Rectal prolapse is a disease in which the rectal mucosa, the anal canal, the entire rectum and part of the sigmoid colon are displaced downward and prolapse out of the anus. Prolapse can occur in all ages, but is more common in young children, the elderly, the chronically ill, and the tall and thin. The incidence is higher in women than in men because of the large lower pelvic opening and multiple deliveries. The disease is characterized by repeated prolapse of the rectal mucosa and rectum from the anus and is accompanied by anal relaxation.
I. Etiology
Factors such as long-term constipation, chronic diarrhea, difficulty in urination due to prostatic hypertrophy, chronic coughing due to chronic bronchitis causes rectal prolapse, etc. can cause rectal prolapse.
(A) developmental incomplete factors: immature development of the sacrum in children or adults with developmental defects, the angle of the sacrum bending forward is small, the development is flat and straight, the rectum is draped, the position of the bladder or uterine sockets is higher, the rectum loses the support role of the sacral surface behind the rectum, and is easily displaced downward when the intra-abdominal pressure is increased.
(B) physical factors: persistent intra-abdominal high pressure due to various reasons, resulting in relaxation of muscle groups, ligaments, fascia and other supporting tissues around the rectum or at the bottom of the pelvis that cannot withstand it. Such as urethral stricture, bladder stones, prostate hypertrophy and other complications of urinary difficulties, heavy physical labor, stubborn constipation, chronic diarrhea, multiple births and other easy to promote rectal prolapse down.
(C) pathological factors: this is the most common cause of morbidity in the clinic, in a sense, prolapse is a complication or secondary disease. Such as suffering from chronic wasting disease or absorption disorders, malnutrition, suffering from internal hemorrhoids, rectal polyps, tumors long-term bulge out of the intestinal wall, old age and weakness, lumbosacral nerve injury, easy to make the pelvic muscle groups and anal sphincter decline, relaxation and weakness, loss of the role of the anal canal, rectal support, rectal submucosa tissue laxity, mucosal layer and muscle layer lost adhesion fixed role, resulting in rectal mucosa downward slippage displacement.
Second, the 3 common causes of rectal prolapse
1, pelvic floor tissue weakness. Older people have loose muscles, women have too many children and perineal tears during childbirth, young children are underdeveloped can cause the anal raphe and pelvic floor fascia underdevelopment, atrophy, can not support the rectum in a normal position.
2, long-term intra-abdominal pressure increase. Such as long-term constipation, chronic diarrhea, prostate hypertrophy caused by urinary difficulties, chronic bronchitis caused by chronic cough and other factors, can cause rectal prolapse.
3, anatomical factors. Pediatric sacrococcygeal curvature is shallower than normal, rectum is vertical, when intra-abdominal pressure increases, rectum loses the support of the sacrum, easy to prolapse. In some adults, the peritoneum in the anterior rectal recess is lower than normal, and when the intra-abdominal pressure increases, the intestinal loops are directly pressed against the anterior rectal wall to push it downward, which easily leads to rectal prolapse.
Third, the pathogenesis
At present, there are two theories on the occurrence of rectal prolapse. One is the sliding hernia theory: that rectal prolapse is a sliding hernia of the peritoneum of the rectopelvic sink, under the pressure of the abdominal viscera, the peritoneal wall of the pelvic sink gradually sags, pressing the anterior wall of the rectum covered by the peritoneal part in the rectocele, and finally prolapses through the anus.
The second is the theory of intestinal sleeve: when the upper end of the rectum is normally fixed near the sacral promontory, due to chronic cough, constipation and other causes of increased intra-abdominal pressure, so that this fixed point is injured, it is easy to occur at the junction of the sigmoid colon and rectum intestinal sleeve, under the continuous action of factors such as increased intra-abdominal pressure, the intestinal tube set into the rectum gradually increased, due to the alternation of intestinal sleeve and sleeve reset, resulting in injuries to the lateral ligaments of the rectum, anal levator muscle, intestinal sleeve The intestinal sleeve gradually worsens and finally prolapses through the anus. It is also believed that the above two theories are the same thing, but the degree is different, and the sliding hernia is also a kind of intestinal overturning, but it does not affect the whole intestinal wall. The latter is a full lamina cribrosa.
