# Rectal prolapse in a child - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: Pediatric Rectal Prolapse - StatPearls (NCBI Bookshelf NBK532308) - https://www.ncbi.nlm.nih.gov/books/NBK532308/ · Rectal prolapse in a child - disease-level clinical article (rectal-prolapse-full.txt) · Rectal prolapse in a child - disease-level clinical article (rectal-prolapse-clinical.txt) · No dose - referral pathway, no medicine given in primary care - Verified date: 2026-08 ## Verified against - Pediatric Rectal Prolapse - StatPearls (NCBI Bookshelf NBK532308) - https://www.ncbi.nlm.nih.gov/books/NBK532308/ - Rectal prolapse in a child - disease-level clinical article (rectal-prolapse-full.txt) - Rectal prolapse in a child - disease-level clinical article (rectal-prolapse-clinical.txt) - No dose - referral pathway, no medicine given in primary care ## Treatment metadata - Reduce it now, then treat the constipation that caused it ## Complete treatment card ```text RECTAL PROLAPSE IN A CHILD Sources: Pediatric Rectal Prolapse - StatPearls (NCBI Bookshelf NBK532308) - https://www.ncbi.nlm.nih.gov/books/NBK532308/ · Rectal prolapse in a child - disease-level clinical article (rectal-prolapse-full.txt) · Rectal prolapse in a child - disease-level clinical article (rectal-prolapse-clinical.txt) · No dose - referral pathway, no medicine given in primary care Review status: REVIEWED against 4 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Caregivers most often notice a dark red bulge coming out of the anus, especially while the child strains. - The condition is usually pain-free, though some children note mild discomfort. - Teenagers more often report straining, anal pain, and passing blood or mucus along with the prolapse. [anal pain · rectal prolapse] SIGNS - what you find (2) - Sphincter tone can be low or absent right after the prolapse, usually returning within a few hours. [rectal prolapse] - In children with an underlying neurologic problem, reduced sphincter tone may not bounce back. TESTS (4) - Because the prolapse often resolves before the visit, a caregiver's description of the bulge may be all that's needed to diagnose it. - Sigmoidoscopy can uncover a hidden prolapse as redness and a granular surface, or as a white- topped, polyp-like lesion on the front rectal wall. - Cystic fibrosis screening is reserved for prolapse that keeps recurring despite conservative care with no other cause identified. - When constipation looks like the underlying cause, contrast imaging of the colon plus anorectal manometry are used. IF NOT THIS - what else fits (2) - A long-standing bowel intussusception can push through the anus and be mistaken for prolapse, causing episodic severe belly pain between well periods. - Looking directly at the protruding tissue helps tell a prolapsed polyp or hemorrhoids apart from true rectal prolapse. Source Rectal prolapse in a child - disease-level clinical article (rectal-prolapse-full.txt) Status traced to the source above 1. REDUCE IT NOW, THEN TREAT THE CONSTIPATION THAT CAUSED IT[1st line] Adult Source Pediatric Rectal Prolapse - StatPearls (NCBI Bookshelf NBK532308) - https://www.ncbi.nlm.nih.gov/books/NBK532308/ Why Two things happen at this visit: the prolapse goes back, and the cause gets a plan. Reduction gets harder the longer it is left, and a child sent home without a bowel regimen simply comes back. No medicine is printed here because the article names the laxatives without any paediatric amount; the doses are on the constipation entry. Caution REDUCE IT TODAY, NOT AT THE NEXT APPOINTMENT - if the prolapse has not gone back by itself, reduce it by hand as soon as you can, because the longer it stays out the harder it gets to put back. HOW IT IS DONE - you need gloves, lubricant, gauze and tape. Sedation and pain relief may be called for, depending on how much bowel is out and how distressed the child is. Put the child knee-chest, on the couch or across a parent's lap, and guide the bowel back with a finger in the rectum. Expect it to go in over 5 to 15 minutes. THE SUGAR TRICK, WITH THE AMOUNT THE ARTICLE GIVES - where reduction is proving hard, a 50% glucose solution, or 113 g of plain sugar, draws fluid out osmotically and brings the swelling down quickly. Ordinary table sugar poured