Rectal prolapse is defined as the herniation of rectum through the anus.It is subdivided into partial and complete prolapse. The term Procedentia refers to the complete variety.(1)
Rectal prolapse usually occurs at extremes of age. It is most common at 3 to 8 years of age. Parents often provide history of a dark red mass protruding from the child’s anus and the child usually is pain free.(2)
The following anatomical features are thought to be important in the aetiology of prolapse:
(1) vertical course of the rectum;
(2) few lateral and anterior posterior curves;
(3) flat surface of coccyx and sacrum;
(4) relatively low position of rectum and other pelvic organs;
(5) great mobility of the sigmoid colon;
(6) lack of support by levator ani muscle; (3)
There are many other conditions that predispose or precipitate rectal prolapse like Diarrhoea,Constipation,Neuromuscular Disorders Pelvic Nerve Disorders ,myelomeningocele, malnutrition, malabsorptionm, etc. Idiopathic rectal prolapse is seen in otherwise normal children. Children with conditions such as rectal polyps, worm infestation, proctitis, ulcerative colitis, Ehlers Danlos syndrome and cystic fibrosis may also develop rectal prolapse.( 4)
Prolapse usually occurs during defecation or crying. Failure to reduce the prolapse leads to venous stasis, edema and ulceration and sometimes necrosis of gut leading to perforation.(5)
In children sweat chloride test & genetic test are done to rule out cystic fibrosis, other investigations like Video defecography to determine if rectum intussuscepts on defecation, rectal manometry to evaluate anal sphincter muscles,Rigid proctosigmoidoscopy to rule out additional lesion like solitary rectal ulcers, if present biopsy taken to exclude other pathology.(6)
The management of rectal prolapse is controversial and no definite protocol is available. Most children with rectal prolapse do not require any specific treatment. Treatment should be directed at proper toilet training, treating constipation and eliminating any underlying cause. Various modes of treatment from minimally invasive to abdominoperineal surgeries are described. The common surgical procedures practiced for the treatment of rectal prolapse are Thiersch suture circlage, sub mucosal injection of sclerosent in the anal canal, transanal mucosal sleeve resection, electrocautrization, posterior sagittal rectopexy and laparoscopic rectopexy.(7)
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