Rectal prolapse

Key points

Occurrence in <4 years - due to anatomic variation (primary)

Occurrence in >4 years - likely underlying cause

Primary

Young children - vertical rectum, mobile sigmoid, poor fixation of rectal mucosa to muscular layers, weak levator

Constipation

Secondary

Parasitic illness, chronic diarrhoea, and malnutrition

Polyps, Ulcerative Colitis, Hirschsprung's disease, Ehlers-Danlos

Cystic fibrosis - largely historical association with rectal prolapse due to malnutrition and large stools

Management

Manage constipation

Minimise toilet sitting

Surgical options

Oily phenol injection to induce submucosal fibrosis

If fails - Laparoscopic rectopexy - Abdominal approach has less recurrence and incontinence compared to rectal approaches, but higher constipation (Pellino et al)

Some surgeons may opt for rectal approaches such as the Delormes procedure

Page edited by Mrs Charnjit Seehra BSc November 2024

References

Flageole, Helene, et al. "Rectal Prolapse." Pediatric Surgery NaT, American Pediatric Surgical Association, 2020. Pediatric Surgery Library, www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829533/all/Rectal_Prolapse.

Pellino G. Abdominal versus perineal approach for external rectal prolapse: systematic review with meta-analysis. BJS Open. 2022