What is rectal prolapse?
The rectum is at the end of the large intestine and is attached to the pelvis by muscles and ligaments. When those muscles become weak, the rectum can slide down and out of the anus. It can protrude outside of the body and feel uncomfortable.
Symptoms of rectal prolapse
You may be able to spot rectal prolapse right away. Rectal prolapse symptoms may include:
- Stool leaking from the anus
- Mucus or blood leaking from the anus called wet anus
- A bright red mass protruding out of the anus
- A feeling of fullness
- Not being able to empty the bowels
- Irritation around the anus
- Itchy anus
- Discomfort in the anus
- Passing many small stools
A rectal prolapse doesn’t usually feel painful.
Causes of rectal prolapse in kids
Rectal prolapse in kids usually develops because the muscles that hold the rectum in place become weak. Certain factors can contribute to rectal prolapse, including:
- Toilet training
- Straining during bowel movements
- Acute or chronic diarrhea
- Chronic constipation
- Congenital conditions like cystic fibrosis or congenital hypothyroidism
- Problems with pelvis bones or intestinal organs
- Spinal cord injury
- Surgery on the anus as a baby
- Parasite infection
- Excessive vomiting
- Chronic coughing
- Anal penetration from sexual abuse
Who can get rectal prolapse?
Rectal prolapse most commonly occurs in children and older adults. It usually occurs in children under four years of age. Children who have constipation, malnutrition, or are toilet training can develop rectal prolapse.
Diagnosis for rectal prolapse in kids
You may be able to notice rectal prolapse right away. Your doctor will take your personal and medical history, a list of your symptoms, and do a physical exam to diagnose rectal prolapse.
Your doctor may check the rectum for loose tissue, bleeding, and how well the sphincter reacts. They may want to do imaging tests like X-Rays, computed tomography (CT) scans or magnetic resonance imaging (MRI) to check for problems with the bones, organs, or the spinal cord.
Treatment for rectal prolapse in kids
Rectal prolapse in kids often gets better on its own without treatment. Good self-care and lifestyle practices will help, but you may need to seek further treatment and medication if it doesn’t get better.
Depending on the cause, your doctor may recommend or prescribe some medications, including:
- Stool softeners to help with constipation
- Laxatives to help with constipation
- Anti-parasite medication
- Pancreatic enzymes for cystic fibrosis
- Thyroid medication for congenital hypothyroidism
- Sclerotherapy injection to scar the surrounding area and keep the rectum in place
Good bowel care and nutrition practices will help manage rectal prolapse. One of the most important things to do is to gently push the rectum back inside as soon as you notice it protruding. If after a few minutes of gentle pressure, the tissue will not go back in, you’ll want to visit the emergency room.
Some other factors that may help include:
- Giving your child a small floor potty during toilet training
- Feeding your child a nutritious, fiber-rich diet
- Giving your child a stool softener until they have regular bowel movements without prolapse
- Giving your child plenty of fluids
Biofeedback therapy can relieve constipation and stimulate pelvic floor muscles that hold the rectum in place. Some children may find greater relief with biofeedback therapy than laxatives as biofeedback therapy teaches the muscles how to work again. Laxatives may make constipation worse as the colon starts to rely on them to work.
If conservative rectal prolapse treatment doesn’t help or there are deformities causing the prolapse, your doctor may recommend surgery. These might involve lifting the rectum and attaching it to the pelvis or narrowing the anus with wire or other thin material.
These surgeries may only be recommended for rectal prolapse that doesn't respond to other treatments.
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Harvard Health Publishing Harvard Medical School: "Treating constipation with biofeedback for the pelvic floor."
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Merck Manual: "Rectal Prolapse."
Segal, J. McKeown, D. Tavarez, M. StatPearls, StatPearls Publishing, 2020.