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RECTAL PROLAPSE

It is the partial or complete projection of the rectal mucosa through the anus. It usually occurs between infancy and 4 years of age, with a greater frequency in boys and during the first year of life.

 

The increased incidence of prolapse in children is associated with anatomical features at this age such as: the vertical course of the rectum, its lower position, greater mobility of the sigmoid, and other factors.

It usually occurs in children younger than one year of age (75% of cases).

Prolapse of the rectum may be a symptom of an underlying condition, the commonest of which is constipation.

Predisposing factors include:

  • increased intra-abdominal pressure (in constipation, severe cough, recurrentvomiting)

  • chronic diarrhea

  • cystic fibrosis

  • malnutrition

  • weakness of the pelvic floor

  • ulcerative colitis

  • colonic polyps

  • congenital hypothyroidism

  • neurological syndromes

while in 17% no underlying etiology is identified.

TYPES

Type I or partial prolapse where only the mucosa protrudes and usually involves a projection of less than 2 cm and causes radial folds in the anal skin.

Type II or true prolapse that involves full projection of the rectalwall and causes concentric folds.

This type is divided into 3 grades:

  • 1st degree of prolapse that includes the dermo-mucosal connection and its length is greater than 5 cm.

  • 2nd degree of prolapse does not involve the dermo-mucosal connection and the length is between 2-5 cm

  • Grade 3 the prolapse is internal and does not pass through the anal canal.

DIAGNOSIS

The diagnosis is clinical and either the parents describe the prolapse of the rectum or it is found during clinical examination.

TREATMENT

Treatment of rectal prolapse is conservative, by treating the underlying cause. Immediate reduction of the protruding bowel is required as soon as possible, while keeping it outside may causeswelling, bleeding, ulcers and greater difficulty in repositioning it into the anal canal.

Surgical treatment is occasionally necessary in frequent recurrences of prolapse or in irreducible cases.Itinvolves sclerosing treatment with submucosal injections ororthopexy(Ekehornmethod). The choice of treatment is determined by the degree of prolapse, the severity of symptoms and the underlying etiology.

The prognosis of rectal prolapse is very good with 90% of children up to 3 years old responding to conservative treatment.