# Rectal Prolapse — GCMD Library living collection

Everything in the library about rectal prolapse — built automatically from dossiers that name it.

Updated: n/a · 5 episodes · 76 cited statements

## Episodes
### Surgical Management
- [Rectal Prolapse Repair Following a Posterior Sagittal Anorectoplasty](https://library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723) — video · 4:55 · [machine version](https://library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723.md)

### Evidence & Research
- [Morbidity of Rectal Prolapse Repair After Surgery for Anorectal Malformation](https://library.globalcastmd.com/watch/morbidity-of-rectal-prolapse-repair-after-surgery-for-anorectal-malformation-10942) — video · 0:39 · [machine version](https://library.globalcastmd.com/watch/morbidity-of-rectal-prolapse-repair-after-surgery-for-anorectal-malformation-10942.md)

### Case-Based Learning
- [Colorectal Quiz Episode 2: When to redo a PSARP](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580) — podcast · 18:15 · [machine version](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580.md)
- [Colorectal Quiz: Episode 2](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867) — podcast · 18:15 · [machine version](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867.md)

### In-Depth Reviews
- [Update Course Rewind: 2020 Colorectal Part 2](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834) — podcast · 11:01 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=0) Introduction: The challenge of redo anorectoplasty decisions (Ep 1)
- [3:19](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=199) Case 1: Seven-year-old boy with posterior misplacement and prognostic factors (Ep 1)
- [8:15](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=495) Case 2: Four-year-old girl with vestibular fistula and visual assessment techniques (Ep 1)
- [11:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=660) JPS study outcomes: Benefits and timing of redo operations (Ep 1)
- [14:43](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=883) Borderline cases and decision-making philosophy (Ep 1)
- [0:01](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=1) Introduction to Update Course Rewind and Rectal Prolapse Topic (Ep 2)
- [0:59](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=59) Initial Case Presentation and Conservative Management Approach (Ep 2)
- [3:51](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=231) Sclerotherapy and Surgical Options for Refractory Cases (Ep 2)
- [8:36](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=516) Psychological Factors and Multidisciplinary Approach (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=0) Case Introduction and Clinical Context (Ep 3)
- [0:54](https://library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=54) Initial Dissection and Mobilization (Ep 3)
- [2:13](https://library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=133) Anoplasty Reconstruction (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/morbidity-of-rectal-prolapse-repair-after-surgery-for-anorectal-malformation-10942?t=0) Rectal Prolapse Repair Morbidity After ARM Surgery (Ep 4)
- [0:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=0) Introduction: The Challenge of Redo Anorectoplasty (Ep 5)
- [2:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=160) Case 1: Seven-Year-Old Boy with Mislocated Anus (Ep 5)
- [7:02](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=422) Case 2 and Technical Considerations (Ep 5)
- [11:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=660) Evidence for Redo Surgery and Timing Considerations (Ep 5)
- [16:41](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=1001) Closing (Ep 5)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Rectal prolapse is a very common problem following repair of an anorectal malformation" (clinical) [Ep 3 · 0:11](https://library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=11)
- "Rectal prolapse can cause mucous production and bleeding" (clinical) [Ep 3 · 0:19](https://library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=19)
- "Rectal prolapse can interfere with the patient's ability to close the anus and thereby affect bowel control" (clinical) [Ep 3 · 0:19](https://library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=19)
- "The anoplasty location should be checked with an electrical stimulator to confirm well-located positioning with circumferential contractions" (clinical) [Ep 3 · 0:44](https://library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=44)
- "Full thickness rectum is incised off the skin edge while preserving the sphincter muscle" (clinical) [Ep 3 · 1:27](https://library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=87)
- "Leaving the right side of the anoplasty untouched reduces the risk of postoperative stricture" (clinical) [Ep 3 · 1:35](https://library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=95)