The onset of the disease is slow. In the early stage, the mass only prolapses from the anus during defecation and can retract on its own after defecation. As the disease progresses, the lack of contraction of the anal raphe and anal canal sphincter requires manual help to return. In severe cases, the mass may also prolapse when coughing, sneezing, straining or walking, and it is not easy to return. If it is not reset in time, the prolapsed intestinal segment may become edematous, strangulated, or even at risk of necrosis. In addition, there is often incomplete defecation and the anal part of the downward, sore and swollen feeling, some may appear lower abdominal distension, frequent urination and other phenomena. The pain is intense when embedded.
Fourth, the cause of pediatric rectal prolapse
The causes of pediatric prolapse have two main categories
1, congenital factors: related to the anatomical characteristics of the rectum of children, that is, the congenital factors of children is the pelvic tissue structure is not well developed, the surrounding tissue supporting the rectum is relatively weak and not firmly fixed.
2, acquired factors: for the pressure in the abdominal cavity for a long time in an increased state, such as forceful defecation, violent cough, vomiting, frequent diarrhea; poor defecation habits, sitting on the potty for too long, etc., can prompt rectal prolapse. This situation may wish to make an analogy, the cuff as the anus, if the clamp and the lining is not firmly connected, the clamp is easy to prolapse from the cuff, the occurrence of prolapse is this reason.
The early manifestation of prolapse is only a red, wet, soft lump at the anal opening during defecation, and the lump quickly retracts into the anus after defecation. After repeated episodes, the lump does not retract immediately and must be returned with the help of hands. As a result of frequent prolapse, the mucosa is stimulated by friction, mucus secretion increases, and the mucosa becomes congested, edematous, bleeding, ulcerated, and even necrotic.
Causes of rectal prolapse in children
Chinese medicine believes that children are prone to prolapse because they are delicate, not fully developed, not real, the sacrum is not bent, the submucosal tissue of the rectum is loose, the rectum lacks the support of the sacrum, and the rectum and pelvis are almost straight, i.e., vertical, more active, not conducive to fixation, and increases the load on the anal sphincter. The amount of load, childhood and prone to malnutrition, whooping cough, enteritis, diarrhea and other disorders.
Long-term intra-abdominal pressure increases, the loss of the pulling and fixing effect on the rectum, it is easy to occur rectal prolapse, which is the main reason why children are prone to rectal prolapse.
Clinically, it is also common to see children defecate and urinate for too long sitting in the pelvis to induce this disease. In children, with the development of the pelvis and the formation of the sacral bend, most patients with rectal prolapse can often heal on their own, so non-surgical treatment is generally applied.
Classification
I. Classification of rectal prolapse
Rectal prolapse can be divided into two kinds of partial and complete according to the degree of prolapse.
(a) partial prolapse (incomplete prolapse): the prolapsed part is only the mucosa of the lower rectum, so it is also called mucosal prolapse. The length of prolapse is 2~3cm, generally not more than 7cm, the mucosal wall is radial, and the prolapse is composed of two layers of mucosa. There is no groove gap between the prolapsed mucosa and the anus.
(B) Complete prolapse: the whole layer of rectum is prolapsed, and in serious cases, the rectum and anal canal can be turned out to the outside of the anus. The length of prolapse is often more than 10cm, or even 20cm, in the shape of a pagoda, the mucosal wrinkled wall is arranged in a ring, the prolapse is composed of two layers of folded intestinal wall, thicker to touch, there is a peritoneal gap between the two layers of intestinal wall.
Second, rectal prolapse grading
In the past, rectal prolapse was clinically divided into complete rectal prolapse and incomplete rectal prolapse. In order to better guide the clinic, in 1975, the National Anal Conference unified the standard and divided rectal prolapse into three degrees. The details are as follows.
Ⅰ degree prolapse: when defecating or increasing abdominal pressure, the rectal mucosa prolapses outside the anus, and the length is within 3 cm, and the prolapsed part can be retracted by itself after defecation, and there are generally no obvious conscious symptoms.
II degree prolapse: when defecating or increasing abdominal pressure, the whole rectum is prolapsed, the length is 4~8 cm, it cannot be retracted by itself, and it needs to be retracted by hand, and it is mostly accompanied by relaxation of anal sphincter.
