What is included in the conservative treatment of pediatric rectal prolapse?

Updated: Dec 12, 2019
  • Author: Jaime Shalkow, MD, FACS; Chief Editor: Carmen Cuffari, MD  more...
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Answer

Conservative management should be the first approach since it may prove useful in over 90% of children. It is aimed at treating the cause and reducing straining. It should be attempted for 1 year before surgical management is chosen.

In patients with diarrhea and constipation, rectal prolapse usually resolves when the stool pattern returns to normal. Therefore, constipation should be aggressively managed. Constipation is treated with dietary modification (total dose per day is 5 g of fiber plus an additional 1 g for each year of age; dose for adults is 20 g once or twice daily) and stool softeners (eg, polyethylene glycol) to reduce straining, or osmotic laxatives. These have been shown to prevent recurrence. Adequate fluid intake should be ensured.

Infectious diarrhea or parasitic infestation should be appropriately treated.

Further management should focus on parental reassurance and education. Instruction on how to reduce a prolapse may prevent repeated presentations to the emergency department.

The type of toilet that the child uses is also important; use of an adult toilet contributes to rectal prolapse because the buttocks are in a dependent position and the feet are unsupported. Using a special child’s toilet or using a step to support the feet can be a useful adjunct to treatment. In some patients, switching from a “potty” chair to an adult commode may help prevent recurrence. Time spent on the toilet should also be limited to minimize straining.


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