- "The rectum is mobilized out until there is slight tension and the intended cut line will comfortably reach the anal skin" (clinical) [Ep 3 · 1:47](https://library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=107)
- "Extra stitches placed into the redundancy help straighten out the rectal tissue prior to incising it" (clinical) [Ep 3 · 2:13](https://library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=133)
- "The Lone Star retractor is very helpful to set up the anoplasty" (opinion) [Ep 3 · 2:28](https://library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=148)
- "The anoplasty technique involves taking a bite of anal skin to full thickness rectal wall" (clinical) [Ep 3 · 2:47](https://library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=167)
- "Dividing the upper and lower quadrants of the left-sided prolapse creates two triangles" (clinical) [Ep 3 · 3:28](https://library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=208)
- "All sutures are tied under slight tension so that once cut, the anoplasty retracts back nicely" (clinical) [Ep 3 · 4:48](https://library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=288)
- "A study examined 85 children treated for rectal prolapse after anorectal malformation surgery" — Lizzie Lee (epidemiological) [Ep 4 · 0:11](https://library.globalcastmd.com/watch/morbidity-of-rectal-prolapse-repair-after-surgery-for-anorectal-malformation-10942?t=11)
- "Approximately 30% of children had recurrence of prolapse requiring another repair" — Lizzie Lee (epidemiological) [Ep 4 · 0:16](https://library.globalcastmd.com/watch/morbidity-of-rectal-prolapse-repair-after-surgery-for-anorectal-malformation-10942?t=16)
- "Children without symptoms from prolapse at initial presentation were more likely to develop stricture later" — Lizzie Lee (clinical) [Ep 4 · 0:20](https://library.globalcastmd.com/watch/morbidity-of-rectal-prolapse-repair-after-surgery-for-anorectal-malformation-10942?t=20)
- "Surgical repair of asymptomatic rectal prolapse may not be indicated because the treatment itself carries risks" — Lizzie Lee (opinion) [Ep 4 · 0:26](https://library.globalcastmd.com/watch/morbidity-of-rectal-prolapse-repair-after-surgery-for-anorectal-malformation-10942?t=26)
- "Anorectoplasty is an incredibly particular procedure where if you don't get it perfect, you might not have the best outcomes" — Rod Gerardo (opinion) [Ep 5 · 0:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=0)
- "Oftentimes your first shot might be your only shot to give this patient a good outcome" — Rod Gerardo (opinion) [Ep 5 · 0:20](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=20)
- "The first case patient has a rectal prostatic fistula as the original malformation" — Marc Levitt (clinical) [Ep 5 · 4:30](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=270)
- "The first case patient has a tethered cord" — Marc Levitt (clinical) [Ep 5 · 4:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=280)
- "The first case patient has a sacral ratio of 0.66" — Marc Levitt (clinical) [Ep 5 · 4:45](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=285)
- "A sacral ratio of 0.7 or greater usually means normal or close to normal sphincters" — Marc Levitt (clinical) [Ep 5 · 6:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=360)
- "The higher the malformation, the worse the prognosis" — Marc Levitt (clinical) [Ep 5 · 5:50](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=350)
- "Patients with myelomeningocele have much more trouble with continence than those with tethered cord" — Marc Levitt (clinical) [Ep 5 · 6:50](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=410)
- "It's amazingly common to have a mislocated anus" — Marc Levitt (clinical) [Ep 5 · 7:50](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=470)
- "A key pitfall is opening the PSARP incision first rather than marking the sphincters first" — Marc Levitt (clinical) [Ep 5 · 8:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=480)
- "The second case patient was born with a vestibular fistula, has normal spine and excellent sacrum" — Marc Levitt (clinical) [Ep 5 · 8:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=520)
- "The electrical stimulator used is the same one anesthesia uses for train of four" — Marc Levitt (clinical) [Ep 5 · 9:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=580)
- "Anesthesiologists should not give skeletal muscle relaxant when using the stimulator because it's weaker than traditional stimulators" — Marc Levitt (clinical) [Ep 5 · 10:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=600)
- "In higher malformations like bladder neck fistula, the sphincter complex is sometimes more anterior than anticipated" — Jason Frischer (clinical) [Ep 5 · 10:30](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=630)
- "The vast majority of redo operations were for mislocation" — Marc Levitt (clinical) [Ep 5 · 11:50](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=710)