Grade III prolapse: the anal canal, rectum and part of sigmoid colon prolapse out of the anus when defecating or increasing abdominal pressure, the length is more than 8 cm, and it is difficult to reset by hand. It may be accompanied by relaxation of anal sphincter, rectal mucosa erosion and hypertrophy, blood in stool, fecal incontinence and other symptoms.
Symptoms
I. Common symptoms of rectal prolapse
The common symptoms of rectal prolapse are incomplete bowel movements; anal part down; lower abdominal distension; frequent urination rectal prolapse refers to the anal canal, rectum, and even rectal prolapse.
The lower end of the sigmoid colon is displaced downward. Only the mucous membrane prolapse is called incomplete prolapse; rectal prolapse of the whole layer is called complete prolapse. If the prolapsed part is inside the rectum of the anal canal, it is called prolapse or internal prolapse; prolapse outside the anus is called external prolapse.
Rectal prolapse is common in children and the elderly. In children, rectal prolapse is a self-limiting disease that can heal itself before the age of 5 years, so non-surgical treatment is the main focus.
In adults, complete rectal prolapse is more serious, and long-term prolapse will lead to pubic nerve damage, anal incontinence, ulceration, perianal infection, rectal bleeding, and the risk of edema, stenosis and necrosis of the prolapsed intestinal segment, which should be treated mainly by surgery. Manual reset; injection therapy; rectal suspension and fixation; prolapsed bowel resection; anal circle reduction.
Second, the early symptoms of rectal prolapse
At the beginning, there is often constipation, irregular bowel movements, a feeling of rectal fullness and swelling, and unclean bowel movements. During defecation there is a swelling prolapse, but it can be retracted by itself. It can be prolapsed by walking and straining for a longer period of time, and often needs to be sent back. The mucus is often discharged and contaminates the underwear due to frequent dislodgement. When the intestinal mucosa is damaged and ulcers occur, it can cause bleeding and diarrhea. Anal and rectal sensation is dull. The symptoms of internal prolapse above the anus are often unchanged, mainly after defecation when the feeling of incomplete evacuation is felt, and the feeling of evacuation is felt only after total straining. The prolapse repeatedly descends and retracts in the rectum, causing mucosal congestion and edema, and often a large amount of mucus and bloody material flows from the anus. Patients often feel pelvic and lumbosacral swelling and dragging, and dull pain in the perineum and posterior femur.
Typical anatomical features of rectal prolapse
① Rectal self-assembly;
②deep depression or deep douglas depression;
③The rectum is not fixed with the sacral promontory;
④Rectal and sigmoid colon are long;
⑤ Weak pelvic floor and anal sphincter;
(6) Possible metrorectal distention and other anomalies. The ideal surgical approach should correct these anomalies as much as possible.
Diagnosis
I. Three major diagnostic criteria of rectal prolapse
The diagnosis of rectal prolapse is divided into the following three criteria, as follows.
1. Grading criteria Ⅰ degree: when defecating or increasing abdominal pressure, the rectal mucosa prolapses outside the anus.
Ⅱ degree: when defecating or increasing abdominal pressure, the whole rectum prolapses out of the anus.
Degree III: When defecating or increasing abdominal pressure, the whole layer of the anal canal and rectum or part of the sigmoid colon prolapses out of the anus. The length of prolapse should be indicated when diagnosing various kinds of prolapse.
2.In rectal prolapse, the judgment of anal sphincter function
(1)Good function of anal sphincter: Self-controlled defecation, strong sphincter contraction and good anal closure.
(2) Poor function of anal sphincter: usually mucus overflows outside the anus, sometimes loose stool cannot be controlled, sphincter contraction is weak, and the anal opening is not closed tightly.
(3) No anal sphincter function: usually gas and dilute stool can not be controlled, sometimes dry stool can not be controlled, sphincter muscle atrophy, no contraction of the anus, the anus can not be closed.
3, rectal prolapse efficacy standards
(1) healed: Ⅰ degree prolapse symptoms disappear, rectal mucosa no longer prolapse out of the anus; Ⅱ, Ⅲ degree prolapse, rectal whole layer no longer prolapse out of the anus.
(2) Improved: symptoms basically disappear and prolapse is significantly reduced.
(3) Invalid: no significant change after treatment.
