Rectal Prolapse

Treatment Overview

See a doctor if you or your child has symptoms of rectal prolapse. Sometimes home treatment such as eating a high-fiber diet can reverse the prolapse.

If the problem does not go away, you may need further treatment. This may include surgery, especially when the whole rectal wall and not just the lining sticks out of the anus (complete prolapse).

Treatment of children with rectal prolapse

In children, rectal prolapse usually goes away on its own. A parent or other caregiver often can manage the rectal prolapse with home care methods until it heals. If your child has a rectal prolapse, you can help prevent the prolapse from coming back by:

• Pushing the prolapse back into place as soon as it occurs. Wear disposable latex gloves and use lubricating jelly. Applying an ice pack can help decrease swelling.
• Having the child use a small toilet that is placed on the floor. This will help support the child's buttocks so that he or she will not have to strain while having a bowel movement.

Most children who develop rectal prolapse between the ages of 9 months and 3 years will respond to home treatment. In these cases, prolapse usually does not continue after age 6.

If a medical condition, such as cystic fibrosis, is causing rectal prolapse, it will usually need to be treated to resolve the prolapse.

If rectal prolapse is not caused by another condition or does not respond to home treatment, your child may need other treatment. Injecting a chemical called a sclerosant into the wall of the rectum can be very effective at treating rectal prolapse in children who do not improve after home treatment.

Treatment of adults with rectal prolapse

Treatments for rectal prolapse in adults focus on changes in diet, medicine (such as stool softeners), and surgery. Treatment choice depends on the type of prolapse, whether you have other physical problems, your age, your activity level, and whether you can do home treatment. Home treatments usually are tried first because surgery does not always cure the condition.

You may treat a prolapse of the lining (mucosal prolapse) by changing your diet to reduce constipation and straining during a bowel movement. Adding fiber to your diet increases the amount of water in your stools and helps them move through the large intestine quickly. You may also use a prescription medicine, such as lactulose, that softens stools and allows them to move through the intestines and pass easily.

If you have a mucosal prolapse that does not improve with a change in diet or other self-care, you may need surgery to secure or remove tissue that slides out of the anus.

If you need surgery, the type of procedure depends on the size of the prolapse and your overall health. This includes any symptoms you have as well as other physical problems that may contribute to the prolapse.

Two types of surgery are used to treat a complete prolapse. A surgeon may operate through the belly to secure part of the large intestine or rectum to the inside of the abdominal cavity (rectopexy). Sometimes the surgeon removes the affected part of intestine. This type of surgery is most often used for younger, physically fit people.

Surgery also can be done through the area between the genitals and the anus (perineum) to strengthen the anal sphincter. This type of surgery is best for people who are elderly or are not physically fit.

Surgery is most often successful for people who still have some control over the anal sphincter. If the sphincter is damaged, surgery may correct the prolapse but not be able to completely correct fecal incontinence. In some cases, fecal incontinence can become worse.

For diagnosis of rectal prolapse and treatment that does not involve surgery, you can see your family medicine doctor, an internist, a pediatrician, or a gastroenterologist. If you need surgery, you will need to see a general surgeon or a colorectal surgeon.

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Author:	Monica Rhodes	Last Updated: August 9, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine C. Dale Mercer, MD, FRCSC, FACS - General Surgery
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