Rectal prolapse, also known as prolapse, is a condition in which the rectal mucosa, anal canal, rectum and sigmoid colon are displaced downward and prolapse outside the anus. It is mostly seen in children and the elderly.
Etiology】
According to traditional Chinese medicine, lack of qi and blood, deficiency of qi and sagging, and inability to take in and take out, resulting in prolapse of the anal canal and rectum. In addition, chronic diarrhea, habitual constipation, and long-term coughing can easily lead to deficiency of qi and deficient retention.
Western medicine believes that the occurrence of this disease is related to the following factors.
1. immature development of children, rectal submucosa relaxation, if long illness and weakness, malnutrition, separation of mucosa and muscle layer, can form rectal mucosal prolapse.
2. Old age and frailty, women’s multiple births, pelvic muscle relaxation, rectal loss of the surrounding tissue fixed support, downward prolapse.
3. Long-term diarrhea, constipation, prostate enlargement, bladder stones, chronic cough and other diseases persistently increase abdominal pressure.
4. Repeated prolapse of internal hemorrhoids, rectal polyps, tumors and other diseases that pull down the rectal mucosa.
5. Various other causes of muscle relaxation and weakness around the anus.
[Clinical symptoms
Prolapse Prolapse of the rectum out of the anus is the main symptom of patients visiting the clinic. The rectal mucosa prolapses out of the anus during defecation at first, and then it is returned by itself after defecation, and gradually worsens after repeated prolapse and needs to be returned by hand; in severe cases, it can be accompanied by anal relaxation, and the rectum can prolapse out of the anus during sneezing, coughing, walking, standing for a long time, and exertion.
Constipation, diarrhea, fecal incontinence, and urgency can be seen, with constipation being the most common, followed by rectal mucosal bleeding and mucus stools.
Other symptoms After repeated prolapse of the rectal mucosa, congestion, edema, increased mucus secretion, and in severe cases, ulceration and bleeding on the surface, as well as anal swelling, perianal itching, urinary frequency, and abdominal distension, can be seen.
Diagnosis】
Prolapse can be divided into three degrees.
First degree prolapse: prolapse of rectal mucosa, light red, 3-5 cm long, soft to touch, inelastic, not easy to bleed, and can be naturally returned after stool.
Second degree prolapse: prolapse of the whole rectum, 5 to 10 cm long, conical, light red, the surface is circular and layered mucosal folds, thicker to the touch, elastic, loose anus, sometimes need to be returned by hand after the stool.
Third degree prolapse: prolapse of rectum and part of sigmoid colon, more than 10 cm long, cylindrical in shape, thick to touch, with a loose and weak anus.
Finger palpation reveals a relaxed anal sphincter with weakened contraction.
[Differential diagnosis
Internal hemorrhoid prolapse: the nucleus of hemorrhoid is prolapsed in pieces, plum-shaped, mostly obvious at 3, 7 and 11 points, the surface mucosa is dark red or greenish purple, and bleeds easily.
Treatment measures
Drug treatment
The internal treatment is to tonify the qi, lift and consolidate, and the formula is used to tonify Zhong Yi Qi Tang; if the prolapse is heavy and not easy to return, it is appropriate to reuse Sheng Ma, Chai Hu, Dang Shen and Huang Qi, and add Jin Zhen Zi and Wu Bei Zi to enhance the astringent effect; if there is more bleeding, use Di Yu, Sophora and Phellodendron charcoal.
The external treatment is mainly astringent and astringent, with the formula of bitter ginseng soup plus pomegranate skin, alum, five times the seeds decoction fumigation, twice a day, and then with five times the seeds of the seeds of the powder or Ma Bo San external application.
Injectable treatment There are more drugs that can be used, and the efficacy is better with the injection of anti-hemorrhoid spirit and 6% alum injection.
(1) submucosal injection method Inject the drug into the submucosal layer of the rectum, so that the rectal mucosa and muscle layer adhesion fixed, divided into point injection method and column injection method.
