Child’s prolapse. Can any doctors comment?

[Unsurewhattodo123]

I wonder if there are any doctors or nurses who can offer any advice or comforting words.
I can’t sleep.
My 8 year old developed a sudden rectal prolapse last week on the toilet. Now it happens with every bowel movement. There is also mild bleeding associated with fissure and pain under the right rib cage each time.

We were told this was not an A+E case.
Doctor thinks it’s caused by straining and will just correct itself and showed me how to “put it back” which I am so uncomfortable with. Usually it goes back alone thankfully.

My child is distressed every toilet trip.

My GP is contacting the rectal surgeon about this and I have to await a letter telling me what , if anything, happens next.

Reading online tells me at this age, it’s rare.

It tells me prognosis is ominous. My child is due to go on holiday with friends and I doubt it can happen now.

What is going to happen? We or on laxative medication but so far consistency of stools aren’t making a difference to the prolapse happening after a bowel movement.

It feels as if doctors are taking a very relaxed approach. I am left at home with an upset child who is so embarrassed and very upset every time it happens or is mentioned. I have to just push it up if it won’t go back itself.. I feel out of my depth and unsupported.

Has anyone been through this?

Praying there are no sinister reasons that this could have occurred so suddenly.

I can’t sleep

I have no real advice, not a Dr but surely considering they have said it's rare for your child's age they would have you seeing a specialist asap rather than wait for a letter.

Holy crap that is awful!

Surely the child needs surgery of some kind.

I don't even know what to say.

Thai you for the quick replies.

I too feel it should be referred quicker but no one seems to think it is as much of an emergency as I do

*thank you

I hope if anyone is medically trained they may be able to let me know wether it is correct to wait or wether I should push to be seen again sooner

Most commonly caused by constipation. Incredibly rare to need surgery. Mainstay of treatment is to properly treat the constipation. Needs to be on enough movicol/laxido to make the poo soft and squidgy/mushy, and keep it that way for at least some weeks.

www.eric.org.uk have lots of helpful stuff on managing constipation

Poor child, poor you. I hate that you feel unsupported. Have you tried calling 111 for further advise about it due to the amount your child is suffering? and [Chocolate] for DS.
Hope you get some answers and more support. Is there an organisation that supports this, the DC and the parents. Just thinking out loud really trying to think of anything that might help.

@nocoolnamesleft do you have experience with this or work i this field? Thank you for replying. Do you mean it can fully correct itself without treatment if constipation is gone? My child would sit a while on the loo but still went once a day , is this still constipation?
If rare to need surgery how does it stop happening?
With a soft poo today the prolapse still followed.

Thanks

@shriek 111 weren’t very great at all.
Told me it was not an emergency and we should attempt to re position it after a bath and to see a gp the next day which I did.i appreciate your response . I don’t know about organisations but maybe tht would be helpful i will look at the link above x

[Edited by MNHQ at poster's request]

Not a surgeon - paediatrician. There are other possible causes, but overwhelmingly most commonly from constipation/straining. Once they've prolapsed once, then it takes much less strain to make it come out again. The idea of getting the poo nice and soft is to abolish straining. Need to avoid any prolonged toilet sitting. To start with tends to still come out, but less pressurised. Then tends to progress to less of it coming out. Then only sometimes coming out. Then staying in. The idea is then to keep the poo really soft for at least a good few weeks after the last prolapse, then only reduce the laxatives very gradually, and going back up if they show any signs of constipation (hard stool, straining, long gaps between stool, rabbit droppings, overflow...) Is worth getting properly checked out, to rule out the unusual reasons, but all of them the starting point for treatment is a trial of laxatives, so GP right to want to try that first. Hope that helps. Obviously, I've not seen your DS, so can only go by what bit you've written, and how this normally goes.

Massively helpful post I really appreciate that. I have been in tears reading up on surgery risks.
Are the less common causes anything sinister? I am such a worrier.
Do you know anything of links between hypermobility and prolapse? I would be very interested to hear if you do, my doctor didn’t want to go there but I had a feeling there was something more to say on the issue.
It’s very difficult for me to see how much prolapses at a time, as it happens on the toilet, and we are working on getting it pulled back in naturally as soon as possible. The first time it resembled a peach in shape and symmetry. After this it has been more controlled and pulled back in, and not got “stuck” out.
My child finds it difficult to know when the need to pass stool has finished, as the prolapse feels like poo coming out also.

The doctor examined his bottom looking for fissures etc but no internal examination has taken place. Is this likely to follow?
Are scans etc used to determine severity if no improvement?
My child tends to need to be well prepared for things to avoid meltdowns so I am trying to keep a level head and explain sensibly what he can expect at each stage as we go on.
I appreciate your responses @nocoolnamesleft and hope I haven’t bombarded you with too many questions! Laying awake with a busy brain!

Also does the pain just below right rib cage after sounds normal? Subsides after ten mins and not severe but sometimes enough for a few tears

Feel your anxiety OP.

No matter what information you get tonight, there won't be anything you can do at this time of day will there.
Try writing down the things you need answers to, then listening to something distracting, or reading to help you wind down and get some sleep.

Oh, you have written everything down, so, there might be more answers for you in the morning, if not, post again.

With reagrds to the pain, I'm speculating because this is only over the internet...it makes me want to have a good feel of his tummy, as you can get that if you're really backed up with constipation, as the gut goes round a corner there. But really cannot know that without actually seeing the patient!!

Your GP was absolutely right not to do an internal examination. In children, you only do a PR (internal exam using a finger) is you have to, and if it has to be done, it should be done only be the most experienced person possible. Whether your DS will need one may well depend upon how well things are improving.

Interesting that you ask about hypermobility. Yes, that can be one of the things that can make constipation more likely, and some sorts of hypermobility can make a prolapse more likely.

Hope that helps - I'm afraid I need to go to bed!

for you, OP

We had this with one of mine when they became obsessed with using the toilet. Lactulose, increasing fluid intake, a stool to rest feet on and strong warnings not to strain (and making move away from the toilet if they weren't productive reasonably fast) - the whole thing is now a dim and distant memory.

If you ever can't reposition the prolapse then that really is a and e job - we never had to go. It is horrifying and frightening but also reasonably common as well. for you and for your little one.

Have you looked at the ERIC website?
They have a telephone help line.
You might find it helpful to talk to someone there.

My cousin's daughter had this. It didn't last forever so don't worry. It's fairly common.

It may help in the mean time to change your child's position whilst sitting on the toilet. Put something like a small child's chair or upturned plastic box at their feet. So they can pop their feet on it bringing knees higher than pelvis this helps to relax and prevent additional straining.

Praying there are no sinister reasons that this could have occurred so suddenly

What are your concerns?

There are links between hypermobility and prolapse

@nocoolnamesleft
Thank you. Yes the doctor had a good feel of the tummy area and said all felt fine.
Do you mind expanding any on possible links between hypermobility and prolapse? I would be very interested to find out more on this.

@AnnieOH1
Thank you
What age was your child at the time? They said it is more common in under 3’s and not so much older than that.
That all sounds reassuring though. We are trialing he footstool also. Thanks

Ds1 when he was 5yrs suddenly developed one. Frightened me to death! It would reduce easily.

Took him to GP for a referral and she'd never experienced it in a child before.

Saw the surgeon who reassued me it is common in kids as they are a lot looser muscle wise but uf it continued as be afwd then he would juat need a small stitch in the bowel.

Many years down the line he saw a pead for who diagnosed him with hyperflexibility, low muscle tone and flat feet