In medical practice, frequent clinical cases are intestinal diseases. In a child, prolapse of the rectum can also be called a common problem. Pathology is a displacement of the walls of the distal section with their subsequent loss through the anus.
Why does bowel prolapse appear in children?
As a rule, the disease is diagnosed in early childhood. At the same time, boys under the age of 5 are much more likely to become sick.
Before examining in detail the prolapse of the rectum in a child and its pathogenesis, it is worth paying attention to the fact that this problem cannot be considered an independent disease. Most often, it appears as a consequence of various pathological conditions. In an adult, as well as in a child, prolapse of the rectum is caused mainly by an increase in intra-abdominal pressure.
In turn, the factors favorable to this process are considered to be the root causes of the origin and formation of the disease. They are divided into two groups.
Pathological predisposition
The first includes predisposing factors that provoke the disease. It:
- Congenital addiction. Due to the fact that in children under the age of 6 years in the bone area of the lumbosacral spine, natural concavity is rather weakly expressed. Due to the absence of lordosis and insufficient pelvic tilt, the rectum is located rectilinearly. With increased intra-abdominal pressure, the entire load is transferred exactly to the anus.
- Douglas space depth. The greater this value (which is characteristic of young children), the lower are the gallbladder cavities in the peritoneum. With high pressure on the front wall, intussusception occurs, which serves as a good reason for the development of pathology in a child. Prolapse of the rectum can also occur in the presence of other anatomical features in childhood: a long mesentery, a loose type of intra-intestinal arteries, etc.
- Other diseases of the gastrointestinal tract caused by malnutrition or malnutrition. In this case, the pathology develops due to dystrophic abnormal changes in the muscles of the pelvic floor and peri rectal fiber.
Acquired Gut Prolapse Factors
The second group of causative factors includes acquired disorders in the functioning of the digestive system and gastrointestinal tract, which served as the starting point for the appearance of the problem. In a child, prolapse of the rectum (what the parents do in this case, the specialist will tell you, therefore it is strongly not recommended to take measures to treat the baby yourself) often occurs due to stool disorders. Difficulties during the act of defecation in the form of regular constipation is the main mechanism for triggering the development of the disease. Frequent straining and prolonged stay on the pot negatively affect the condition of the sphincter of the anus.
Meanwhile, quite often other factors can cause an increase in pressure in the intraperitoneal cavity, which provokes prolapse of the rectum in children. The causes of this pathological phenomenon often lie in a tearful cough with bronchitis or difficulty urinating (for example, with phimosis in boys).
In addition, for the manifestation of this serious pathology, as a rule, a combination of factors plays a decisive role. In most cases, with one or more of the above problems, prolapse of the rectum in the child occurs gradually.
Features of the symptoms of the disease in children
The danger of this pathology is that its first symptoms for a long time can remain completely invisible. The reason for this is prolapse of the rectal mucosa. In children, this most often occurs one-sidedly and in stages. During bowel movements, a part of the intestine partially falls out, and after the process is completed, it again hides behind the sphincter.
During this period, the parents of the baby may notice redness in the anus, resembling a socket. In fact, this manifestation should be alarmingly regarded by parents. Bloody staining of the anus also serves as a clear sign of bowel prolapse.
A progressive disease is characterized by more severe symptoms. A slit-like or star-shaped hole in the middle of a slightly bluish hue can be called characteristic.
Signs of a Progressive Illness
In addition, for a long time, the tone of the sphincter of the anus remains, it is difficult to adjust the fallen region of the intestine, so any attempts are accompanied by painful sensations in the child. The prolapse of the rectum subsequently manifests itself as hypotension of the muscles of the pelvic floor, as a result of which it is possible to straighten the fallen part back into the anal canal without difficulty, but its subsequent dumping occurs immediately.
When the pathology is launched, the dropping out part often acquires significant dimensions, sometimes making up the length of the entire organ. Each prolapse of the rectum in children (it is impossible to imagine a photo for ethical reasons) occurs uncontrollably, for example, when sneezing or coughing, with little physical exertion. Most often, it’s fashionable to correct this element only manually. The weakness of the external sphincter contributes to the aggravation of the pathological condition of the child, where fecal incontinence is a huge problem .
At the same time, maintaining the contractility of the sphincter muscles can adversely affect the development of the disease and lead to such a complication as mucosal infringement. In this case, the child will need emergency surgery.
