The anterior rectal protrusion refers to the protrusion of the anterior lower rectum in the direction of the vagina, forming a cystic cavity, especially when struggling to defecate, resulting in fecal retention and difficulty in defecation. It is one of the exit obstruction syndromes. It can be classified as “constipation” in Chinese medicine. Diagnostic criteria (1) Diagnosis of disease 1, Chinese medicine diagnostic criteria Chinese medicine disease name: Chinese medicine has not proposed a clear title of rectal prolapse, it is classified as “constipation” in the disease. (1) Symptoms: ① Difficulty in defecation Difficulty in defecation is the main symptom of rectal prolapse. The abdominal pressure increases when defecating, and the fecal mass is rushed to the anterior protrusion under pressure, and after stopping the force, the fecal mass is squeezed back to the rectum, causing difficulty in defecation. A few patients need to put pressure in the perianal and vaginal area to help defecation, and even put their fingers into the rectum to dig out the fecal mass. The feces cannot be eliminated, and after the patient changes from squatting to standing position, the feces in the rectum will again stimulate the defecation receptors in the back wall of the rectum, causing the urge to defecate again, resulting in incomplete defecation. Because the defecation receptors are located in the posterior wall of the rectum and behind the anterior rectal protrusion, when the patient is in the standing or sitting position, the anterior rectal protrusion is the lowest point of the rectum, and the feces enters the rectum and first enters the anterior rectal protrusion, it is not possible to effectively stimulate the defecation receptors and produce the desire to defecate. Only when there is enough fecal matter produced can there be effective stimulation and bowel sensation, which is the main reason for the long defecation time. This is the main reason for the long defecation time. The effective defecation pressure in the rectum decreases, so the stool cannot be excreted directly. (⑤) Inability to make effort because of the anterior rectal protrusion, the patient has difficulty in defecating and the stool enters the anterior rectal protrusion, and despite efforts to increase the abdominal pressure, the patient is unable to defecate because the anterior rectal protrusion does not create enough pressure in the rectum for defecation. (6) Dropping sensation Because of the accumulation of fecal masses in the rectum, the patient has a feeling of anal dropping. (7) Abdominal distension Because of the difficulty in defecation of the anterior rectum, sometimes the exhaustion is also affected, and the gas in the intestine is not expelled smoothly, which causes abdominal distension. (2) Physical signs: Rectal palpation palpates a depressed weak area in the anterior rectal wall above the anal canal, and when the patient is asked to make a defecation movement, the weak area can be seen to protrude significantly to the front. Some patients need to put pressure around the anus in order to pass stool, or put their fingers into the vagina to block the protrusion of the anterior rectal wall, or even use their fingers to reach into the rectum to pick out the fecal mass. (2) Examination methods Defecography can show the depth and width of the anterior rectal protrusion and provide an imaging basis for diagnosis. The colonic transmission test can understand whether the colonic transmission function is normal and whether there is slow transmission type constipation in the colon. The colonic transmission test of rectal protrusion can show that the barium particles are concentrated in the end of the rectum and still cannot be expelled for 72 hours. (3) Staging Mild rectal protrusion depth 0.6–1.5cm Moderate rectal protrusion depth 1.6–3.0cm Severe rectal protrusion depth 3.0cm or more (2) Diagnosis of symptoms 1, spleen qi deficiency: fatigue, poor food intake, defecation Difficulty in defecation, with anal swelling and incomplete bowel movement, several times a day, thin and soft in quality, but difficult to solve. Pale tongue, thin coating, weak pulse. 2.Qi and Yin deficiency: dizziness and weakness, dry mouth and desire to drink, difficulty in defecation, prolonged defecation time, feeling of incomplete stool, stool for a few days, hard texture. Light red tongue, thin coating, weak pulse. 3.Qi blockage: constipation, unable to pass stool, or even difficult to pass stool even if the stool is not coarse, with frequent belching, chest fullness, or even distension and pain in the abdomen, reduced food intake, thin and greasy tongue coating, string pulse. (C) Differential diagnosis 1. Giant colon syndrome: clinically, there are symptoms of incomplete obstruction such as stubborn constipation and abdominal distension, and the diagnosis can be confirmed by barium x-ray imaging, pathology and colonoscopy. 