| Manual reduction (medical) |
Patient placed prone, lubrication applied, digital rectal exam performed and manual reduction of rectal prolapse is assisted with hyperosmolar agent |
May require multiple reductions, can be performed outpatient and by parents |
If unable to reduce, may require inpatient hospitalization |
| Bowel regimen (medical) |
Use of laxatives, good toileting habits, high fiber diet and constipation management after ruling out other underlying conditions |
Up to 94% success rate with non-operative management |
Children over the age of 4 may have longer time to resolution or are more likely to fail this management option |
| Injection sclerotherapy (procedural) |
Sclerosing agents injected above the dentate line to induce inflammation. Agents include: ethyl alcohol, 5% phenol in almond oil, 50% dextrose, 15% saline, and sodium tetradecyl |
First line treatment; resolution rates are 55–96% (varies widely) |
May require general anesthesia and multiple procedural interventions; complications: perianal fistula, rectovaginal fistula, temporary limping, and abscess formation |
| Thiersch stitch/anal cerclage (procedural) |
A circumferential absorbable suture placed between skin and anal mucosa and tied down over Hager dilators |
90% resolution with 1–2 Thiersch procedures. Also useful for patients who have recurrent rectal prolapse |
May require multiple procedures prior to successful resolution |
| Ekehorn’s rectopexy (procedural) |
U-shaped suture inserted through the rectal ampulla and tied externally at sacrococcygeal junction, tying down the suture over a piece of iodine-soaked gauze |
100% resolution in 3 studies |
Requires general anesthesia; occasional localized infection requiring antibiotics |
| Suture rectopexy (procedural) |
Intra-abdominal technique with rectal tissue sutured to pre-sacral space to promote adherence. Approach can be laparoscopic or robotic. Resection rectopexy is controversial |
0–40% recurrence rates (varies widely) |
Use of general anesthesia; complications: urinary retention, constipation |
