In the large intestine the lower part is called rectum. It is usually attached to the pelvis with ligaments and muscles. Rectal prolapse occurs when the lining of a child’s rectum protrudes through the anus and out of the body. Tendons and muscles can become weak due to problems such as chronic constipation, chronic diarrhea, or straining while going to the bathroom. Underlying conditions like cystic fibrosis and Hirschsprung’s disease can also cause constipation.

Types

There are three types of fecal prolapse.

Partial prolapse (also known as mucosal prolapse). The lining (mucous membrane) of the rectum slips out of place and usually sticks out of the anus. This happens when you have a bowel movement. Partial prolapse is more common in children younger than 2 years old.

Complete prolapse. The entire wall of the rectum pops out of the space and usually protrudes from the anus. First, it can only occur during bowel movements. Eventually this can happen when you are standing or running. And in some cases, the enlarged tissue is outside your body.

Internal prolapse (intussusception). Like the folding parts of a toy telescope, a part of the large intestine (colon) or part of the wall of the rectum can slide up or down. The rectum does not come out of the anus. (See picture of intussusception). Intussusception in children is very common and rarely affects adults. In children, the cause is generally unknown. In adults, it is usually associated with another intestinal problem, such as tissue growth (such as a polyp or tumor) in the intestinal wall.

Causes

Children are at increased risk of rectal prolapse due to a structural problem in digestive problems. Other common conditions that increase a child’s risk of constipation include:

Infection

Intestinal infection in children is caused by inflammation of the rectum and movement through the anus. This infection can be caused by parasites or bacteria.

Increased abdominal pressure

It develops in children due to regular straining during bowel movements, such as chronic constipation. During constipation, pushing too hard causes the rectum to pass through the anus.

Chronic diarrhea

A condition that prevents proper absorption of food, such as inflammatory bowel disease, can cause chronic diarrhea. Diarrhea causes inflammation of the rectum in children, which moves through the rectum.

Malnutrition

Malnutrition (malnutrition) is the most common cause of constipation in children. Malnutrition prevents children from developing adipose tissue, which helps hold the baby’s rectum in place.

Cystic fibrosis

Mucous gland infection is associated with conditions throughout the body, including digestive problems. Children with rectal prolapse for no apparent reason should be tested for cystic fibrosis, which can cause mucus to thicken and become sticky.

Hirschsprung’s disease

Birth defects Hirschsprung’s disease affects the nerve cells of the large intestine and the muscular contractions of the intestine. This condition can lead to constipation.

Symptoms

• Irritation of the stool is usually only apparent on the basis of the physical examination. It appears as a dark red mass in the anus. The mass may be present only during defecation. (See Figure 3A)

• A mass in the anus requires immediate medical attention without going away on its own. This mass must recede before blood can compromise the section.

• The irritation of the stool is associated with the discomfort that comes from below. Increased pain means that the tissue that comes out may not have good blood flow.

• Sometimes there is the possibility of passing mucus or small amounts of blood.

Diagnosis

Your child’s healthcare provider will examine your child’s anus for rectal irritation. You can also look for rectal polyps. A rectal polyp is a small growth of tissue on the lining of the rectum. You can also look for lumps that are not visible from the outside, even inside your child’s anus. They may ask about your child’s bowel habits. Tell your healthcare provider about other medical conditions your child may have. Following tests are suggested to the child.

• A sweat chloride test will show the amount of chloride in your baby’s sweat. This test is used to verify the presence of CF. If your child has CF, the amount of chloride in the sweat is high.

• X-rays, ultrasound, or CT scan can show problems with the rectum. You can give your child a contrast liquid to help the intestines show up better in the pictures. Your healthcare provider may also put contrast liquid in your baby’s anus. Tell your healthcare provider if your child has ever had an allergic reaction to contrast liquid.

• A pattern of your baby’s bowel movements shows the germ that is causing your baby’s illness.

