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Rectal Prolapse In Children

WHAT YOU NEED TO KNOW:

What is a rectal prolapse?

A rectal prolapse is a condition that causes part of your child's rectum to move down through his anus. The rectum is the end of your child's bowel. A prolapse may happen during your child's bowel movement. A prolapse may also happen when your child is 1 to 5 years of age, when he begins standing or potty training. The cause of your child's rectal prolapse may not be known.

What increases my child's risk for a rectal prolapse?

  • An infection in your child's bowel can cause his rectum to swell and move down through his anus. Infection may be caused by parasites or bacteria.
  • Constipation may cause your child to push too hard during a bowel movement. The pressure from pushing may cause the rectum to come through the anus.
  • Malnutrition may cause loss of fat tissue that helps hold your child's rectum in the right place.
  • Diarrhea may cause swelling of your child's rectum. This may cause the rectum to move through his anus.
  • Chronic conditions such as Cystic fibrosis (CF) or ulcerative colitis (UC) may cause malnutrition and constipation. UC can also cause diarrhea.

What are the signs and symptoms of a rectal prolapse?

  • Rectal tissue seen through the anus after or during your child's bowel movement
  • Pain or discomfort during a bowel movement
  • Swollen, pink, or red rectum
  • Bleeding or mucus from your child's rectum that may happen from rubbing against his underwear or diaper

How is a rectal prolapse diagnosed?

Your child's healthcare provider will examine your child's anus to check for a rectal prolapse. He may also check for rectal polyps. A rectal polyp is a small growth of tissue in the lining of the rectum. He may also feel inside your child's anus to check for bumps that he cannot see from the outside. He may ask about your child's bowel habits. Tell your healthcare provider about other medical conditions your child has. Your child may need any of the following tests:

  • A sweat chloride test shows the amount of chloride in your child's sweat. This test is used to check for CF. The amount of chloride in your child's sweat will be high if he has CF.
  • An x-ray, ultrasound, or CT may show problems with the rectum. Your child may be given contrast liquid to help the intestines show up better in the pictures. Your healthcare provider may also place contrast liquid into your child's anus. Tell the healthcare provider if your child has ever had an allergic reaction to contrast liquid.
  • A sample of your child's bowel movement may show what germ is causing your child's illness.

How is a rectal prolapse treated?

A rectal prolapse may get better without treatment. Your child may need any of the following:

  • Antibiotics help treat a bacterial infection.
  • Antiparasitics help treat or prevent a parasite infection.
  • Bowel movement softeners help prevent constipation.
  • Laxatives help your child's intestines relax and loosen to prevent constipation.
  • Injections may prevent your child's rectum from moving through his anus. He may be given one or more shots of numbing medicine. A needle will be inserted into the rectum and medicine will be given. Your child may feel some pushing or discomfort as the needle enters his rectum.
  • Surgery may be needed if other treatments do not work. Surgery can help position your child's rectum so that it does not come down through his anus. Surgery may include placing sutures or mesh into the rectum, or removing the part of the rectum that is prolapsed.

What is manual reduction of a rectal prolapse?

Manual reduction is a procedure you can do to place your child's rectum back inside of the anus. Your child's healthcare provider may show you how to do a manual reduction. The following are general steps to follow. Your child's healthcare provider may give you specific steps to follow for your child.

  • Place your child face down on a bed or comfortable surface. Have him bend his knees.
  • Wash your hands and put on gloves. Lubricate your glove with petroleum jelly. If you do not have gloves or jelly, wrap a finger in toilet paper.
  • Hold the rectum on both sides of the anus. If you use toilet paper, place your finger in the center of the rectum. Gently apply firm, steady pressure on your child's rectum and push it into the anus. You may need to apply pressure for several minutes if the bowel is swollen.
  • If you used toilet paper to perform manual reduction, withdraw your finger and leave the toilet paper in place. Your child will pass the toilet paper with his next bowel movement.
  • Inspect your child's anus. You should not see the rectum. If a prolapse happens again, you can repeat manual reduction. You can also hold the rectum in place with gauze and tape across your child's buttocks. Before you apply gauze, place a quarter size amount of petroleum jelly on the gauze. The petroleum jelly will prevent the gauze from sticking to your child's rectum. Remove the gauze as directed by your child's healthcare provider.

How can I manage my child's rectal prolapse?

  • Increase the amount of liquid your child drinks. Liquids can help keep your child's bowel movements soft and prevent constipation. Ask your child's healthcare provider how much liquid your child should drink each day.
  • Feed your child a variety of high-fiber foods. This may help decrease constipation by adding bulk and softness to your child's bowel movements. Healthy foods include fruit, vegetables, whole-grain breads, low-fat dairy products, beans, lean meat, and fish. Ask your child's healthcare provider for more information about a high-fiber diet.
  • Have your child use a potty. Your child's feet need to reach the ground when he sits on the potty. His buttocks need to be at the level of the seat. He should not be leaning forward or standing. A potty will prevent him from straining and causing a rectal prolapse. You may place your child on an adult toilet if a potty is too small.

Call 911 for any of the following:

  • Your child has trouble breathing.
  • Your child's heart is beating faster than usual.
  • Your child loses consciousness.

When should I seek immediate care?

  • Your child has severe pain in his abdomen.
  • Your child's abdomen looks bigger than usual.
  • Blood from your child's rectum soaks through his underwear or diaper.
  • Your child has a prolapse and you are unable to manually reduce it.

When should I contact my child's healthcare provider?

  • Your child has a fever.
  • Your child has nausea or is vomiting.
  • You have questions or concerns about your child's condition or care.

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2015 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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