- "Stricture was the second most common reason for redo operations" — Marc Levitt (clinical) [Ep 5 · 12:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=720)
- "Less common reasons for redo included remnant of original fistula (roof), rectal prolapse, and others" — Marc Levitt (clinical) [Ep 5 · 12:10](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=730)
- "Quality of life improved with a redo operation" — Marc Levitt (clinical) [Ep 5 · 12:30](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=750)
- "Patients had improved ability to achieve continence after redo" — Marc Levitt (clinical) [Ep 5 · 12:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=760)
- "20% of patients with a poor sacrum or poor spine developed bowel control after their redo" — Marc Levitt (clinical) [Ep 5 · 12:55](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=775)
- "Patients with good potential (good sacrum and spine) did extremely well after redo" — Marc Levitt (clinical) [Ep 5 · 13:10](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=790)
- "Patients who did not develop voluntary bowel movements were still able to be clean with bowel management program using enemas or antegrade Malone" — Marc Levitt (clinical) [Ep 5 · 13:20](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=800)
- "The average age of patients in the study was about three and a half years" — Marc Levitt (epidemiological) [Ep 5 · 13:10](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=790)
- "There is an advantage to getting the anatomy right the younger the child is" — Marc Levitt (opinion) [Ep 5 · 13:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=820)
- "The process of learning to achieve control with new anatomy after redo may take six to 12 months" — Marc Levitt (clinical) [Ep 5 · 14:30](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-13867?t=870)
- "For anorectoplasty, if you don't get it perfect, you might not have the best outcomes, which separates it from other surgical procedures." — Jason Frischer (opinion) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=0)
- "A lot of surgeons agree that oftentimes your first shot might be your only shot to give this patient a good outcome and the right anatomy." — Jason Frischer (host_summary) [Ep 1 · 0:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=40)
- "The original malformation in Case 1 was a prostatic fistula." — Marc Levitt (clinical) [Ep 1 · 4:30](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=270)
- "The patient in Case 1 has a tethered cord and a sacral ratio of 0.66." — Marc Levitt (clinical) [Ep 1 · 4:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=280)
- "The family doesn't really care how technically elegant is your analplasty. What they care about is whether that analplasty that you make is going to work and is the child going to be clean and in normal underwear." — Jason Frischer (opinion) [Ep 1 · 5:50](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=350)
- "The higher the malformation, the worse the prognosis." — Jason Frischer (clinical) [Ep 1 · 6:25](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=385)
- "A sacrum ratio of 0.7 or greater usually means normal or close to normal sphincters and good muscle tone, indicating that spine innervation of that area is probably good." — Jason Frischer (clinical) [Ep 1 · 6:35](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=395)
- "Patients can come with associated spinal anomaly, most commonly tethered cord, but the worst is a myelomeningocele, and those patients have much more trouble with continence." — Jason Frischer (clinical) [Ep 1 · 6:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=400)
- "Visual cues for identifying correct sphincter location include the anal dimple, a midline raised area where the sphincters are, the ellipse, color change, indentation or raised area, and appropriate perineal body length." — Marc Levitt (clinical) [Ep 1 · 7:29](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=449)
- "It's amazingly common to have a mislocated anus, either because the surgeon misses where the center is during laparoscopic pull-through or opens the PSARP incision first." — Jason Frischer (clinical) [Ep 1 · 7:44](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=464)
- "A key pitfall is opening the PSARP incision first; instead, mark the sphincters first, then open the PSARP so you don't get confused when placing the anoplasty in the correct location." — Jason Frischer (clinical) [Ep 1 · 8:05](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=485)
- "Case 2 patient was born with a vestibular fistula, has a normal spine and an excellent sacrum, indicating a much better prognosis for bowel control." — Marc Levitt (clinical) [Ep 1 · 8:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=520)
- "The electrical stimulator used is the same one that anesthesia uses for their train of four, with an inexpensive connection with little pins." — Marc Levitt (clinical) [Ep 1 · 9:50](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=590)
