Bowel management of rectal prolapse: Yes, it works

A structured bowel management program and good toileting behaviors can resolve rectal prolapse, regardless of patient age, according to a retrospective review of patients at a pediatric colorectal center. The findings showed that medical management alone led to resolution in 88% of patients.

Of 47 children referred to the center during a 10-year period, 29 were aged ≤ 4 years (group A) and 18 were older than 4 years (group B); median age of diagnosis was 4 years. All children were placed on a bowel management program that included good toileting habits (no straining and no more than 5 minutes on the toilet at a time) along with high-dose stimulant laxatives such as senna (eg, Ex-Lax) dosed at 2 mg/kg daily, if the child had a history of constipation. After a clinic visit, practitioners followed patients for 1 week with daily abdominal radiographs and phone calls to adjust laxative dosing as needed.

Rectal prolapse resolved at a median time of 9 months (maximum, 31 months). A comparison of groups A and B showed few differences with regard to constipation and medical diagnoses, but children in group A were less likely to have behavioral health diagnoses and more likely to require manual reduction. The number of children requiring surgery was similar in the 2 groups (1 in A and 2 in B). Median time to spontaneous resolution was 6.5 months in group A and 13.5 months in group B.

Thoughts from Dr. Farber

The concept of “resolved” is not well defined in this report (a certain number of consecutive days without prolapse?), and the use of frequent x-rays strikes me as excessive, but the underlying point is well made: A good bowel program to handle constipation should obviate the need for surgery in most patients.

Reference

1. Short SS, Wynne EK, Zobell S, Gaddis K, Rollins MD. Most children experience resolution of idio- pathic pediatric rectal prolapse with bowel management alone. J Pediatr Surg. Published online November 24, 2021. Epub ahead of print. doi:10.1016/j. jpedsurg.2021.11.003