Rectal prolapse is a condition in which rectal wall tissue becomes stretched and protrudes through the anus. Children with anorectal malformations may have rectal prolapse because they were born with complex malformations, poorly developed pelvic structures, poor or absent sphincters, poor nerves, and, in general, poor mechanisms to keep the rectum suspended.
Rectal prolapse can be a problem because it produces wetness (mucus produced by the rectal tissue), which can pass through the underwear and clothes. Also, when the child is very active the prolapsed rectal tissue can be injured, and may bleed. In patients with anorectal malformations, certain types of rectal prolapse may even interfere with bowel control.
Many children with anorectal malformations receive a colostomy at birth, followed by surgery to place the anus within limits of the sphincters. After the patient has undergone a protocol of anal dilations to reach the correct size of the anus, the patient undergoes the last operation which is the colostomy closure (if present) .
Prior to the colostomy closure, the rectal prolapse must be repaired. The procedure for rectal prolapse takes approximately 45 minutes and is painless. The patient can be discharged the same day. Two weeks after the operation, the patient begins to follow the same protocol of anal dilations, and thereafter, the colostomy is closed. It is extremely unusual for a prolapse to come back after the operation.
Rectal prolapse can worsen when a child is constipated. Children with anorectal malformations often need to receive laxative foods and/or laxative medications to make their bowel movements quick and easy episodes.