🧒💩 Rectal Prolapse in Children: A Parent-Friendly Guide

✅ Rectal prolapse means the lining (or sometimes the full thickness) of the rectum temporarily slides out through the anus, often during straining.
It can look scary, but many cases in young children improve with treating the cause (especially constipation or diarrhea).
Still, you should get it assessed so the underlying reason is addressed safely.

1) 🧾 Quick “At-a-glance” box (top of page)

✅ Condition name: Rectal Prolapse
Common names: “Rectum coming out,” prolapsed rectum

Plain-language summary (2–3 lines):
Rectal prolapse is usually triggered by straining, chronic constipation, diarrhea, or weakness of pelvic support. It may reduce on its own or need gentle manual reduction. Treating the underlying cause (often constipation) is the key to stopping recurrences.

Who it affects (typical ages):
Most common in toddlers and preschool-aged children, but can occur at any age.

✅ What parents should do today:

• If prolapse is happening now: keep child calm and call for guidance
• Treat constipation or diarrhea aggressively (with clinician plan)
• Avoid prolonged toilet sitting and straining
• Book an appointment for evaluation (especially if recurrent)

⚠️ Red flags that need urgent/ER care:

• Prolapse will not go back in (stuck)
• Severe pain, dark/purple tissue, or heavy bleeding
• Child very unwell, fever, dehydration

🟡 When to see the family doctor/clinic:

• First episode of rectal prolapse
• Any recurrence
• Prolapse with chronic constipation, chronic diarrhea, poor growth, or blood in stool

2) 🧠 What it is (plain language)

The rectum is the last part of the large intestine.

Rectal prolapse happens when:

• the rectal lining slips outward during straining
• it appears as a red, moist “donut” or “tube” of tissue

In many children, it’s temporary and related to bowel habits.

What part of the body is involved? (small diagram required)

Common myths vs facts

• Myth: “Rectal prolapse means my child has a dangerous disease.”
  Fact: Often it’s due to constipation/straining and improves with treatment.
• Myth: “It will always need surgery.”
  Fact: Many children do not need surgery.
• Myth: “It’s okay to ignore if it goes back in.”
  Fact: It still needs evaluation so the cause is treated.

3) 🧩 Why it happens (causes & triggers)

Common causes

• chronic constipation and straining
• chronic diarrhea
• prolonged toilet sitting
• “holding” behaviors leading to hard stools

Less common but important causes (brief)

• malnutrition or poor muscle tone
• conditions increasing pressure in belly (chronic cough)
• intestinal infections or inflammation
• cystic fibrosis (historically linked; not always the case, but should be considered when appropriate)
• anatomic or neurologic issues (rare)

Triggers

• straining
• large hard stool
• frequent watery stools
• coughing spells

4) 👀 What parents might notice (symptoms)

• red tissue coming out of anus during stooling
• mucus or small bleeding
• discomfort or “something is stuck” feeling
• constipation signs (hard stools, stool withholding)
• diarrhea pattern (frequent watery stools)

What’s normal vs what’s not

✅ Common/expected:

• mild discomfort
• small streak of blood from irritation

⚠️ Concerning:

• tissue becomes dark/purple or very swollen
• heavy bleeding
• cannot reduce
• child appears very unwell

Symptom tracker

• stool frequency and consistency
• straining time on toilet
• any bleeding
• recurrence frequency

5) 🏠 Home care and what helps (step-by-step)

✅ The main goal is to reduce straining and treat constipation/diarrhea.

What to do during a prolapse episode (first aid)

✅ Do this now:

1. Keep child calm and lying on their side.
2. If your clinician has taught you: apply gentle pressure with a clean, gloved hand and lubricant to help it slide back in.
3. A cold compress over a clean cloth can reduce swelling.
4. Call your clinic for guidance, especially if first episode.

⚠️ If it won’t go back in or looks dark/purple, go to ER immediately.

Daily prevention steps

• treat constipation consistently (stool softeners as prescribed)
• encourage regular toilet sitting but no long sitting
• feet supported on a stool (better pushing mechanics)
• avoid straining contests—gentle, relaxed stooling

6) ⛔ What NOT to do (common mistakes)

• Don’t let your child sit on the toilet for 20–30 minutes.
• Don’t stop constipation treatment too early.
• Don’t force the prolapse back aggressively or repeatedly if painful.
• Don’t ignore recurrent episodes.

7) 🚦 When to worry: triage guidance

🔴 Call 911 / Emergency now

• child collapses or is severely unwell
• severe bleeding with weakness

🟠 Same-day urgent visit

• prolapse cannot be reduced within a short time
• prolapsed tissue is dark/purple or very swollen
• fever with dehydration
• significant bleeding

Example: “The rectum is out and won’t go back in after gentle attempt.”

