Prolapse is a disease in which the rectal mucosa, anal canal, entire rectum and part of the sigmoid colon are displaced downward and prolapse out of the anus, characterized by repeated prolapse of the rectal mucosa and rectum out of the anus with anal relaxation. It is equivalent to the rectal prolapse in Western medicine. Etiology and pathogenesis】 The deficiency of qi and blood in children, the decline of qi and blood in the elderly, the deficiency of qi and blood in women, and chronic diarrhea and dysentery, habitual constipation, and long-term coughing can easily lead to deficiency of qi and deficiency of rectum, resulting in the prolapse of the rectum outward. Western medicine believes that the systemic functional status, especially neurological decompensation, has a significant impact on the occurrence of rectal prolapse. However, local factors such as anatomical defects and dysfunction, enterogenic diseases, and increased abdominal pressure are also important conditions that cause prolapse. Diagnosis】 1. Clinical manifestations Mostly seen in young children, the elderly, the chronically ill and frail, and the tall and thin. The incidence is higher in women than in men because of factors such as larger lower pelvic opening and multiple deliveries. The onset of the disease is slow and there are no obvious systemic symptoms. In the early stage, the mucous membrane is prolapsed from the anus after the stool, and it can be returned by itself after the stool, and then gradually it cannot return naturally, and it must be reset by hand or lying down. If the patient is not treated for a long time, all layers of the rectum will be displaced downward, and the rectum or part of the sigmoid colon will be prolapsed, even when coughing, squatting or walking. Patients often have incomplete stool and poor bowel movement, or lower abdominal pain, soreness and heaviness in the waist, groin and both lower limbs. Because the rectal mucosa is repeatedly prolapsed and exposed, congestion, edema, erosion and bleeding often occur, so mucus can flow from the anus, stimulating the perianal skin and causing itching. The anus can be seen to be spread out, and finger examination often reveals that the anal sphincter is relaxed and the contraction force is weakened. Anoscopy can see the folded mucosa in the rectum. Rectal prolapse can be divided into three degrees: (1) first degree prolapse: prolapse of rectal mucosa, light red, 3~125px long, soft to touch, inelastic, not easy to bleed, can be self-retracted after stool. (2) Second-degree prolapse: prolapse of the whole rectum, the prolapse is 5~250px long, cone-shaped, light red, the surface is circular and layered mucosal folds, thicker and more elastic to touch, the anus is loose, and sometimes needs to be returned by hand after stool. (3) Third degree prolapse: prolapse of rectum and part of sigmoid colon, up to 250px or more, cylindrical in shape, thick to touch, with a loose and weak anus. Differential diagnosis】 Internal hemorrhoid prolapse should be distinguished from first degree rectal prolapse. When internal hemorrhoid prolapses, the nucleus of the hemorrhoid comes out in pieces, there is no annular mucosal crease, dull red or greenish purple, and it bleeds easily. Treatment】 Internal and external medication, acupuncture, injection and surgery. Internal and external drug treatment can enhance the tension in the pelvic cavity and strengthen the support of rectal fixation. For the first degree of rectal prolapse, especially for children, we can receive better results. But for the second and third degree rectal prolapse can only improve the symptoms, it is difficult to completely cure. Injections and surgical treatment is mainly to make the rectum and the surrounding tissues or rectal layers of tissue adhesion fixed, so that the rectum no longer down prolapse. (1) Internal treatment (1) ①Spleen deficiency and qi trapping symptoms: prolapse of anal swelling during stool, with varying degrees of severity and light red color; accompanied by anal swelling, blood in stool, fatigue, loss of appetite, or even dizziness and tinnitus, soreness and weakness of waist and knees; light tongue, thin white fur, weak pulse. Treatment: Tonify Qi, elevate, astringent and consolidate. Remedy: tonifying the middle and benefiting the qi, plus or minus. If the prolapse is heavy and cannot be regained by itself, ascending marijuana, Chai Hu, Radix et Rhizoma Ginseng and Astragali should be used; if the waist is sore and the ears are ringing, add Cornu Cervi Pantotrichum, Raspberry and Chebulus. ②Damp-heat infusion evidence Symptoms: prolapsed swelling in the anus, purple dull or deep red, or even surface ulceration, erosion, anal pain, burning sensation on internal finger examination; red tongue, yellow greasy coating, string