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Title: Rectal prolapse in children

What is rectal prolapse? — Rectal prolapse is a condition that happens when some or all of the tissue that lines the rectum sticks out of the anus (figure 1).

It is most common in babies and children younger than 4 who also have another health problem. The most common problems are:

●Constipation – This means the child’s bowel movements:
•Are too hard
•Are difficult to get out
•Happen fewer than 3 times a week
●Diarrhea – This means the child’s bowel movements:
•Are watery or runny
•Happen more than 3 times a day
●Problems with the brain or spinal cord – The spinal cord is the highway of nerves that connects the brain to the rest of the body. It runs through the spine (also called the backbone). Problems with the brain or spinal cord weaken the muscles near the rectum. Conditions that can lead to rectal prolapse include:
•Spina bifida – This condition happens when a baby’s spine does not grow normally before birth.
•Brain and spinal cord injuries – These are usually caused by bad car crashes or falls.
●Cystic fibrosis – This disease causes thick mucus and other fluids to build up and clog different parts of the body. Children with cystic fibrosis can have frequent lung infections. They also can have large, bulky bowel movements.
What are the symptoms of rectal prolapse in children? — The main symptom is bright red tissue sticking out of the anus. The tissue might have mucus or blood. Rectal prolapse is not usually painful but can be uncomfortable. The tissue might stay outside the anus or move back inside the body.

Is there a test for rectal prolapse? — No. But your child’s doctor or nurse should be able to tell if your child has the condition by doing an exam. If the tissue has moved back inside your child’s body, you can describe the tissue to the doctor. This can help the doctor know if the child has rectal prolapse.

How is rectal prolapse treated? — The doctor will push the rectal tissue back into the child’s anus with a gloved finger. Some children need medicines to make them relaxed and sleepy before the doctor does this. The doctor can also teach parents how to push the tissue back if it comes out again.

If this treatment does not work or the problem keeps coming back, the child might need surgery.

Other treatments can help prevent rectal prolapse from happening again. The treatment depends on what caused the prolapse the first time.

A child who is constipated and has rectal prolapse should:

●Eat a diet that has lots of fruits and vegetables
●Sit on the toilet for 5 or 10 minutes after meals, if he or she is potty trained. Parents can give rewards just for sitting there.
●Stop potty training for a while, if he or she is in the middle of potty training
Your child’s doctor might also give your child medicines that soften bowel movements, such as PEG (polyethylene glycol 3350, sample brand name MiraLAX).

Children with diarrhea need treatment for the cause of the diarrhea. Most of the time, diarrhea is caused by an infection or is a side effect from a medicine.

Children with rectal prolapse who do not have an obvious cause should be tested for cystic fibrosis. Children who already have cystic fibrosis can take medicines called “pancreatic enzymes.” These help make the child’s bowel movements more regular.

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