How is endorectal mucosal prolapse treated?

  Endorectal mucosal prolapse is a functional rectal disease and can be considered a precursor of rectal prolapse, which means that if the endorectal prolapse develops further, it may prolapse out of the anus and lead to a true rectal prolapse. Therefore, some experts believe that endorectal mucosal prolapse and rectal prolapse have the same anatomic pathological changes, but with different severity. Since the rupture of the submucosal tendon causes the separation of the mucosal layer from the muscular layer and its accumulation in the intestinal cavity, the patient has a feeling of obstruction and incomplete defecation, etc. Once diagnosed by a doctor, appropriate treatment must be applied to solve the problem.  First of all, patients are advised to use conservative treatment methods first, and if conservative treatment is effective, surgery may not be necessary. Conservative treatment includes drinking more water, exercising more, eating more vegetables and fruits, developing the habit of regular bowel movements, taking oral medication, topical medication and other treatment methods. Special emphasis should be placed on not squatting on the toilet for a long time, because the longer you squat, the more the symptoms may worsen, related to high rectal pressure and compression of the mucosa downward.  When medication is not satisfactory, injections or surgery can be used. Injections are classical, effective and safe, mainly by injecting sclerosing agents into the submucosa of the intestine, causing a sterile inflammatory reaction in the submucosa, and through the inflammatory stimulation to achieve adhesions between the mucosa and the muscular layer, and for those who are not fit for surgery, such as the elderly, injection therapy can have the wonderful effect of “four two break a thousand pounds”, the disadvantages of injection therapy are The disadvantage of injection therapy is that it is easy to recur.  The main surgical methods are transanal surgery, including ligation, ligation, and in recent years, PPH and TST. At present, ligation is to use special instruments with negative pressure attraction to ligate the mucous membrane of the internal prolapse to achieve the therapeutic effect, and the location of the ligation point is decided according to the internal prolapse site, and it is appropriate to achieve clear exposure of the intestinal cavity. The more economical method should be mucosal ligation, the method under direct vision will be internal prolapse site for point ligation, to achieve the effect of ligature site necrosis off, ligation and ligature has the same wonderful, but more economical, safer and more reliable than the ligature. Ligation should grasp the scale, not to ligate the rectal stenosis, more attention should be paid to the occurrence of bleeding due to the dislodgement of the thread after ligation, so that each ligation point is not easy to range too large to prevent the occurrence of complications after dislodgement. This method is very effective if the procedure is done properly.  PPH and TST mainly use mucosal circumcision or partial excision on hemorrhoids, and then fix the mucosal break in the rectal muscle layer by titanium staple anastomosis, which is effective when used properly, but more complications (stricture, pain, bleeding, etc.) when used improperly, and it is not suitable for grassroots development because it is more expensive.