In young children, after appropriate analgesia and sedation, prolapse can be reduced manually by replacing the protruding mucosa proximal to the anorectal ring of sphincter muscles. Every effort should be made to prevent the child from becoming constipated, and the child should be referred for further evaluation.
Surgical intervention is generally indicated in all other age groups unless the prolapse is minimal. A variety of effective surgical procedures is available and may be used depending on the degree of prolapse and the general health of the patient. All adults should be referred to have a proctosigmoidoscopic examination to rule out tumor. In addition, one should check for the possibility of an anterior rectal wall ulcer that may occur in patients with recurrent prolapse.
If vascular compromise appears to have occurred, reduction may be necessary on an emergency basis. Because of the risk of having reduced ischemic bowel that could perforate, these patients must be hospitalized.
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