Indications First- and second-degree rectal prolapse, with first-degree effect.
Contraindications Proctitis, diarrhea, perianal inflammation and persistent abdominal pressure increasing disease.
Operation method Take the lateral recumbent or truncated position, after local disinfection, expose the rectal mucosa outside the anus, or under the anoscope, 1 cm above the dentate line, select 2 to 3 planes in a circular pattern; or select 4 to 6 rows longitudinally. Choose 4 to 6 points per plane or per row, with the distance of each point staggered with each other, and inject 0.2 to 0.3 ml of drug per point, without piercing too deeply into the muscle layer or injecting too shallowly into the mucosa to avoid ineffectiveness or necrosis. The total amount is generally 6 to 10 ml, and the injection is completed and fixed by compression with tartan gauze. Columnar injection, 1 cm above the dentate line at 3, 6, 9 and 12 points of the exposed extra-anal rectal mucosa, and columnar injection of the submucosa. The length depends on the length of the prolapse, and the amount of medicine per column is 2-3 ml. After the injection, it is sent back to the anus. Rest properly on the day of injection and do not engage in strenuous activities. Enter a liquid diet, control the stool 2 to 3. Generally, an injection can be received after satisfactory results, such as poor results, 7 to 10 days after another injection.
(2) perirectal injection method
Indications: second- and third-degree rectal prolapse, adhesion of rectum to surrounding tissues by injecting drugs.
Contraindications: enteritis, diarrhea, acute inflammation around the anus.
Preoperative preparation: one enema in the evening before surgery and one enema before surgery.
Operation method: under lumbar anesthesia or local anesthesia, take a truncated position, local and anal canal, lower and middle rectal disinfection, selected at a distance of 1.5 cm from the anal verge, 3, 6, 9 three entry points, then use a thin lumbar penetration needle and 20 ml syringe, inhalation injection solution, selected 3 points to pierce the skin, subcutaneous into the sciatic rectal fossa, about 4-5 cm, the needle tip encountered resistance, that is, to reach the anal raphe, through the anal raphe At this time, the index finger of the other hand into the rectum, carefully find the tip of the needle site, to determine the tip of the needle outside the rectal wall, and then the needle deeper 2 ~ 3cm, in order to ensure that the tip of the needle is not pierced into the rectal wall, to the tip of the needle outside the rectal wall can slide freely prevail. Then slowly inject 6-8 ml of the drug, so that the drug is evenly dispersed in a fan shape. Inject the opposite side with the same method, and finally inject at 6 points, enter the needle along the posterior rectal wall, pierce 4~5cm to the posterior rectal space, inject 4~5ml of drug, inject a total of 20~24ml of drug at three points. after the injection, local disinfection, apply sterile gauze externally. Rest in bed, control stool for three days, and give sterile paraffin oil 100ml oro-abdominal before the first stool to lubricate the intestinal tract. Distension and pain around the anus for 1 to 3 hours after injection, which can usually be relieved by itself. Two to three days after surgery, sometimes there is low fever, such as not more than 38 degrees Celsius and local non-inflammatory as absorption fever, if more than 38 degrees Celsius and local inflammatory changes such as redness and swelling, anti-inflammatory treatment should be given.
Surgical treatment Applicable to severe rectal prolapse, the surgical route has four kinds: trans-abdominal, trans-perineal, trans-sacral, trans-abdominal and perineal, each method has certain indications and advantages and disadvantages, and it is appropriate to carry out in a specialist hospital.
Home care]
Those who have prolapsed should wash the anal area with warm water after each bowel movement and send the prolapsed material back in time.
Prevention and rehabilitation
1. promptly treat diarrheal diseases such as enteritis and dysentery, especially in children.
2. prevention and control of constipation, do not exert efforts to blame.
3. timely treatment of diseases that can increase abdominal pressure, such as chronic cough, prostate hypertrophy, bladder stones, etc.
4. adequate rest for women after childbirth and delivery
5. frequent anal lifting exercises to enhance the function of the anal sphincter.