Rectal Prolapse in Children: An Update to Causes, Clinical Presentation, and Management.

Background: Rectal prolapse is a protrusion of rectal mucosa through the anal sphincter. Although uncommon, it is seen more often in children, younger than 4 years of age. The last data analysis of rectal prolapse and its clinical characteristics in children was performed over 30 years ago. Since that time, many medical advances have occurred that may alter our workup and management of this disease in children. We performed a chart review to reassess the clinical characteristics of rectal prolapse and its management.

Methods: This was a retrospective descriptive analysis study, assessing children less than 18 years of age that were diagnosed with rectal prolapse from 1999 to 2014 at a single tertiary care center. The onset of presentation, demographics, etiology, clinical characteristics, and management were analyzed.

Results: A total of 158 patients were diagnosed with rectal prolapse, with mean age of onset being 3 years. Constipation was the leading cause, with straining being the most common complaint. Stool consistencies with constipation varied. Many patients diagnosed with idiopathic recurrent rectal prolapse had either a social stressor or were described as having unusual behaviors associated with prolapse. Cystic fibrosis was only diagnosed in 4 patients. Thirty-four patients (22%) required surgical correction.

Conclusions: Constipation remains the main cause of rectal prolapse. Cystic fibrosis is no longer a common etiology for rectal prolapse, because of the implementation of newborn screening. Patients with social stressors or atypical behavior may be at risk for recurrent rectal prolapse.