- "You have to tell your anesthesiologist not to give skeletal muscle relaxant because the stimulator is a little bit weaker than the traditional stimulator." — Marc Levitt (clinical) [Ep 1 · 10:10](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=610)
- "In higher malformations such as a bladder neck fistula in a boy, the sphincter complex isn't always where you think it's going to be and is sometimes more anterior than anticipated." — Jason Frischer (clinical) [Ep 1 · 10:19](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=619)
- "The vast majority of patients who get redos had mislocation, followed by stricture, then less common reasons including remnant of the original fistula (roof), rectal prolapse, and others." — Marc Levitt (host_summary) [Ep 1 · 12:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=720)
- "Quality of life improved with a redo operation." — Marc Levitt (host_summary) [Ep 1 · 12:30](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=750)
- "Patients had an improved ability to achieve continence after redo operations." — Marc Levitt (host_summary) [Ep 1 · 12:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=760)
- "In the JPS study, 20% of patients with a poor sacrum or poor spine actually developed bowel control after their redo." — Marc Levitt (host_summary) [Ep 1 · 12:55](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=775)
- "Patients with good potential (good sacrum and good spine) did extremely well after redo operations." — Marc Levitt (host_summary) [Ep 1 · 13:10](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=790)
- "Patients who did not develop voluntary bowel movements after redo were still able to be clean with a bowel management program using enemas or antegrade via a Malone." — Marc Levitt (host_summary) [Ep 1 · 12:50](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=770)
- "The average age of patients in the JPS study is about three and a half years, give or take." — Marc Levitt (host_summary) [Ep 1 · 13:10](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=790)
- "If you know the anatomy is off, you should do the redo, and there's an advantage to getting the anatomy right the younger the child is." — Marc Levitt (opinion) [Ep 1 · 13:28](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=808)
- "For a two-year-old with a mislocated anus or bad prolapse, offer a redo and let them live in diapers for a year or two with better anatomy, then see if they can successfully potty train." — Marc Levitt (opinion) [Ep 1 · 13:50](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=830)
- "Many patients present after the age of potty training because they're incontinent, and evaluation reveals the reason is they don't have the best operation—their anus isn't in the right place." — Marc Levitt (clinical) [Ep 1 · 14:20](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=860)
- "For patients presenting with incontinence after potty training age, do the redo and usually add a Malone at the same time so they can learn how to get control with their new anatomy before attempting voluntary bowel movements." — Marc Levitt (opinion) [Ep 1 · 14:30](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=870)
- "The process of learning control with new anatomy after redo and Malone may take 6 to 12 months." — Marc Levitt (clinical) [Ep 1 · 14:35](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=875)
- "For a patient with a mislocated anus that's 50% within the sphincter complex, three and a half years old and fecally incontinent, one approach is to redo them, do a Malone, get them perfectly clean mechanically, then see if they can develop bowel control." — Marc Levitt (opinion) [Ep 1 · 15:03](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=903)
- "An alternative approach for borderline cases is to let the child take their car out for a ride first and see how it works—if it drives well, stay with that anatomy; if not, then consider the redo." — Jason Frischer (opinion) [Ep 1 · 15:19](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=919)
- "If patients haven't declared their continence yet because they're not old enough to do so from a behavioral point of view, give them a chance—they may succeed." — Marc Levitt (opinion) [Ep 1 · 15:45](https://library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=945)
- "Rectal prolapse is a relatively unusual problem in pediatric surgery." — Eunice Huang (epidemiological) [Ep 2 · 0:59](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=59)
- "Children develop rectal prolapse because of their anatomy: they have a very weak pelvic floor and the rectum is very low, so it tends to pop out easily if they strain hard enough." — Eunice Huang (clinical) [Ep 2 · 2:44](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=164)
