What is Pediatric Rectal Prolapse?
Rectal prolapse means some or all of the lining of your rectum falls through your anus. This is the condition, often seen in children from infancy up to 4 years old, where it typically corrects itself over time with simple treatments. Most cases are seen during the first year of a child’s life. However, if a child starts showing symptoms after the age of 4, they might have a long-term issue that makes them more prone to developing rectal prolapse. In some cases, the condition may continue without resolving, and the child may need surgery to fix it.
What Causes Pediatric Rectal Prolapse?
Kids are more likely to experience a condition known as rectal prolapse, mainly due to some physical differences that exist when they’re young. In children, the rectum, which is the last section of the large intestine, runs in a straight line along the tailbone, and sits lower than other organs in the pelvic area. The lining of the rectum, known as the mucosa, is also extra stretchy and loosely attached to the underlying muscle layer in children. Furthermore, a part of their large intestine, the sigmoid colon, is more flexible and their levator ani muscle, which supports the rectum, isn’t as strong as in adults. Lastly, in babies less than a year old, there are features in the rectum, known as the Houston valves, that aren’t fully developed and provide support.
Rectal prolapse also occurs due to increased bowel movement, increased pressure inside the abdomen, and certain inherited conditions. The increased bowel movement often comes from infections caused by certain bacteria or parasites, leading to diarrhoea. Conditions like ulcerative colitis or excessive use of laxatives can also result in this. The pressure inside the abdomen can increase due to long-term constipation, persistent coughing, excessive vomiting, or straining during urination because of blockages. In addition, kids with certain inherited conditions such as cystic fibrosis, myelomeningocele, Hirschsprung’s disease, spina bifida, and congenital hypothyroidism are more likely to experience rectal prolapse. Other causes include malnutrition and physical defects like polyps or tumours in the mucosa, and certain conditions affecting the anus.
Risk Factors and Frequency for Pediatric Rectal Prolapse
Rectal prolapse, a condition where the rectum – the end section of the intestine – drops down, can happen in children too. It’s seen just as much in boys as in girls, especially between the ages 1 and 3. This condition is more frequently encountered in less developed countries, often due to reasons like diseases caused by parasites, lack of proper nutrition, and sickness that causes diarrhea.
- Rectal prolapse can happen in children, equally in boys and girls.
- It is more common in children aged 1 to 3.
- The condition is more prevalent in less developed countries.
- Common causes in these countries are parasitic diseases, malnutrition, and diarrheal illnesses.
- In the United States, the most common reason for rectal prolapse is constipation.
Signs and Symptoms of Pediatric Rectal Prolapse
Rectal prolapse in teenagers is often recognized by symptoms like strain during bowel movements, pain in the rectum, and passing stools mixed with blood or mucus. In young children, this condition is usually noticed by their parents. It’s marked by a dark red mass sticking out from the rectum during straining, which often goes back in on its own by the time the child gets medical attention. Rectal prolapse might cause mild uncomfortable sensations, but it usually doesn’t hurt. If a doctor examines when the rectum has prolapsed, the patient may have reduced or no tension in the rectal muscles. But usually, these muscles regain their normal tension after a few hours.
Testing for Pediatric Rectal Prolapse
Rectal prolapse is usually diagnosed through considering your medical history and a physical examination. Sometimes, the rectal prolapse may not be obvious by the time you reach your doctor, so they might rely on your descriptions of symptoms to make a diagnosis. For those whose prolapse is thought to be caused by constipation, your doctor may use a test called contrast radiography of the colon and anorectal manometry. These tests help to examine the colon and rectum and measure pressure inside your rectum.
If you have a more severe or hidden rectal prolapse, your doctor might do a colonoscopy or sigmoidoscopy. These tests use a small, flexible camera to look inside your rectum. This can help your doctor identify reddening and roughness in the lower part of your rectum, as well as a unique, bumpy white lesion on the front wall of your rectum.
These tests can also help your doctor see rectal polyps, which are small clumps of cells that form on the lining of the rectum, or ulcers, which are painful sores. Your doctor might also perform a type of x-ray called fluoroscopic dynamic defecography or a magnetic resonance imaging scan to understand more about the prolapse and check for any related problems in the pelvic floor, which is a mesh of muscles that support the bladder, uterus (in women), and rectum.
Treatment Options for Pediatric Rectal Prolapse
Rectal prolapse, a condition where the rectum, the lower end of the bowel, slips outside the anus, can often be managed at home. This usually involves taking mild medications to soften the stool or trigger bowel movements, avoiding excessive straining during bowel movements, and treating any other health conditions that may be causing the prolapse. Following these steps diligently can prevent the prolapse from recurring and becoming a chronic problem. In fact, about 90% of children under 3 years old who develop rectal prolapse see improvement with these simple measures.
For children with a condition called cystic fibrosis, which makes them more likely to experience rectal prolapse, adjusting their pancreatic enzymes is important. Pancreatic enzymes are substances that help digest food, and optimizing their levels can help prevent rectal prolapse.
If the rectal prolapse starts causing ongoing discomfort, rectal pain or bleeding, sores in the rectum, or if it becomes difficult to manually push back the prolapsed rectum, further medical intervention may be needed. A common initial treatment is injection sclerotherapy, which involves injecting a special solution into the rectum to help shrink the prolapsed tissue. Other possible treatments include Thiersch cerclage, a procedure that supports the anus with a wire or thread loop, and rectopexy, a surgery to secure the rectum in its correct position.
What else can Pediatric Rectal Prolapse be?
When trying to diagnose rectal prolapse, which is when part of your rectum falls out of place and sticks out of your anus, doctors need to rule out other conditions that might explain the symptoms. These could include:
- Ileocecal intussusception (when one part of the intestine slips into another part)
- Prolapsing rectal polyp (a growth in the rectum that may protrude from the anus)
- Prolapsing rectal duplication cyst (a rare type of cyst in the rectum that may protrude from the anus)
- Rectal hemorrhoids (swollen blood vessels in the rectum or anus)
It should be noted that while rectal prolapse is usually painless, ileocecal intussusception typically causes intermittent severe pain. Doctors can also often tell the difference between a prolapsing rectal polyp, a prolapsing rectal duplication cyst, and rectal hemorrhoids by examining the prolapsed tissue because of how it would look and feel around the circumference.
What to expect with Pediatric Rectal Prolapse
The outlook for rectal prolapse is usually positive, particularly when it is identified between the ages 9 months and 3 years, and not linked to any other health problems. It is typically seen in children and often does not happen again after the age of 6. However, it should be noted that if the rectal prolapse is discovered after the age of 4, there is a greater chance that the child might have underlying neurological or musculoskeletal issues. These conditions may need surgery and could lead to symptoms persisting into adulthood.
Possible Complications When Diagnosed with Pediatric Rectal Prolapse
The complications from surgery generally include:
- Bleeding
- Harm to the opening of the bladder
- Injury to the nerves in the lower spine area
- Blood clots in the pelvic region