| Rectal prolapse is the medical term that describes when the terminal end of the colon, the rectum, protrudes or is sticking out of the anus. Think of the colon as a long tube with several layers. The outermost layer is very thin and is called the serosa. The middle two layers are muscular and the innermost layer is mucous membrane. Mucous membrane is shiny and moist and is the same kind of tissue as what lines the inside of the mouth. Because it has a rich supply of blood vessels, the mucous membrane appears very pink. Sometimes the mucosal layer sticks out of the rectum much like someone were trying to turn the colon inside out. This can happen if a person has been straining very hard to have a bowel movement. Fortunately this is not very common.
The most important thing for a parent to remember is: don't panic. Rectal prolapse is stressful enough for the child who may think his insides are going to fall out entirely, and the parent can help enormously by remaining calm. The second most important thing to do is to try to reduce the prolapse by taking a generous amount of lubricant like K-Y Jelly and applying it to the protruding part of the rectum, then gently pushing the mucous membrane layer back up the rectum using a piece of plastic wrap or a latex glove to protect your hand from feces. For parents who think they cannot do this, then call your pediatrician. Most physicians will want to see your child if it is during office hours, or they will instruct where to go after hours.
Why do children have rectal prolapse? The most common reason is simple constipation, but about twenty percent of children with cystic fibrosis will have rectal prolapse. Sometimes rectal prolapse if the first sign of cystic fibrosis. If your child should have a bout of rectal prolapse, do not be surprised if your doctor discusses signs and symptoms of cystic fibrosis with you to determine if a further evaluation for that disease needs to be done.
Once a child has had rectal prolapse, be aware that it can happen again. For a young child, the experience of having her rectum "fall out" can be very frightening. She may start to withhold her bowel movements in an effort to keep this from ever happening again. Unfortunately, that will only make matters worse because it sets up the child for recurrent constipation followed by straining and very large bowel movements.
Most doctors will want to start the child on a daily stool softener to encourage the child to have a soft, mushy bowel movement at least every other day. There are many different stool softeners out there and you will want to discuss exactly what to do with your pediatrician or family practitioner. Occasionally, a child will need treatment with surgery to keep the rectum from prolapsing but again, this is not needed very often.
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