Second, rectal prolapse examination to confirm the diagnosis
1.Anal visual examination: soft lump-like intestinal mucosa can be found to prolapse out of the anus when defecating, and intestinal mucosa can be seen to prolapse out of the anus when the patient moves to defecate.
2.Proctal finger examination: It is a simple and easy but very important clinical examination method to check the disease by sticking a finger into the anus of the patient.
3, blood urine and stool routine examination.
4.Proctoscopy: is the use of proctoscope to examine the rectum.
5.Barium enema imaging: to understand whether there is an overgrown sigmoid colon.
7.Fecal imaging: It is seen that the force discharge first appears in the rectal intussusception, and then develops into extra rectal prolapse.
Treatment
External rectal prolapse is not difficult to diagnose, the patient squatting to do fecal movements, abdominal muscle force, prolapse can appear. Part of the prolapse can be seen as a round, red, smooth surface swelling, the mucosa is “radiolucent” fold, soft, and retracts on its own after defecation. If the prolapse is complete, the prolapse is longer, the prolapse is pagoda-like or spherical, and the surface can be seen as circular rectal mucosal folds. Rectal palpation feels that the sphincter is relaxed and weak. If there is small intestine in the prolapse, sometimes intestinal sounds can be heard.
Rectal mucosal prolapse needs to be differentiated from cricoid internal hemorrhoids. In addition to the difference in medical history, in the case of prolapsed cricoid internal hemorrhoids, congested hypertrophic hemorrhoids in the shape of a plum, bleeding easily, and a depressed normal mucosa between the hemorrhoids can be seen. On rectal palpation, the sphincter is strongly contracted, while the rectal mucosa is flaccid in prolapse, which is an important point of differentiation.
The diagnosis of endorectal prolapse is difficult and requires fecal imaging to assist in the diagnosis, but the disease should be suspected when the patient complains of obstruction in the rectal jugular and a feeling of incomplete fecal evacuation.
The prolapse of the rectum in young children is mostly self-healing, so non-surgical treatment is the main focus. That is, with the growth and development of children, the formation of sacral curvature, rectal prolapse will gradually disappear. Such as correcting constipation and developing good bowel habits. Defecation time should be shortened, and rectal prolapse should be reset immediately after defecation. If the prolapse is long, the prolapse is congested and edematous, the prolapse should be taken in prone or lateral position, immediately reset by manipulation, pushing the prolapse into the anus, and after the reply, rectal palpation should be done to push the prolapsed intestinal tube above the sphincter. After the manual reset, the anus should be blocked with gauze rolls, and then the two buttocks should be fixed with adhesive tape to temporarily close the anus to prevent recurrence in a short period of time due to crying or increased abdominal pressure. If the disease lasts longer and the above methods are still not effective, injection therapy can be used. Method: Injecting petrolatum vegetable oil into the rectal submucosa or a circle around the rectum, in 4 to 5 places, each place, the total amount of injection. The injection route can be through the anoscope under direct vision to inject the drug into the submucosa, so that the mucosa and muscle layer adhesion; or through the perianal skin, under rectal diagnosis to do perirectal injection, so that the rectum and the surrounding adhesion fixed.
In adults with incomplete prolapse or mild complete prolapse, if the sphincter tone is normal or slightly weak, similar to three mother hemorrhoidectomy or glue ring ligation treatment is feasible, and sclerotherapy injection can also be used. If the sphincter is flaccid, anal ring reduction or sphincteroplasty can be considered.
Treatment of complete rectal prolapse in adults is mainly surgical, with four surgical routes: transabdominal, transperineal, transabdominal perineal and sacral. There is no single surgical approach that can be used for all patients, and sometimes several surgical approaches are needed for the same patient. In the past, surgery only paid attention to repairing the pelvic floor defect, and the recurrence rate was high. In recent years, research has been conducted on the doctrine of rectal prolapse of the intestine, and surgery paid attention to treating the rectum itself, and now the following procedures are mostly used.
Care
A, rectal prolapse patients’ life care
1, the patient should first actively treat the various factors causing rectal prolapse under the guidance of a doctor, while treating chronic cough, constipation and other causative factors, and change the malnutrition. In the early stages of the disease young children as long as the cause is eliminated, or defecation using the method of tape to pull the two buttocks together, can help tighten the anus, the prolapse can mostly be cured.