2.Anal and rectal stenosis: with defecation difficulties and obstruction symptoms, the diagnosis can be clearly made by finger diagnosis or sigmoidoscopy and barium X-ray imaging. 3, retrovaginal hernia: retrovaginal hernia refers to the herniation of the peritoneum between the vagina and rectum into the vagina, and its contents include small intestine, mesentery, omentum, etc. Posterior vaginal hernia mostly has a feeling of heaviness and falling in the pelvis, especially when standing, which is due to the gravitational traction of the intestinal tube in the sac contents. It is diagnosed by rectal and vaginal examination, and if there is a feeling of fullness between the thumb and index finger, it indicates a posterior vaginal hernia. Chinese medicine diagnosis and classification treatment 1. Spleen qi deficiency Treatment: Benefit qi, promote lifting, strengthen the spleen and relieve dampness. Astragalus membranaceus 15g, Radix Codonopsis pilosulae 10g, Atractylodes macrocephala 10g, Radix Angelicae Sinensis 9g, Pericarpium Citri Reticulatae 3g, Radix Achyranthes bidentatae 3g, Radix et Rhizoma chaihu 3g, Poria cocos 10g, Semen coicis 20g, Radix et Rhizoma glycyrrhizae 6g. 2, qi and yin deficiency treatment: benefit qi and nourish yin formula: yu hui tang plus reduction. Astragalus membranaceus 15 grams, yam 10 grams, Zhi Mu 6 grams, Wu Wei Zi 10 grams, pollen 6 grams, Mai Dong 10 grams, Sheng Di 10 grams, Yuan Shen 10 grams. 3, qi blockage Treatment: smooth the qi, move stagnation and relax the bowels. Shen Xiang 6 g (later), Mu Xiang 12 g, Betel nut 15 g, Wu Yao 10 g, Citrus aurantium 15 g, Chai Hu 12 g, Qing Pi 10 g, Bai Shao 30 g. Fourth, the treatment routine Patients do not appear obvious clinical symptoms, first consider conservative treatment, instruct patients to eat more high-fiber food, drink more water, with appropriate physical activities, develop good regular bowel habits, from the diet to control the development of the disease. Through the above treatment, the symptoms of general patients have different degrees of improvement, after three months to six months of regular non-surgical efficacy treatment symptoms do not improve, the efficacy is not obvious to consider surgery. V. Surgical treatment The radical cure for rectal prolapse is surgery, but generally first non-surgical treatment, six months to a year or more of poor or no effect of treatment, or even the symptoms gradually aggravated; no systemic diseases or systemic diseases well controlled, no contraindications to surgery, consider surgical treatment. (A) Transanal rectal prolapse repair (Sehapayak procedure) Sehapayak sutured the anal raphe in 1985 to repair the rectovaginal septum. 1, A longitudinal incision 5-6 cm long is made in the midline of the anterior rectal wall from above the dentate line, and the submucosa is incised to expose the rectovaginal septum. 2. The assistant will insert the left index finger into the vagina for guidance to avoid damage to the vaginal mucosa during surgery and to help stop bleeding by compression. Separate 1-2 cm along the submucosa to both sides to expose both anal levator muscles. The edges of the anal raphe are intermittently sutured with chromic gut sutures for 3-5 stitches to repair and reinforce the rectovaginal septum. 3. Excise the excess mucosa and intermittently suture the mucosal incision. Finally the assistant extracts the index finger. (B) Endorectal elimination suture repair Closed repair (Block procedure): according to the size of the anterior process, the rectal mucosa is clamped with vascular forceps, and the defect is repaired by continuously suturing the rectal mucosa and its muscular layer from the bottom up with 2-0 chromium intestinal sutures from the dentate line. When suturing, attention should be paid to the fact that the continuous suture must be wide at the bottom and narrow at the top to avoid the formation of a mucosal flap image at the upper end for defecation. A small amount of fluids on the day of surgery, the next day a retrograde juice diet, and then gradually resume a general diet. After surgery, we should also continue to give high-fiber food, drink more water and have regular bowel movements to avoid recurrence of constipation. It is worth noting that the number of patients with pure rectal prolapse is small, and most patients have combined perineal descent, endorectal overlap, anterior rectal wall mucosal prolapse, intestinal hernia, etc., which should be treated at the same time, otherwise the efficacy will be affected.