🟡 Book a routine appointment

• first prolapse episode that reduced
• recurrent episodes
• constipation or diarrhea evaluation
• poor growth or chronic symptoms

🟢 Watch at home

• a single episode that reduced easily, with a clear plan and prompt follow-up arranged

8) 🩺 How doctors diagnose it (what to expect)

What the clinician will ask

• constipation vs diarrhea history
• straining patterns
• toilet training behaviors
• growth and nutrition
• coughing or chronic illness history

Physical exam basics

• perianal exam
• abdominal exam for stool burden
• sometimes rectal exam (gentle and selective)

Possible tests (and why)

• often none needed if clearly constipation-related
• stool studies if diarrhea/infection suspected
• screening for underlying conditions if recurrent/severe (case-by-case)
• imaging or endoscopy only if red flags or atypical pattern

What tests are usually not needed

• extensive scans for one mild constipation-related episode

9) 🧰 Treatment options

✅ Treating the cause is the main treatment.

First-line treatment

• constipation management (stool softeners, fiber plan, hydration)
• toilet habit changes (short sits, foot support)
• treat diarrhea if present (cause-specific)
• skin protection (barrier creams if irritation)

If not improving (next steps)

• pediatric GI evaluation
• consider pelvic floor support strategies
• address underlying conditions (nutrition, chronic cough, infections)

Severe cases (rare; hospital care or surgery)

• prolapse that repeatedly gets stuck
• bleeding, ulceration
• failure of medical management
• procedures may include injection sclerotherapy or surgical fixation (specialist-directed)

Treatment notes (parent-friendly)

• improving stool consistency is the “core solution”
• most cases resolve with time and proper bowel regimen

10) ⏳ Expected course & prognosis

• Many children improve over weeks to months once constipation/diarrhea is controlled.
• Recurrence risk remains if straining returns.

What “getting better” looks like

• fewer episodes
• no straining
• soft stools
• confident toileting

What “getting worse” looks like

• more frequent prolapse episodes
• episodes are harder to reduce
• increased bleeding or pain

11) ⚠️ Complications (brief but clear)

Common complications

• irritation and small bleeding
• anxiety around toileting

Rare serious complications

• tissue swelling and trapping (incarceration)
• ulceration or significant bleeding

12) 🛡️ Prevention and reducing future episodes

• maintain soft stools long-term
• avoid prolonged toilet sitting
• treat cough/diarrhea promptly
• good hydration and balanced diet
• follow-up if recurrence

13) 🌟 Special situations

Infants

Often linked to diarrhea or straining; needs evaluation.

Kids with chronic constipation

May need a longer bowel regimen than expected.

Kids with cystic fibrosis or malnutrition concerns

May need targeted testing and nutrition support.

Neurodevelopmental differences/autism

Use visual toileting schedules; avoid power struggles; caregiver-guided routines.

Travel considerations

Carry stool softener plan and “what to do if prolapse happens” instructions.

School/daycare notes

• ensure bathroom access
• avoid withholding
• allow water bottle
• communicate bowel regimen if needed

14) 📅 Follow-up plan

• follow-up with family doctor or pediatric GI based on recurrence
• track episodes and stool pattern
• adjust constipation plan as needed
• urgent plan if prolapse becomes stuck

15) ❓ Parent FAQs

“Is it contagious?”

No.

“Can my child eat ___?”

Yes—focus on stool-softening habits (fluids, fiber as tolerated).

“Can they bathe/swim/exercise?”

Yes, usually.

“Will they outgrow it?”

Many children do, especially when constipation is treated consistently.

“When can we stop treatment?”

Only when stools are reliably soft and prolapse has stopped for a sustained period; taper with clinician guidance.

16) 🧾 Printable tools (high-value add-ons)

🧾 Printable: Rectal Prolapse One-Page Action Plan

If prolapse happens:

• Keep child calm, lying on side
• Gentle reduction if taught by clinician
• Cold compress over cloth if swollen
• Call clinic if first time or recurrent

Urgent/ER if:

• won’t go back in
• tissue dark/purple or very swollen
• heavy bleeding or severe pain
• child very unwell

🧾 Printable: Stool & Prolapse Tracker

Date: ______

• Stools: hard / soft / watery
• Straining: none / mild / severe
• Toilet sitting time: ______
• Prolapse: yes/no
• Reduced easily: yes/no
• Notes: _______________________

🧾 Printable: “Red Flags” Fridge Sheet

⚠️ Urgent: prolapse stuck out, dark/purple tissue, heavy bleeding, very unwell child.

17) 📚 Credible sources + last updated date

Trusted references:

• Children’s hospital constipation and rectal prolapse education pages
• Pediatric GI patient education resources

Last reviewed/updated on: 2025-12-30
Local evaluation steps vary based on recurrence and associated symptoms.