How is bowel prolapse treated?
Parents, timely contacting specialists with this problem with their baby, can not worry. Most often, the prognosis for recovery is very favorable. In addition, the tactics of therapy are more conservative in comparison with the treatment of adult patients. At the same time, folk remedies cannot overcome prolapse of the rectum in children. Treatment should be carried out only under the supervision of specialists coordinating the use of certain drugs and procedures.
Individually, depending on the clinical picture of the manifestation of the disease, the well-being of the baby and the duration of the pathology, the doctor prescribes one of three options for differentiated therapy:
- conservative treatment
- sclerosing method;
- surgical intervention.
Conservative treatment
The first treatment option for rectal prolapse in a child under 5 years old is the most common and in demand. With mucosal prolapse, this type of treatment is indicated in most cases for older children. The main tasks of this complex of restoration measures are:
- stabilization of character and elimination of any disorders of the stool, defecation;
- the establishment of a normal regime of intestinal emptying as soon as possible;
- selection of the most suitable diet during the adjustment of nutrition.
All this can be achieved only with the help of diet therapy. It is possible to eliminate the root cause of the disease - high intra-abdominal pressure - by choosing the optimal nutritional scheme with the necessary corresponding effect of relaxation or consolidation. In the absence of positive dynamics, the doctor may prescribe the use of special medicines.
Therapy without a pot
Once the correct bowel movement has been established, it is imperative to rid the child of frequent urge to empty. To restore the pelvic muscles and their functional connections, the violation of which causes prolapse of the rectum in children, Komarovsky recommends minimizing possible stress and straining. As a rule, during treatment, the child is not allowed to use the potty or toilet bowl; he should defecate exclusively in a lying or upright position. The lack of load on the anus is one of the fundamental conditions for the treatment of this pathology, and this moment requires a lot of patience and attention on the part of parents.
Often, for a complete recovery, such a regimen is established by a doctor for a period of about 3-4 months. The success of such treatment guarantees an almost one hundred percent result. The advantages of this method of treatment are obvious: there is no extraneous intervention in the child’s body, self-healing occurs due to muscle recovery and shortening of their fibers.
However, recovery does not at all mean that the result has been finally achieved and the child does not face a relapse. Over the next year, it is extremely important to monitor its condition and, upon repeated loss, set the intestine into the anal canal as quickly as possible.
How to self-adjust a child's bowel prolapse?
Particularly noteworthy is the familiarization with the nuances of the reduction technique. Regardless of age, prolapse of the rectum in a child (2 years or 6 years) requires urgent simple manipulation. The main thing is that the baby is calm, as relaxed as possible. The child should lie on his back. The precipitated fragment of the rectum must be lubricated with a lubricant, after which, after putting on the gloves, grabbing it with the fingers of both hands and without pushing efforts, gently and accurately set it inward. It should begin from the central part, since with the correctly performed technique the edges of the prolapsed intestine will spontaneously straighten into the anal canal. As soon as the corrected fragment is found inside, it is important for the child to slowly turn on his stomach and bring the buttocks.
How is sclerotherapy
In more complex, neglected cases, treatment is carried out in a hospital setting and, as a rule, they resort to the help of a surgeon. Sclerosing therapy, often applicable today, is also a method of surgical intervention. The procedure is the introduction of special substances, the action of which is aimed at swelling of the peri rectal fiber.
Next, the expected cell necrosis occurs, which is replaced by sclerosis and scarring of the tissues surrounding the rectum. This allows you to tightly fix their epithelium and the surface of the intestine.
Probable complications of sclerosis
Meanwhile, most specialists in the field of pediatric surgery are very reserved about this method of treatment. The reason for this is the frequent administration of drugs, as well as a high risk of necrotic complications of the internal walls of the intestine. Sclerosing therapy can take place only when the conservative treatment option has been completely unsuccessful or there is a considerable chance of developing an infringement.
The second method of surgical intervention involves rectopexy - removal of the falling out area according to the Zerenin-Kümmel technique.
In any case, each disease, including bowel prolapse in children, is much easier to prevent than to cure. To prevent development, pathology should be prevented by any potentially dangerous factors. In particular, do not force the baby to sit on the pot for a long time and take urgent measures for the slightest violations of the stool.