What to do if your baby has rectal prolapse

After birth, the baby depends on his parents for daily care. If he is unwell, he can only express it by crying. Everything requires careful observation by his parents. Some parents will pay attention to finding the cause as soon as they find something abnormal when their children are feeling uncomfortable. For example, rectal prolapse is usually discovered during defecation. Once discovered, the child should be sent to the hospital immediately. The treatment effect is very good, so there is no need to worry.

Rectal prolapse, also known as rectal prolapse, refers to the anal canal, rectum or even sigmoid colon protruding out of the anus. Rectal prolapse in children is more common in children aged 1-3 years old. There is no obvious gender difference in the incidence, and most children can recover on their own.

1. Causes

It is caused by the interaction of innate and acquired factors.

1. Congenital anatomical defects ① The straight state of the sacrum: The physiological curvature of the sacrum of infants and young children is not fully formed, and the rectum and anal canal are almost in a straight line. ② Pelvic floor muscle paralysis: more common in patients with lumbar spinal cord and meningocele, the anal levator muscles relax and lengthen. ③ The anal canal (uterus) rectal pouch is too deep: it weakens the fixation force of the rectum. ④ The rectal arteries are scattered and small: the rectal part loses important supporting power.

2. Acquired contributing factors ① Malnutrition and emaciation: The fat tissue in the ischiorectal fossa decreases, and the support and fixation for the rectum are lost. ② Intestinal gas disorder during defecation: It is more common in people with chronic constipation, but can also be seen in people with long-term diarrhea. The bad habit of squatting on the potty for a long time every time you have a bowel movement can also easily cause rectal prolapse in children. ③ Bladder fibrosis: often accompanied by relaxation of the connective tissue of the pelvic floor. ④ Abnormally increased abdominal pressure: seen in children with long-term or severe cough, urinary stones, chronic bacterial dysentery and phimosis. ⑤ Long-term unbalanced diet: Lack of fiber-rich foods and long-term liquid diet can easily lead to rectal prolapse.

2. Pathological classification

1. Type I is mucosal prolapse, in which the anal canal and rectal mucosa separate from the muscular layer and protrude out of the anus, also known as incomplete prolapse. This type is the most common clinically. The prolapsed mucosa is ring-shaped, light red in color, soft in texture, and sometimes the two folded layers of mucosa can be touched. The length protruding from the anus does not exceed 4 cm and is easy to retract or return on its own.

2. Type II is complete prolapse, in which both the vertical intestinal mucosa and muscle layer protrude out of the anus, also known as true prolapse. Long-term type I mucosal prolapse may progress to complete prolapse. The prolapsed mass is slightly cone-shaped and slightly curved backwards. A depression can be seen at the top. There are multiple annular mucosal folds on the surface, which are light red or dark red in color. They feel thick and elastic to the touch. They can protrude 10 cm outside the anus, and the anus is relaxed. The prolapsed material often requires auxiliary reduction.

3. Type III, i.e., colon intussusception prolapse, is rare in clinical practice. The anal canal, the entire layer of rectum and part of the sigmoid colon prolapse out of the anus. The prolapsed mass is oval in shape, the anus is extremely loose, the mucosa may be edematous, with increased secretions, erosion, bleeding, ulceration and even necrosis, which is easy to become incarcerated and cause Warner difficulty.

3. Clinical manifestations

1. The "lump" of prolapse is the most intuitive and important manifestation. The onset stage is that a light red mass protrudes from the anus when straining during bowel movements, and the mass often shrinks on its own after defecation. After repeated attacks, the lump must be lifted up by hand. If it continues to develop, as long as the abdominal pressure increases slightly, the lump will prolapse even if there is no bowel movement. The prolapsed mucosa may be rubbed and become congested and edematous, with increased secretions, erosion, bleeding, ulceration and even necrosis.

2. Associated symptoms: Children have a feeling of anal prolapse, pain in the lower abdomen and lumbosacral region, frequent bowel movements with small amounts of stool, a feeling of incomplete bowel movements, frequent urination, accompanied by mental manifestations such as irritability and restlessness, and irritation symptoms such as perianal eczema.

3. Manifestations related to contributing factors include malnutrition, weight loss, long-term constipation or diarrhea, urinary stones, phimosis, and various acute and chronic diseases that cause coughing.

4. Diagnosis and differential diagnosis

Most parents reported that their children had a history of lumps protruding from the anus during bowel movements. The doctor asks the child to squat or lie on his side and hold his breath while doing bowel movements and observe, during which a lump caused by prolapse can be seen. The clinical types can be basically distinguished based on the size, length and shape of mucosal folds of the tumor. Clinically, the diagnosis can be easily made based on the medical history, characteristics of the prolapsed mass, symptoms and contributing factors. In rare cases, rectal prolapse in children should be differentiated from rectal polyps, perianal vascular ectasia, and advanced intussusception:

1. During the diagnosis and treatment of rectal polyps, parents’ medical history is unclear and their expressions are ambiguous. Larger rectal polyps are easily described as rectal prolapse, and the anus should be carefully examined. Rectal polyps are accompanied by a history of recurrent bloody stools. After the examiner retracts the mass outside the anus, a spherical, lubricated, mobile mass can be felt in the rectum during a digital rectal examination, with a long, thin pedicle connected to the rectal wall. After the finger is removed, there is often blood on the fingertip. Children with recurrent rectal prolapse may also develop polyps due to long-term inflammatory stimulation of the rectum, but these polyps are generally small and pedunculated.

2. The perianal blood vessels dilate and appear purple-blue during defecation or increased abdominal pressure, and there is no mucosal prolapse.

3. In the late stage of intussusception, the head of the intussusception may accidentally protrude through the sigmoid colon, rectum, and anal canal and out of the anus. The general condition of this type of child is more serious than that of rectal prolapse. Most of them have a recent history of paroxysmal abdominal pain, vomiting, bloody stools, and abdominal masses, but no repeated prolapse of masses outside the anus. During rectal examination, there is a gap between the intestinal tube at the head of intussusception and the anal canal. The finger can reach deep into the rectal cavity through this gap, but no fold can be felt at the continuous part of the anal canal and rectal mucosa.