Rectal prolapse in pediatrics

Rectal prolapse in pediatrics has its highest incidence in infancy and is u ncommonly seen in industrialized countries. The prolapse may involve only t he mucosa (mucosal prolapse) or all layers of the rectum (complete prolapse or procidentia). It is usually detected by the child's parents and is brou ght urgently to medical attention; however, it is usually spontaneously red uced by the time they reach the practitioner's office. Rectal prolapse shou ld be viewed as a symptom of an underlying condition rather than a discrete disease entity. Potential causes are increased intraabdominal pressure, di arrheal and neoplastic diseases, malnutrition, and conditions predisposing to pelvic floor weakness. Its strong association with cystic fibrosis makes the sweat test mandatory for infants and children with recurrent rectal pr olapse. Of particular importance are three entities related to rectal prola pse that may easily escape diagnosis by practitioner: occult rectal prolaps e, solitary ulcer of the rectum syndrome, and inflammatory cloacogenic poly ps. The treatment of rectal prolapse is mainly conservative and is directed at the underlying conditions. Surgical intervention may be required for re current rectal prolapse refractory to conservative measures. The simplest, less invasive, yet highly effective approach, appears to be perirectal inje ction with a sclerosing agent. While the majority of children experience sp ontaneous resolution of the prolapse, the prognosis is worse when presentat ion occurs after the age of 4 years.