Dr. Vivek M. Rege
Pediatric Surgeon & Pediatric Urologist
B J Wadia Hospital For Children, Hurkisondas Hospital, Wockhardt Hospital, Mumbai

This is a frightening symptom with which the parents rush to the doctor. They have noticed that their child passes blood from the anus and an associated mass comes out when the child goes to pass stool. The blood scares them and the mass confuses them, and very often they feel that these are piles. Piles rarely if ever, occur in a child hence that possibility should not be entertained. There are 3 possible conditions that could present with bleeding and mass coming out of the rectum - a rectal polyp, rectal prolapse and lastly but least commonly is an intussusception.

The differentiation of these conditions is necessary as the treatment is completely different for each of these conditions. Here the observations by the parents are extremely important to help reach the diagnosis along with a proper examination. The age and other symptoms of the child are important and must be asked for.
A child of 2-4 years with painless bleeding per rectum and a rounded mass coming out after passage of stool, no associated constipation, and blood being bright red fresh and not mixed with stool or mucus is most likely to be a rectal polyp.


A child with a recent history of diarrhea, gastroenteritis; or even a child with chronic constipation with straining to pass stool, painful defecation and a mass coming out of the rectum long with blood that is mixed with mucus. The mass coming out may be all around and with typical folds seen and goes back on its own - is likely to be a partial mucosal rectal prolapse. These children may also complain of abdominal pain off and on.

An infant 6 - 9 month old who is having episodes of acute colicky severe pain with drawing p of legs, screaming followed by periods of sudden quietness, with passage of blood & mucus mixed together is likely to be an intussusception. This is telescoping of intestine over each other resulting in intestinal obstruction, congestion of the blood supply and oozing of the blood into the lumen of the large intestine. This is a semi emergency and requires admission and therapy.

A thorough examination must be done to come to the correct diagnosis. Besides examining the abdomen and the history, a per rectal examination is a must to be done with a gloved finger. This can often differentiate between the 3 conditions.
If the finger goes in easily and is moved around in circular fashion, the mass may be felt at one point of the circumference of the inner wall of the rectum and the rest of the wall is normal ? this goes in favour of a rectal polyp. The mass will have a base, an elongated stalk and a mass at the tip which may be brought out easily of the rectal opening.
If the finger goes in easily, and no mass can be felt all round the inner wall, but there are the presence of loose transverse mucosal folds inside, this may well be the loose mucosal that prolapses out and looks like a mass. Straining while passing stool and loose mucosal cuse the congestion and the blood in the lumen that comes out.
If the finger goes in easily, and the mass is felt in the rectum and the examining finger can go all around the mass on all sides then this could be intussusception.
The therapy will naturally depend on the cause of the mass.