2, rectal prolapse should be reset immediately after the caregiver or patient can gently hold it back by hand. If the prolapse is not easy to reset because of edema, serious need to go to the hospital to reset under anesthesia. After reset, the patient should lie down for half an hour and take oral laxative.
3.Patients should be encouraged to insist on doing auxiliary exercises, such as practicing contraction of the anus twice a day for 5-10 minutes each time to enhance the contraction ability of the anal sphincter.
4.The squatting position is forbidden during defecation, and the bed can be used to defecate in the flat position with the bedpan to reduce the chance of prolapse.
5.Some patients can also try the Chinese medicine tonic Chinese Yi Qi Tang plus reduction or acupuncture treatment, with the main method of tonifying Qi, lifting and fixing astringency.
6, for severe rectal prolapse or by non-surgical treatment for a long time invalid, should be advised to accept anal loop reduction or rectal suspension and other surgery.
Second, the rectal prolapse patient’s diet care
1, rectal prolapse patients diet should be light, easy to digest, less dregs, so as not to increase the number of feces.
2, patients with habitual constipation or poor defecation, usually eat more vegetables and fruits containing fiber, keep the stool soft, do not use too much force when defecating or squatting too long. Adult stool, the posture should be reclined, not upright, pay attention to the regulation of diet, to avoid constipation or diarrhea, to prevent rectal prolapse.
3, patients should not eat irritating food, such as spicy oil, mustard, chili, etc.; should not eat too much grease; should not eat fish, crabs and other hairy products.
Prevention
I. Preventive measures for rectal prolapse
Rectal prolapse patients should adhere to the physical exercise and strong abdominal muscle exercise to improve the human body Qi and blood deficiency and lack of Qi, which is very important for consolidating the effectiveness and prevention of rectal prolapse is of practical significance. Specific preventive measures are.
(1) actively remove all kinds of triggering factors, such as cough, sedentary standing, diarrhea, long-term cough, enteritis and other diseases, infants and children should pay particular attention.
(2) pay attention to increase nutrition, regularize life, do not squat on the potty for a long time, develop the habit of regular bowel movements, prevent dry stools, after the stool and before bedtime can use hot water sitz bath, stimulate the contraction of the anal sphincter, which has a positive effect on the prevention of rectal prolapse.
(3) Patients with habitual constipation or difficulty in defecation should eat more fiber-containing foods and not use excessive force when defecating.
(4) Women should take adequate rest after childbirth and delivery to protect the normal function of the anal sphincter. Those with prolapsed uterus and visceral prolapse should be treated promptly.
(5) Do anal gymnastics regularly to promote the movement of the anal sphincter, which has the effect of enhancing the function of the anal sphincter and has a certain effect on the prevention of this disease.
Second, the prevention of rectal prolapse – anal function exercise
Anal functional exercise is one of the important elements of anal self-care, which can effectively prevent and treat various common anal diseases, such as hemorrhoids, rectal prolapse, anal fissure, anal stenosis, anal incontinence, etc., and has an extremely important role in the functional recovery of patients after anal surgery. The following are four simple and easy methods.
1, finger expansion exercise: the right index finger coated with appropriate amount of lubricant, first in the anal opening press rub 1 minute, then slowly reach into the anus up to 2 knuckles, to the front, back, left and right four directions to expand the anus for 3 minutes, uniform force, do not use inappropriate violence, can be carried out after the stool and once before bed. It is especially suitable for post-operative patients as well as patients with anal canal circumferential stenosis and advanced anal fissure.
2, supine knee flexion exercise: supine knee flexion, head up, right hand to the left knee, and then relaxed recovery; then flexion knee head up, left hand to the right knee, relaxed recovery. Each exercise 30 times.
3, rapid contraction exercise: can quickly contract the anus, 30 times per minute, 2-3 times a day.
4.Anus lifting exercise: sit quietly, relax, clench the buttocks and thighs hard, close the eyes, with the inhalation, upward collection of the anus, after lifting the anus slightly closed, and then with the exhalation, the whole body relaxation. Practice 90 strokes each time. Three times a day, placed after the stool and once before going to bed.
