treating the predisposing or underlying condition Bothersome pedunculated lesions can be tied off with silk suture Rectal prolapse , partial or complete herniation of the layers of the rectum through the levator muscle and then the anal orifice, is a phenomenon typically seen in children between and years of age ( Fig 120.24 ) The most common predisposing conditions, severe constipation and severe diarrhea, are characterized by repeated straining on defecation, which stretches pelvic suspensory structures, facilitating herniation Patients with spina bifida may have prolapse as a consequence of deficits in perineal innervation with attendant atrophy of the supporting perineal muscles Rectal prolapse may be the first presenting symptom in children with cystic fibrosis It is also associated with pinworm infection Occasionally, an apparent rectal prolapse represents the lead end of intussusception In these cases, patients have a history of consistent with intussusception including antecedent, intermittent abdominal pain or irritability and may have vomiting, lethargy, and/or rectal bleeding Clinically, a cylindrical mass with a central orifice and a glistening red surface is seen protruding through the anus This can be confused with prolapsed internal hemorrhoids which, unlikely the mass of a rectal prolapse, often have a sulcus that extend perpendicular toward the anus Acutely, the mass can be reduced with steady, gentle pressure Pain control and anxiolysis may be indicated Applying sugar to the exposed mucosa and waiting to 10 minutes can decrease edema and facilitate reduction Emergent surgical consultation should be obtained for ischemic or gangrenous tissue, inability to reduce, or immediate reoccurrence Attention is then directed at identifying and treating the underlying condition to prevent recurrences The need for operative intervention for persistent recurrences is rare and is largely limited to neurologically challenged patients with intractable constipation