive childhood trichocephaliasis]. Rev Gastroenterol Mex. 2002 Jul-Sep. 67(3):212. [QxMD MEDLINE Link].
Pancharoen C, Likitnukul S, Chongsrisawat V, Vivatvekin B, Bhattarakosol P, Suwangool P, et al. Rectal prolapse associated with cytomegalovirus pseudomembranous colitis in a child infected by human immunodeficiency virus. Southeast Asian J Trop Med Public Health. 2003 Sep. 34(3):583-4. [QxMD MEDLINE Link].
Kuiper RJ, de Jong JR, Kneepkens CM. [There is something coming out of the anus of my child]. Ned Tijdschr Geneeskd. 2011. 155:A2735. [QxMD MEDLINE Link].
Akkoyun I. The advantages of using photographs and video images in telephone consultations with a specialist in paediatric surgery. Afr J Paediatr Surg. 2012 May-Aug. 9(2):128-31. [QxMD MEDLINE Link].
Akkoyun I, Akbiyik F, Soylu SG. The use of digital photos and video images taken by a parent in the diagnosis of anal swelling and anal protrusions in children with normal physical examination. J Pediatr Surg. 2011 Nov. 46(11):2132-4. [QxMD MEDLINE Link].
Fang SH, Cromwell JW, Wilkins KB, Eisenstat TE, Notaro JR, Alva S. Is the abdominal repair of rectal prolapse safer than perineal repair in the highest risk patients? An NSQIP analysis. Dis Colon Rectum. 2012 Nov. 55(11):1167-72. [QxMD MEDLINE Link].
Dolejs SC, Sheplock J, Vandewalle RJ, Landman MP, Rescorla FJ. Sclerotherapy for the management of rectal prolapse in children. J Pediatr Surg. 2017 Oct 10. 32 (1):36-42. [QxMD MEDLINE Link].
Khalil. Rectal Prolapse and Cystic Fibrosis.

Media Gallery

Image of young patient with full-thickness rectal prolapse with multiple circular folds seen on exposed 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.
Levator ani muscle is shown in red. It includes ileococcygeus (stretches during defecation and labor), pubococcygeus (maintains integrity of pelvic floor), and puborectalis muscles (closes the anorectal canal as a sling).
Deep, superficial, and subcutaneous external sphincter.
Anatomy of internal and external anal sphincter mechanisms.
Image demonstrates mucosal prolapse, with radial folds seen on mucosa.
Diagram depicting clinical difference between true (full-thickness) prolapse (left), including all layers of rectum, with circular mucosal folds, and mucosa-only prolapse (right), in which radial folds are seen.
Thiersch procedure. Perianal subcutaneous sutures create mechanical barrier for prolapse.
Lomas and Cooperman modified the Thiersch procedure by performing right anterior and left posterior radial incisions, encircling the anus with a Marlex mesh stripe, and tying it around a finger placed on the anal canal. Care must be taken to avoid perforating the posterior vaginal or anterior rectal walls. The skin is closed, and the mesh left subcutaneously.
Ripstein procedure is designed to maintain normal posterior rectal curvature by attaching it to the presacral fascia, thus avoiding the straight tube that intussuscepts during straining. (A) Rectum is mobilized down to the coccyx. (B) Marlex mesh is placed around rectum while this is tensed upward and sutured to the presacral fascia with nonabsorbable sutures. Mesh loop must be loose enough to prevent postoperative constipation. (C) Sagittal view shows suspended rectum. (D) Peritoneum is closed with a continuous absorbable suture.
Intraoperative photograph of a 12-year-old girl with recurrent rectal prolapse and mucosal ulceration with profuse bleeding. She had a long sigmoid colon, which was resected; end-to-end anastomosis was performed. This photograph depicts anastomosed rectum fixed to presacral fascia with mesh. Non-absorbable sutures retain the mesh to the serosa. Note that the mesh is slightly loose to allow for child's growth. Uterus and its ligaments can be seen in front of rectum. Iliac vessels remain intact on each side.
Ivalon sponge procedure. (A) Rectum is mobilized. Meticulous hemostasis is mandatory to prevent hematoma that predisposes patient to prosthetic material infection. (B) Ivalon rectangular sponge made of polyvinyl alcohol is sutured to sacral periosteum. (C) Rectum is retracted upward, and sponge is wrapped around it and tied to the anterior sacral surface. A portion of the anterior rectal wall is left free to prevent luminal obliteration. (D) Peritoneum is closed with continuous absorbable suture.

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Author

Jaime Shalkow, MD, FACS Pediatric Surgical Oncologist, ABC Cancer Center; Associated Researcher, Anahuac University, Mexico

Jaime Shalkow, MD, FACS is a member of the following medical societies: American College of Surgeons, International Society of Paediatric Surgical Oncology, International Society of Pediatric Oncology, Latin American Pediatric Surgical Oncology Group, Mexican Association of Pediatric Surgery, Mexican Society of Oncology

Disclosure: Nothing to disclose.

Coauthor(s)

Pablo Magaña Mainero, MD General and Laparoscopic Surgeon, ABC Medical Center; Assistant Director, General Hospital of Mexico “Dr Eduardo Liceaga”, Mexico

Pablo Magaña Mainero, MD is a member of the following medical societies: American College of Surgeons, Mexican Association for Endoscopic Surgery, Mexican Association of General Surgery, Mexican Hepato Pancreato Biliary Association

Disclosure: Nothing to disclose.

Andrés Olivares Ronces, MD Assistant Surgeon, Centro Médico ABC Campus Observatorio, Mexico

Disclosure: Nothing to disclose.

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, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received honoraria from Abbott Nutritionals for speaking and teaching. for: Abbott Nutritional, Abbvie, speakers' bureau.

Additional Contributors

Brian F Gilchrist, MD Surgeon-in-Chief of Pediatric Surgery, The Floating Hospital for Children at Tufts-New England Medical Center; Associate Professor, Department of Surgery, Tufts University School of Medicine

Brian F Gilchrist, MD is a member of the following medical societies: American College of Surgeons, American Pediatric Surgical Association, Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Ignacio Guzman, MD Medical Staff, Medical and Surgical Patient Care, General Hospital of Mexico; Medical Staff, Pediatric Surgical Oncology, National Institute of Pediatrics, Mexico

Disclosure: Nothing to disclose.

Joyce Vazquez-Braverman, MD Instructor of ACLS, BLS, and Heartsavers, American Heart Assocation

Joyce Vazquez-Braverman, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Issac Octavio Vargas Olmos Universidad Anahuac, Mexico

Disclosure: Nothing to disclose.

Shahida Bibi, MD Resident Physician, Department of Surgery, Bronx-Lebanon Hospital Center

Disclosure: Nothing to disclose.

Acknowledgements

Robert Baldassano, MD Director, Center for Pediatric Inflammatory Bowel Disease, Children's Hospital of Philadelphia; Professor, Department of Pediatrics, Division of Gastroenterology and Nutrition, University of Pennsylvania School of Medicine

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