There are three types of rectal prolapse:
- Complete: full thickness of rectum prolapses through anus (two layers of rectum with an intervening peritoneal sac, which may contain small bowel)
- Incomplete/mucosal: prolapse limited to only two layers of mucosa
- Concealed: internal intussusception of upper rectum into lower, with no extrusion into the anus
- Most cases occur in children <4 years of age around time of toilet training; equal incidence in boys and girls
- In older children and adults, strong (6-fold) female predilection
- Common in developing countries, perhaps because of poor nutrition and parasitic infection; less common in industrialized countries
- Cystic fibrosis (CF)
- Typically presents between 6 months and 3 years of age in patients with CF
- Presentation in children with CF >5 years of age is rare.
- Chronic constipation
- About 50% of children with chronic constipation will experience prolapse.
- Inheritance patterns depend on associated underlying etiologies.
- No known inheritance pattern for idiopathic rectal prolapse
Exact etiology uncertain
Commonly Associated Conditions
- Excessive straining with bowel movements from constipation and toilet training (hips and knees flexed) is the most common cause in industrialized countries.
- Diarrhea; may be more of a cause in tropical and subtropical countries
- Infections: hookworms and other parasitic infections
- Malnutrition; can cause loss of the ischiorectal fat pad
- Complication of past surgery, such as imperforate anus repair
- Complete prolapse is rare in children, but when it occurs, it may be related to poor fixation of rectum to sacrum and to weak pelvic and anal musculature.
- Ulcerative colitis
- Hirschsprung disease
- Ehlers-Danlos syndrome
- Rectal polyp
- Rectal neoplasm
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Cabana, Michael D., editor. "Rectal Prolapse." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617507/all/Rectal_Prolapse.
Rectal Prolapse. In: Cabana MDM, ed. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617507/all/Rectal_Prolapse. Accessed June 9, 2023.
Rectal Prolapse. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult (8th ed.). Wolters Kluwer. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617507/all/Rectal_Prolapse
Rectal Prolapse [Internet]. In: Cabana MDM, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2023 June 09]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617507/all/Rectal_Prolapse.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Rectal Prolapse ID - 617507 ED - Cabana,Michael D, BT - 5-Minute Pediatric Consult UR - https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617507/all/Rectal_Prolapse PB - Wolters Kluwer ET - 8 DB - Pediatrics Central DP - Unbound Medicine ER -