pulse. Treatment: Clearing heat and relieving dampness. Remedy: Dioscorea Z percolating dampness soup plus or minus. If there is a lot of bleeding, add Diyu, Sophora and Phellodendron charcoal. (2) External treatment ① Fumigation: fumigate with bitter ginseng soup plus pomegranate bark, kufu alum and wubei zi in decoction twice a day. (2) external application: external application of Wu Bei Zi San or Ma Bo San. 2, other therapies (1) injection method inject the liquid into the submucosa of the rectum or around the rectum, so that the separated rectal mucosa and muscle layer adhesion fixed, or so that the rectum and the surrounding tissue adhesion fixed. ① Submucosal injection method This method is divided into two kinds of submucosal layer dot injection method and column injection method Indications: first and second degree rectal prolapse, with the best effect of first degree rectal prolapse. Contraindications: proctitis, diarrhea, perianal inflammation and persistent abdominal pressure increasing disease Drug: 6%~8% alum solution or 1:1 elimination hemorrhoid injection Operation method: take lateral or truncated position, after local disinfection, expose the rectal mucosa outside the anus, or under the anoscope, select 2~3 planes in a 25px circle on the dentate line, or select 4~6 rows longitudinally. Each plane or each row select 4~6 points, the distance of individual points are staggered with each other, and each point is injected with 0,2~0,3ml of medicine, do not pierce too deeply into the muscle layer or inject too shallowly into the mucosa to avoid ineffectiveness or necrosis. The total amount is usually 6~10 ml. After the injection is completed, it is fixed by compression with tower-shaped dry gauze. Columnar injection is made in the submucosal layer 25px above the dentate line at 3, 6, 9 and 12 points of the extra-anal rectal mucosa. The length depends on the length of the prolapse, and the amount of medicine per column is 2~3ml, which is sent back to the anus after injection. Rest properly on the day of injection, and do not engage in strenuous activities. Fluid diet and stool control for 1~3 days. Generally, satisfactory results can be received after one injection, and if the effect is not good, inject again after 7~10 days. ② perirectal injection method Indications: second- and third-degree rectal prolapse Contraindications: enteritis, diarrhea, acute inflammation around the anus. Drug: 6%~8% alum solution or 1:1 anti-hemorrhoid injection Pre-operative preparation: 1 enema in the evening before surgery and 1 enema each before surgery. Operation method: Under lumbar anesthesia or local anesthesia, take the truncated position. Local and intra-anal disinfection, wearing sterile gloves vertically, select three entry points at 37,5px from the anal verge at 3, 6 and 9 points, then use a thin lumbar penetration needle and 20ml syringe to inhale the injection solution, select 3 points to pierce the skin, subcutaneous, into the scirorectal fossa, about 4~125px, the needle tip meets resistance, that is, reach the anal raphe, cross the anal raphe and enter the pelvic rectal space. At this point, the index finger of the other hand into the rectum, carefully find the tip of the needle outside the rectal wall can slide freely prevail, and then slowly inject 6 ~ 8ml of drugs, so that the drug is fan-shaped evenly dispersed. Inject the opposite side with the same method. Finally, inject at point 6, enter the needle along the posterior rectal wall, pierce 4~125px, go to the posterior rectal space, inject 4~5ml of drug. 16~20ml of drug is injected at three points in total. Rest in bed and control stool for 3 days. Distension and pain around the anus for 1~3 hours after injection, which can usually be relieved by itself. Sometimes there is low fever 2~3 days after the operation, if it does not exceed 38C and there is no local infection, it is absorption fever and can be treated without special treatment; if it exceeds 38C and there is local redness, swelling and other infectious inflammatory changes, antibiotic treatment should be given. (2) Acupuncture ① Body acupuncture and electro-acupuncture: take points Changqiang, Baihui, Feet Sanli, Chengshan, Bars, and Tizhang points. (2) Plummer’s needle: pointing at the external sphincter area around the anus. In addition, there are surgical methods such as rectal scar support fixation, anal tightening and rectal suspension. Prevention and care】 1. Prompt treatment should be given after prolapse to prevent it from developing to a serious degree. 2.Avoid weight-bearing distances and actively treat chronic diarrhea, constipation, chronic cough, etc. to prevent excessive increase of abdominal pressure. 3, local can be fixed with a d-ring brace pad cotton, or daily exercise exercise to lift the anus.