title: Rectal prolapse in older children associated with behavioral and psychiatric disorders.
abstract: OBJECTIVE
  Rectal prolapse (RP) beyond infancy is challenging, and despite surgical correction, recurrences are not uncommon, suggesting that underlying contributing processes may have a role. This study highlights a previously poorly recognized relationship between RP in older children and behavioral/psychiatric disorders (BPD). We describe the incidence of recurrence and use of behavioral, psychological and physical therapeutic tactics in a multidisciplinary approach to pediatric RP.
  
  
  METHODS
  A retrospective 20-year review of RP in children >3 years of age was adopted. Charts were reviewed for gastrointestinal, connective tissue, and BPD conditions, incidence of recurrence, and therapies employed including surgery, behavioral, and physical therapy.
  
  
  RESULTS
  45 patients were included, ranging from 3 to 18 years of age; 29 males. Thirty-seven underwent surgery. Six of the 45 were excluded as they had gastrointestinal or connective tissue conditions placing them at risk for prolapse. Over half (21/39, 53%) had BPD. Slightly more than half of patients had a recurrence, but there was no increased risk in those with associated BPD. While all 21 underwent some therapy for their BPD, over the past 5 years we have enrolled eight of these patients into a program of behavioral and/or physical therapy with all reporting reductions in frequency and severity of prolapse after initiating pelvic floor strengthening, behavior modification, and biofeedback, and avoidance of surgery in three.
  
  
  CONCLUSIONS
  This study highlights an important group of pediatric patients with RP that may well benefit from a combination of behavioral therapy, physical therapy as well as surgical intervention to obtain the most optimal outcome.
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, Mott Children's Hospital, 1540 E. Hospital Dr., SPC 4211, Ann Arbor, MI, 48109-4211, USA.
authors.forename: Shelley Reynolds
authors.initials: SR
authors.lastname: Hill
authors.forename: Peter F
authors.initials: PF
authors.lastname: Ehrlich
authors.forename: Barbara
authors.initials: B
authors.lastname: Felt
authors.forename: Dawn
authors.initials: D
authors.lastname: Dore-Stites
authors.forename: Kim
authors.initials: K
authors.lastname: Erickson
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Teitelbaum
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002653:Child Behavior Disorders / Q000150:complications*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D012005:Rectal Prolapse / Q000209:etiology* / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies