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What is rectal prolapse?

The rectum is the lower portion of the large intestine. Normally, it is attached to the pelvis with ligaments and muscles. Rectal prolapse occurs when the lining of a child's rectum protrudes through the anus and outside the body. This can occur because the ligaments and muscles become weakened from problems including chronic constipation, chronic diarrhea, or straining while going to the bathroom. Underlying conditions such as cystic fibrosis and Hirschsprung's disease can also cause rectal prolapse.

Rectal Prolapse | Symptoms & Causes

What are the symptoms of rectal prolapse?

The main symptom of rectal prolapse is the protrusion of part or all of the rectum's lining through your child's anal sphincter. You may notice a dark red mass protruding from the anus, sometimes accompanied by blood or mucus, particularly when your child is straining. Rectal prolapse isn't usually painful, but it can cause discomfort. Other symptoms may include:

  • fecal incontinence (leakage of stool from the anus)
  • feeling of fullness or of not being able to completely empty the bowels
  • anal itching or irritation

What causes rectal prolapse?

Rectal prolapse occurs when the muscles and ligaments that support the rectum become weakened. Certain factors can make your child more likely to experience rectal prolapse, including:

  • straining while going to the bathroom
  • chronic constipation
  • acute or chronic diarrhea
  • malnutrition
  • cystic fibrosis
  • neurological conditions such as tethered cord or spinal cord injury
  • Hirschsprung's disease and other colorectal and pelvic malformations
  • anal penetration, such as from sexual abuse

Rectal Prolapse | Diagnosis & Treatments

How is rectal prolapse diagnosed?

Parents typically first notice rectal prolapse — its appearance is usually obvious and alarming if your child hasn't previously experienced prolapse. Physicians diagnose rectal prolapse based on a physical examination. They may also use various imaging tests to determine if an underlying condition is responsible.

How is rectal prolapse treated?

Most mild cases of rectal prolapse can be treated by your child's physician, who will manually push the prolapse back in place. They will also make recommendations that address the cause of prolapse, such as giving your child a stool softener and increasing dietary fiber to improve regular bowel movements.

If your child experiences frequent or severe rectal prolapse, you may need to see a specialist to treat the underlying condition. Depending on the type of prolapse, your child may require surgical intervention. The doctor will discuss the best treatment options with you. These may include:

  • sclerotherapy, in which a sclerosing agent is injected around the rectum to scar the surrounding tissue and keep the prolapse in place
  • Thiersch cerclage, in which a wire or other thin material is used to narrow the anus
  • trans-anal resection, in which surgeons remove the prolapse through the anus
  • laparoscopic sigmoid resection, in which surgeons remove the sigmoid colon
  • rectopexy, in which the rectum is sutured to the sacrum

How we care for rectal prolapse

Most children who experience mild rectal prolapse can be treated by their pediatrician and likely won't have another one. But for kids who have frequent or severe prolapse, treatment by a specialist is often necessary. The skilled clinicians in the Colorectal and Pelvic Malformation Center at Boston Children's Hospital see infants and children who experience rectal prolapse due to Hirschsprung's disease and other chronic conditions.

Rectal Prolapse | Programs & Services