Three, the prevention of rectal prolapse daily attention
Rectal prolapse patients should adhere to the physical exercise and strong abdominal muscle exercise to improve the human body qi and blood deficiency and lack of qi, which is very important for consolidating the effectiveness and prevention of rectal prolapse practical significance of specific preventive measures are.
① actively remove various precipitating factors such as coughing sedentary standing diarrhea long-term coughing enteritis and other diseases infants and children should pay particular attention to
②Patients with habitual constipation or difficulty in defecation should eat more fiber-containing foods in addition to do not use excessive force when defecating
③Women should take adequate rest after childbirth and delivery to protect the normal function of the anal sphincter, such as uterine prolapse and visceral prolapse should be treated promptly
④Frequent anal gymnastics to promote the movement of the anal sphincter muscle group has the effect of enhancing the function of the anal sphincter to prevent rectal prolapse has a certain effect
⑤ usually pay attention to increase nutrition life regularization do not squatting for a long time potty to develop the habit of regular defecation to prevent dry stool after the stool and before bedtime can use hot water bath to stimulate the contraction of the anal sphincter muscle has a positive effect on the prevention of rectal prolapse.
Hazards
Rectal prolapse as an anorectal disease, there are many hazards to human body and life, mainly the following four kinds.
1, rectal prolapse initially have constipation, irregular bowel movements, always feel rectal fullness and swelling and defecation is not clean. During defecation there is a mass prolapse, but it can be retracted by itself.
2, rectal prolapse gradually aggravated, in addition to defecation force caused by prolapse, in coughing, walking and other slight abdominal pressure, can cause prolapse, often can not be retracted by themselves, it is necessary to use the hand to prolapse the mass into the anus. Due to the frequent prolapse and discharge of mucus will often contaminate underwear.
3, rectal prolapse can also cause bleeding and diarrhea when the intestinal mucosa is damaged and ulcers occur. If the prolapsed mass cannot be retracted, inflammation and swelling will easily occur, and pain will occur, further aggravating constipation.
4, prolapse in the rectum repeatedly descending and retracting, causing mucosal congestion and edema, often by the anal outflow of large amounts of mucus and bloody things. Patients often feel pelvic and lumbosacral swelling and dragging, dull pain in the perineum and posterior femur, etc.
In addition, if the rectal prolapse is more serious, long-term prolapse will cause pubic nerve damage resulting in anal incontinence, ulceration, perianal infection, rectal bleeding, and the risk of edema, stenosis and necrosis of the prolapsed intestinal segment.
Diagnosis and differentiation of prolapse of the rectum
In the early stage, the mucous membrane prolapses from the anus after defecation and can be retracted by itself; later, it gradually cannot return by itself and needs to be restored by hand, often with a little mucus flowing out from the anus, a feeling of falling and incomplete defecation after defecation, and an increase in the number of defecation; later, it can be prolapsed after coughing, sneezing, walking, standing for a long time or with a little force, with a feeling of local distension after prolapse, and also with lumbosacral distension and pain, with mucous secretion from the prolapsed mucous membrane and mucous membrane The mucous membrane is often stimulated to become congested, edematous, erosion and ulceration, and the secretion can be mixed with bloody mucus, which can stimulate the perianal skin and cause itching. Due to the relaxation of the anal sphincter, it seldom occurs, but once it happens, the patient feels severe local pain, the swelling cannot be reset by hand, and the prolapsed anal canal soon becomes swollen, congested and cyanotic, the mucosal folds disappear, and if not treated in time, strangulation and necrosis may occur. When it is not prolapsed, physical examination shows that the anal opening is spread out, and finger examination often reveals that the anal sphincter is relaxed and the contraction force is weakened. The examination should exclude rectal tipped polyps and severe internal hemorrhoid prolapse, and the patient can be asked to squat and exert himself, and after all the anal canal is prolapsed, the examination will be performed again to determine whether it is partial and complete prolapse. Clinically, the prolapse is divided into three degrees according to the severity of prolapse: first degree for rectal mucosal prolapse, second degree for full rectal prolapse, and third degree for rectal and sigmoid prolapse.
Rectal prolapse can be divided into rectal prolapse in children and rectal prolapse in adults, and the two types of patients are very different in terms of differentiation and diagnosis because of their age and physiological conditions.