- "The majority of pediatric rectal prolapse cases do not need surgery." — em gootee or todd ponsky (host_summary) [Ep 2 · 2:26](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=146)
- "The most common reasons for rectal prolapse in children are constipation, sitting on the potty too long, or sitting on it incorrectly." — em gootee or todd ponsky (host_summary) [Ep 2 · 2:33](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=153)
- "Physical exam is key to distinguish rectal prolapse from intussusception, polyps, and rectal hemorrhoids." — em gootee or todd ponsky (host_summary) [Ep 2 · 2:55](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=175)
- "Conservative treatment includes managing constipation, teaching proper toilet sitting with a smaller seat so children don't fall through, providing a step for proper upright posture, and limiting time on the toilet without distractions like iPads." — Eunice Huang (clinical) [Ep 2 · 3:13](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=193)
- "Parents should be taught how to safely reduce a prolapse to avoid incarceration." — em gootee or todd ponsky (host_summary) [Ep 2 · 3:39](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=219)
- "Dr. Sean St. Peter's sclerotherapy technique uses 5 ccs of Sotradechol injected in 4 quadrants with any remaining volume injected in between." — Shawn St. Peter (clinical) [Ep 2 · 4:28](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=268)
- "Sclerotherapy has a low threshold for use because it is simple, innocuous, and can provide a window of a couple months without prolapse that allows younger children to see less frequent episodes." — Shawn St. Peter (opinion) [Ep 2 · 4:11](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=251)
- "A systematic review in the Journal of Pediatric Surgery included 27 publications with 900 patients: 300 underwent sclerotherapy (8 studies, 3 sclerosing agents) and 600 underwent operative management (22 studies, 17 different procedures)." — Eunice Huang (epidemiological) [Ep 2 · 5:10](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=310)
- "The large number of different operative procedures (17 procedures across studies) indicates uncertainty about which is the best procedure for rectal prolapse." — Eunice Huang (opinion) [Ep 2 · 5:46](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=346)
- "Transabdominal procedures have a pretty high success rate for correcting rectal prolapse based on published data." — Eunice Huang (clinical) [Ep 2 · 5:56](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=356)
- "A 2019 Journal of Pediatric Surgery review of sclerotherapy publications found that alcohol is the most popular sclerosing agent and is pretty effective." — em gootee or todd ponsky (host_summary) [Ep 2 · 6:31](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=391)
- "Alcohol as a sclerosing agent is probably really easy to obtain in the hospital setting." — em gootee or todd ponsky (opinion) [Ep 2 · 7:04](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=424)
- "The complication rate of sclerotherapy is mostly negligible, complications are acute, and there is minimal risk of long-term problems." — Eunice Huang (clinical) [Ep 2 · 7:14](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=434)
- "Patients with rectal prolapse should be evaluated to rule out underlying diseases, especially cystic fibrosis." — Eunice Huang (guideline) [Ep 2 · 7:41](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=461)
- "Sclerotherapy with ethyl alcohol is the recommended first option after failed conservative management, can be performed up to 3 times, and has an estimated cumulative success rate of a little bit over 80%." — em gootee or todd ponsky (host_summary) [Ep 2 · 8:04](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=484)
- "Laparoscopic rectopexy is the recommended operative approach for patients who fail sclerotherapy because it has the lowest complication rate and the highest success rate." — em gootee or todd ponsky (host_summary) [Ep 2 · 8:12](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=492)
- "Some patients with rectal prolapse and anxiety develop a feedback loop where prolapse becomes an emotional release mechanism for evacuating stool." — Eunice Huang (clinical) [Ep 2 · 9:34](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=574)
- "Pelvic floor therapy is useful in strengthening pelvic floor musculature and, when combined with sclerotherapy and support for anxiety, leads to more durable outcomes." — Eunice Huang (clinical) [Ep 2 · 9:34](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=574)
- "Patients with rectal prolapse may benefit from a multidisciplinary team approach including behavioral therapy and physical therapy." — em gootee or todd ponsky (host_summary) [Ep 2 · 9:20](https://library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=560)

## Changelog
- Sep 7: 2 items added automatically
- Sep 7: 3 items added automatically

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