a. Attempt to visualize prolapse. If prolapsed rectum is not visualized, examine child in squatting position. If prolapse is not seen, digital exam may reveal dilated anal orifice with poor tone. If prolapse is seen, ascertain whether a finger
can be passed into the space between the anal wall and the mucosa of the protruding mass. If so, this may be an intussusception or a rectal polyp. Rectal prolapse will not allow passage of a finger between the protruding mass and the anal wall. If mass is plum colored, it is likely to be a rectal polyp.
b. Determine whether prolapse is complete or incomplete. In complete rectal prolapse, the full thickness of the rectum prolapses through anus. In this situation, concentric mucosal rings may be seen. Incomplete prolapse is limited to two layers of mucosa and reveals radial folds. If more than 5 cm of rectum is emerging, it is most likely a complete prolapse.
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