Most of the rectal prolapse in children is partly mucosal type, and it is not necessary to improve the physical condition and treat the predisposing factors, because it can mostly heal by itself. If non-surgical treatment fails, sclerotherapy can be considered, that is, 5% phenol glycerin injected into the rectal submucosa to play a role in fixing the relaxed submucosal tissue. Gabriel advocates the use of perineal subcutaneous metal wire buried in the perineum and removed after 3 weeks, or lamb’s intestine wire buried in the perineal skin. Only rarely is a larger procedure similar to adult rectal prolapse required.
Adult rectal prolapse is mainly complete full-layer prolapse, so it requires surgery, and there are more surgical methods, some people counted a total of 54 kinds since Moschowitz in 1912, which can be roughly divided into the following categories.
①Prolapsed intestinal canal resection;
②Prolapsed mucosal resection or folding operation;
③Anal ring reduction;
④Pelvic floor repair or strengthening;
⑤ Rectal suspension and fixation;
(6) Raising or closing the rectal bladder or rectal uterine sink;
(7) Shortening of the intestinal canal or mesentery;
(viii) repair of sliding perineal hernia.
The surgical routes are transabdominal, transperineal, transabdominal perineal and trans-sacral. Each of these surgeries has its own advantages and disadvantages and recurrence rate, and the surgical approach should be decided according to the condition. Sometimes several surgical approaches are used to cure the same patient, for example, Goligher used 10 surgical approaches for 152 cases of complete rectal prolapse and performed 173 surgeries. In the past, many surgeries paid attention only to repairing pelvic floor defects, with a high recurrence rate; in recent years, it has been noted that intussusception is the main pathogenesis of rectal prolapse, and the surgical approach is mainly directed at the rectum itself.
Why are elderly people prone to rectal prolapse?
1, rectal prolapse in the elderly is mostly caused by old age and weakness, lack of qi and blood, Qi sinking, Qi deficiency can not be collected. Deficiency” is the main cause of morbidity in the elderly.
2, due to the elderly systemic tissue decline, muscle relaxation, coupled with some chronic diseases, such as constipation, bronchitis, cough, prostate hypertrophy, urinary difficulties, etc.. Frequent increase in abdominal pressure, while the septum muscle decreases, compressing the abdominal organs pushing the sigmoid colon and rectum downward displacement, and because of the weakness of the elderly, sphincter muscle relaxation, pelvic rectal fossa, sciatic rectal fossa fat amount is reduced, which is also one of the reasons why the elderly are prone to incomplete rectal prolapse.
3, the treatment of rectal prolapse in the elderly, should pay attention to both the local pathogenic factors, but also the overall condition of the whole body.
Why are children prone to rectal prolapse?
1, because the child’s physique is delicate, development is not fully mature, the yuan qi is not real, sacral bending has not grown, rectal submucosal tissue is also relatively loose, rectal lack of sacral support, and rectum and pelvis almost straight, that is, vertical state, more activity, is not conducive to fixed, and increased the load of the anal sphincter, childhood and prone to malnutrition, whooping cough, enteritis, diarrhea and other disorders.
2, long-term intra-abdominal pressure increases, the loss of the rectum pull fixed role, it is easy to occur rectal prolapse, this is the main reason why children are prone to rectal prolapse.
3, clinically it is also common to see children defecate, urinate too long sitting in the potty and induce the disease.
4, children with the development of the pelvis, the formation of sacral bending, most patients with rectal prolapse can often heal themselves, so the general application of non-surgical treatment.
Rectal prolapse patients how to self-care?
1, usually should strengthen physical exercise, enhance physical fitness. Patients do daily anal lifting exercises to strengthen the contraction function of the anal sphincter.
2, timely treatment of chronic cough, bladder stones, prostate hypertrophy, chronic constipation and diarrhea and other diseases that increase abdominal pressure, to avoid long-term increase in abdominal pressure.
3, timely treatment of chronic diarrhea, constipation, internal hemorrhoids, rectal polyps and other diseases.
4, children with malnutrition should be treated in a timely manner, and those who are deficient after illness and old and frail should take qi-raising drugs.
5, rectal prolapse should be reset in time.
6, adjust the defecation habits, do not squat for a long time and excessive force defecation.
How to care for pediatric rectal prolapse?