onto the mucosa, left a few minutes, then reduce. It is a topical osmotic agent, not a dose, which is why it is not offered as a prescribing row. WHEN IT WILL NOT GO BACK - a prolapse you cannot reduce by hand needs an urgent surgical opinion, so that it can be reduced under sedation or a general anaesthetic. Do not keep trying past the point where the tissue is dusky or the child is exhausted; bowel left prolapsed goes on to ulcerate, to obstruct venously, and to thrombose. TEACH THE PARENTS BEFORE THEY LEAVE - parents, and the child, can be taught to reduce it themselves should it happen again, and while definitive treatment is being arranged the carers should be shown how to do it properly. Add the posture: teach them how the child should sit to open the bowels, with the buttocks properly supported and as little straining as possible. THE BOWEL REGIMEN IS THE ACTUAL TREATMENT - the first aim in rectal prolapse is to find what is predisposing to it and treat that. Send the child home on a bowel regimen: a stool softener where there is constipation, or an end to prolonged straining. Keep it going until the child has passed stool regularly for several months with no prolapse. THE LAXATIVE LADDER, WITHOUT AMOUNTS FROM THIS ARTICLE - where a young constipated child keeps prolapsing despite an osmotic agent such as polyethylene glycol, the next rung is to add a stimulant laxative, sennosides for instance, and after that bisacodyl if it is still needed. No milligrams are stated, so none are printed; take the weight-based doses from the constipation entry. LOOK FOR THE OTHER CAUSES, NOT JUST CONSTIPATION - let the organism you find direct the treatment: Shigella spp, Escherichia coli, or an intestinal parasite - Trichuris trichiura, enterobiasis (pinworm), giardiasis. An antibiotic given empirically for suspected bacterial enteritis is generally advised against. Whipworm and giardia are ordinary findings in Cairo and each has its own entry here. CYSTIC FIBROSIS IS A SECOND-LINE THOUGHT, NOT A FIRST ONE - screen for it only where the prolapse keeps returning despite conservative treatment and nothing underlying has been found. MOST YOUNG CHILDREN NEVER NEED SURGERY - close to 90% of children under 4 years get better on medical treatment alone and never come to an operation. Past 6 years of age, a recurrence is unusual. AGE OVER 4 CHANGES THE ANSWER - a child who first presents after the age of 4 is likelier to have something else behind it - a neurological or pelvic musculoskeletal abnormality, or chronic functional constipation - and does less well on conservative treatment. Refer such a child promptly for a surgical opinion and consideration of an operation. THE REFERRAL LIST, IN FULL - send to paediatric surgery for: a prolapse that will not respond; two or more episodes that needed reducing by hand; rectal pain that persists; rectal bleeding that persists; excoriation of the perineum; a pelvic floor permanently weak (myelomeningocele, spinal cord injury, tethered cord); an anatomical anomaly acting as a lead point (a polyp, lymphoid hyperplasia, a solitary rectal ulcer, or - rarely - a tumour); a Hirschsprung disease or imperforate anus already repaired surgically; and trauma to the rectum or anus, whether from physical or sexual abuse. That last one is on the article's own list and it is not optional to consider. WHAT ELSE PROTRUDES FROM AN ANUS - ileocaecal intussusception: uncommon, but an ileocolic intussusception left long enough can travel far enough down that the bowel, or the appendix, comes out through the anus and looks like a prolapse. Such a child tends to look ill, with bouts of severe abdominal pain and relatively normal spells in between. An ill child with a protruding mass is a surgical emergency, not a prolapse. A prolapsing rectal polyp and haemorrhoids also come out of the anus, and looking directly at the tissue is what tells them apart. WHAT TO EXPECT AFTERWARDS - where the prolapse went back on its own or was reduced by hand, what follows most often is local pain and a little bleeding from the mucosa that stops by itself. Tell the family that a streak of blood and soreness for a day is expected, and that anything more should be reviewed. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)