Our Summary

This research looks at how to treat children with a condition called rectal prolapse, where the rectum (the end part of the large intestine) slips out of place and can stick out of the anus.

In recent times, almost half of children with this condition have needed surgery. However, the researchers in this study have been trying a non-surgical approach, using a program to manage the child’s bowel movements.

The researchers looked back at the records of 47 children diagnosed with rectal prolapse between 2011 and 2020, excluding any with other rectal conditions. Most of these children (96%) also had constipation, and some (14%) also had psychiatric diagnoses.

The children were put on a bowel management program, which included laxatives for most (94%). Over a follow-up period with a median duration of 181 days, the rectal prolapse resolved itself in a median time of 9 months.

When the researchers compared children who were four years old or younger to those older than four, they found that the younger children were less likely to also have a psychiatric diagnosis and that their prolapse resolved itself more quickly. However, there was no difference in the need for surgery between these two age groups. Only a small number (6.4%) of patients needed surgery for their prolapse.

The researchers therefore conclude that a bowel management program is an effective way to treat most children with rectal prolapse, suggesting that surgery is not necessary for most children with this condition.

FAQs

  1. What is the non-surgical approach used by researchers to treat rectal prolapse in children?
  2. Did the research find any difference in the need for surgery between children who were four years old or younger and those older than four with rectal prolapse?
  3. How effective was the bowel management program in treating children with rectal prolapse according to the study?

Doctor’s Tip

If surgery is recommended for rectal prolapse, your doctor may advise you to follow their post-operative instructions carefully to ensure a successful recovery. This may include taking prescribed medications, avoiding heavy lifting or strenuous activities, and following a special diet to promote healing. It’s important to communicate any concerns or symptoms with your doctor during the recovery process to ensure the best outcome.

Suitable For

Rectal prolapse surgery is typically recommended for patients who do not respond to non-surgical treatments such as bowel management programs, medication, or lifestyle changes. Patients who may be recommended for rectal prolapse surgery include:

  1. Patients with severe or chronic rectal prolapse that does not improve with conservative treatments.
  2. Patients with recurrent rectal prolapse episodes.
  3. Patients with significant symptoms such as rectal bleeding, pain, or difficulty with bowel movements.
  4. Patients with underlying conditions that contribute to rectal prolapse, such as pelvic floor dysfunction or neurological disorders.
  5. Patients with complications of rectal prolapse, such as fecal incontinence or ulceration of the rectal mucosa.
  6. Patients who have a large prolapse that is causing significant discomfort or interference with daily activities.

Ultimately, the decision to recommend rectal prolapse surgery will depend on the individual patient’s symptoms, medical history, and response to conservative treatments. It is important for patients to discuss all treatment options with their healthcare provider to determine the most appropriate course of action.

Timeline

Overall timeline:

  • Patient is diagnosed with rectal prolapse, often associated with constipation
  • Patient is put on a bowel management program, including laxatives
  • Over a median follow-up period of 181 days, the rectal prolapse resolves itself in a median time of 9 months
  • Only a small number of patients (6.4%) end up needing surgery for their prolapse

Before surgery:

  • Patient experiences rectal prolapse, constipation, and potentially other symptoms
  • Patient undergoes non-surgical treatment with a bowel management program
  • Rectal prolapse resolves over time with the program

After surgery:

  • Only a small number of patients end up needing surgery for rectal prolapse
  • Surgery may be necessary if non-surgical treatment is not successful
  • Post-surgery recovery and follow-up care may be needed to ensure the success of the procedure.

What to Ask Your Doctor

Questions a patient should ask their doctor about rectal prolapse surgery may include:

  1. What are the potential risks and complications associated with rectal prolapse surgery?
  2. How long is the recovery period after rectal prolapse surgery?
  3. What are the success rates of rectal prolapse surgery?
  4. Are there any alternative treatment options to surgery for rectal prolapse?
  5. How will my bowel movements be affected after rectal prolapse surgery?
  6. Will I need to make any lifestyle changes or follow a special diet after rectal prolapse surgery?
  7. How long will the results of rectal prolapse surgery last?
  8. Are there any long-term effects or complications associated with rectal prolapse surgery?
  9. How experienced is the surgeon in performing rectal prolapse surgery?
  10. Are there any specific pre-operative or post-operative instructions I should follow for rectal prolapse surgery?

Reference

Authors: Short SS, Wynne EK, Zobell S, Gaddis K, Rollins MD. Journal: J Pediatr Surg. 2022 Oct;57(10):354-358. doi: 10.1016/j.jpedsurg.2021.11.003. Epub 2021 Nov 25. PMID: 34872729