Rectal prolapse — the protrusion of the lining of a child’s rectum through the anal sphincter — can occur for many reasons. In the pediatric population, it most commonly occurs in children under 4 years old but can affect older children as well. Children with colorectal and pelvic malformations tend to be at increased risk for rectal prolapse, as are those with chronic constipation or diarrhea and neurological conditions such as tethered cord or spinal cord injury.

To learn more about the effectiveness of both approaches, Nandivada and her colleagues reviewed medical records from 67 children who were referred for treatment for rectal prolapse at the Colorectal and Pelvic Malformation Center. colonic stenting procedure

After comparing medical management, sclerotherapy, and surgical correction (rectopexy or transanal resection) as initial treatment strategies, the team found that only 33 percent of patients resolved with sclerotherapy alone, compared to 79 percent who underwent surgery as initial management. Overall, when used as an initial management approach, surgery had a significantly higher success rate than sclerotherapy, even after controlling for severity of disease, psychiatric diagnosis, age, and other factors.

The results — published in the Journal of Pediatric Gastroenterology and Nutrition — have helped inform the center’s approach to rectal prolapse, says Nandivada. Medical therapy and pelvic floor physiotherapy remain the first-line therapies for most children with rectal prolapse, especially under age 5 years. However, for older children, especially adolescents, with persistent prolapse despite lifestyle modification, pelvic floor therapy, and constipation management:

“We believe this treatment algorithm for rectal prolapse can help minimize time to resolution and avoid unnecessary procedures,” she explains.

Learn more about the Colorectal and Pelvic Malformation Center.

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