“Want to hear the funniest therapy that actually works?” – Dr. Ben Schnapp, former Chief Resident extraordinaire

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It was my first month of intern year, and I had just presented a patient with a recurrent rectal prolapse. Ben Schnapp, the senior resident, was delighted to show me what he said was the “the funniest therapy that actually works.” I followed Ben up to the cafeteria, where he rummage through the concessions grabbing several stray sugar packets. This was to become a teaching pearl that, despite my best efforts, I would never forget.

How to reduce a rectal prolapse

Step One: Apply gentle steady pressure with a gloved hand
Step Two:  If you have difficulty reducing the prolapse, apply granulated sugar to the prolapse.
Step Three: Let the sugar sit for 15 minutes and then reattempt the reduction. The sugar will absorb the extra water and cause the prolapse to shrink.
Step Four: If “sugaring the rim” fails, the next step is surgical reduction – so call your consult and pass that baton!
Pro Tip: Yes, you must use granulated sugar. A sugar substitute will not work! (Sorry, no Splenda!)

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Case reports suggest this method works about 50% of the time. That may seem small but if it saves someone a trip to the OR then it’s worth a try.

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References:

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Coburn, William M., Marie A. Russell, and Wayne L. Hofstetter. “Sucrose as an aid to manual reduction of incarcerated rectal prolapse.” Annals of emergency medicine 30.3 (1997): 347-349.

Myers, James O., and David A. Rothenberger. “Sugar in the reduction of incarcerated prolapsed bowel.” Diseases of the colon & rectum 34.5 (1991): 416-418.

Seenivasagam, T., et al. “Irreducible rectal prolapse: emergency surgical management of eight cases and a review of the literature.” The Medical journal of Malaysia 66.2 (2011): 105-107.