Treatment

Prolapse in children goes away on its own. It can help prevent the prolapse from coming back. If you can, replace the prolapse as soon as it occurs. Your child can also use a potty toilet that is considered stupid so that she doesn’t leak when she defecates.

Sometimes children need treatment. For example, if the prolapse does not go away on its own, an injection of the medicine into the rectum may help. If the prolapse is caused by another condition, the child may need treatment for that condition.

• Most mild cases of rectal prolapse can be treated by your pediatrician, who will manually reverse the prolapse. They also make recommendations that address the cause of prolapse, such as feeding your baby stool and increasing dietary fiber to improve normal 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 need surgery. Suitable treatments are discussed by the doctor with you. These may include:

• Sclerotherapy, in which a sclerosing agent is injected around the rectum to replace scar tissue and prolapsed surrounding tissue.

• Thiersch’s circulation, in which wire or other thin material is used to cut the anus

• Transasal 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 perforated to the sacrum

Surgical treatment for children

Surgical intervention In general, conventional treatment failed in children younger than 4 years who tried nonsurgical treatment for more than one year [20].

Surgery can also be used in cases of complicated rectal prolapse, for example, recurrent rectal prolapse requiring manual reduction, painful prolapse, ulceration, and rectal bleeding.

These include several different operations:

• Circumferential injection procedures: Injection procedures use sclerosing agent to promote adhesion formation, which stabilizes the rectum.

• Thiersch operation – Synthetic materials are used to create the perianal sling to support the rectum.

• Lockhart-Mummy Operation: A mesh gauze packing is temporarily placed in the retrorectal space to promote adhesions that stabilize the rectum.

• Catheterization treatment: The enlarged rectum is catheterized to produce inflammation and scarring.

• Abdominal rectopexy: endoscopic or open approach. Parectal tissue adheres to the presacral region to ensure proper anatomical position and tissue adhesion.

• Echohorn Rectopexy – A suture is placed in the rectal ampulla through the lower part of the sacrum to induce inflammation and adhesions between the rectal wall and the indirect wall.

• One study found that the use of laparoscopy (using stitches, mesh, amputation, or elevatorplasty) in the treatment of complete rectal prolapse was associated with a safer, more effective, and better functional outcome.

Home treatment for adults can help treat prolapse and try other types of treatments first.

• If your doctor says it’s okay, you can push the prolapse into that area.

• Avoid constipation. Drink plenty of water and eat fruits, vegetables, and other high-fiber foods. Changes in diet are usually enough to improve or reverse the prolapse of the lining (partial prolapse) of the rectum.

• Do Kegel exercises to strengthen the muscles in your pelvic area.

• Don’t strain when you have a bowel movement. Use a stool softener if necessary.

Surgery is required for those with a complete prolapse or those with a partial prolapse that does not improve with a change in diet. The surgery involves attaching the rectum to the muscles of the pelvic floor or the lower end of the spine (sacrum). Or, a section of the large intestine that does not support the surrounding tissue may be surgically removed. The surgery can include both procedures.

Prevention

• Avoiding rectal prolapse is the main way to solve the problem.

• If a child is constipated, sitting or sitting on the toilet for a long time, the sphincter muscle relaxes by clamping on the rectum and causing prolapse. Recommended changes in bowel habits. Helps prevent constipation in foods like dairy, rice, and bananas. Medications such as polyethylene glycol (Miralax), docusate, and senna help keep stools soft.

• There may be changes in defecation habits: limiting the time spent on the toilet, using the specific toilet for children or placing the stool in front of the adult toilet. Sitting the child in the toilet for a long time during training, which is considered stupid, contributes to prolapse; It is important to limit the time you spend in the bathroom.

• Chronic cough should be treated.

•  If there is diarrhea, it should be treated.

• In some cases, certain medical treatments, such as cystic fibrosis (which requires resetting the enzyme), may be necessary to prevent recurrent prolapse.