The early manifestation of prolapse is only a red, wet, soft lump at the mouth of the anal station during defecation, and the lump quickly shrinks into the anus after defecation. After repeated attacks, the lump cannot be retracted immediately and must be returned by hand. Due to frequent weight removal, the mucosa is stimulated by abrasion, mucus secretion increases, and the mucosa becomes congested, edematous, bleeding, ulcerated, and even necrotic. When the anal canal and rectum turn outward and come out of the anus, it is called prolapse of the anal canal and rectum, or prolapse for short. Mostly occur in children within 4 years of age, but infants within 1 year of age are rarely seen suffering from this disease, which can mostly heal on its own as they grow older.
How to eat after having rectal prolapse?
After having a rectal prolapse, special attention should be paid to diet to avoid aggravating the symptoms of rectal prolapse. So, rectal prolapse patients need to pay attention to the following 3 aspects of the diet, as follows.
(1) rectal prolapse patients should have a light diet, easy to digest, less dregs, so as not to increase the number of feces.
(2) Patients with habitual constipation or poor defecation, usually eat more vegetables and fruits containing more fiber, keep the stool soft, do not use too much force when defecating or squatting too long. When adults have a bowel movement, the posture should be reclined, not upright, pay attention to the regulation of diet, to avoid constipation or diarrhea, to prevent rectal prolapse.
(3) In addition, rectal prolapse patients should also pay attention not to eat too much spicy oil, mustard, chili and other irritating foods. Also pay attention not to eat too much greasy things, scallops, crabs and so on should also pay attention to eat less.
How to avoid the occurrence of pediatric prolapse?
1, to make children develop the good habit of regular daily defecation, avoid sitting on the potty for too long.
2, children with constipation, usually should drink more water, eat more fiber-rich food.
3.Children with cough and recurrent diarrhea should be treated actively to prevent the occurrence of prolapse. For frequent prolapse that cannot return on its own, treatment must be carried out in hospital. If general conservative treatment is still not effective, then surgery must be performed.
Who is prone to rectal prolapse?
Who is prone to rectal prolapse and what are the reasons why they are prone to rectal prolapse? Experts say that infants and older people are prone to rectal prolapse. The reasons for susceptibility to rectal prolapse lie in the following areas.
Chinese medicine believes that: children are prone to prolapse when their qi and blood are not strong, and the elderly are prone to prolapse when their qi and blood have declined. rectal prolapse is very common in children under the age of 5, because children are delicate, not fully mature, their vital energy is not real, their sacrum is not bent, their rectal submucosal tissues are loose, their rectum lacks the support of the sacrum, and their rectum is almost straight with their pelvis, i.e., in a vertical state, which is more active, not conducive to fixation, and increases The load of the anal sphincter is increased, and the children are prone to malnutrition, whooping cough, enteritis, diarrhea and other disorders. Long-term intra-abdominal pressure increases, the loss of the pulling and fixing effect on the rectum, it is easy to occur rectal prolapse, which is the main reason why children are prone to rectal prolapse. Clinically, it is also common to see children defecate and urinate for too long sitting in the pelvis to induce this disease. In children, with the development of the pelvis and the formation of the sacral bend, most patients with rectal prolapse can often heal themselves, so non-surgical treatment is generally applied.
In the elderly, rectal prolapse is caused by old age and weakness, lack of qi and blood, deficiency of qi and inability to take in qi. “Deficiency” is the main cause of morbidity in the elderly. Due to the general tissue decline and muscle relaxation in the elderly, coupled with some chronic diseases, such as constipation, bronchitis, cough, prostate hypertrophy, difficulty in urination, etc.. Frequent increase in abdominal pressure, while the septum muscle decreases, compressing the abdominal organs pushing the sigmoid colon and rectum downward, and because of the weakness of the elderly, sphincter muscle relaxation, pelvic rectal fossa, sciatic rectal fossa fat amount is reduced, which is also one of the reasons why the elderly are prone to incomplete rectal prolapse. Therefore, the treatment of rectal prolapse in the elderly should pay attention not only to the local pathogenic factors but also to the overall condition of the whole body.
For people who are prone to rectal prolapse, they should prevent rectal prolapse early, prevent constipation and diarrhea, and elderly people can exercise properly to enhance their physical fitness and keep away from rectal prolapse.