Reduction of Rectal Prolapse

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1. If rectal prolapse is noted on exam, attempt reduction by grasping protruding bowel with a lubricated glove and gently pushing it back in.

2. If it is difficult to reduce prolapse due to bowel edema, provide firm gentle pressure for several minutes to reduce swelling and enable reduction.

3. Perform a rectal exam after reduction to ascertain that prolapse is completely reduced.

4. Teach parents how to reduce prolapsed rectum.

5. If prolapse recurs rapidly, reduce again and tape buttocks together for several hours.

6. Inability to reduce rectal prolapse may lead to venous stasis. Edema and ulceration also may occur.

B. Surgical Consultation. Consider in the following situations.

1. Recurrent prolapse.

2. Mucosal ulceration.

3. Failure to obtain reduction despite sedation.

4. Full-thickness prolapse in patients with meningomyelocele or those who have had pull-through procedures for imperforate anus and Hirschsprung disease.

C. Evaluation for Predisposing Conditions. Treat underlying causes (ie, constipation, diarrhea, cystic fibrosis).

D. Follow-up. Contact with child's primary care physician is crucial to ensure prevention of recurrence.

Problem Case Diagnosis. The 2-year-old patient, who has a chronic history of constipation, is diagnosed with simple rectal prolapse. It is noted to occur while squatting. After reduction of the prolapse, therapy for the underlying constipation is begun.

Teaching Pearl: Question. How can a polyp be differentiated from rectal prolapse on examination?

Teaching Pearl: Answer. A polyp usually is plum colored and does not fill the entire anal circumference.

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Constipation Prescription

Constipation Prescription

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