Rectal prolapse is a disease in which the rectal mucosa, the entire rectum, or even part of the sigmoid colon is displaced downward and prolapses outside the anus. The clinical characteristics are: the rectal mucosa prolapses during early defecation and resets itself after defecation, but with the development of the disease, anal swelling, dampness and perianal itching may occur. Prolapse can occur in people of all ages, but it is more common in children and elderly people who are physically weak, in menstruating mothers, or with a history of long-term diarrhea, constipation, or cough.
In the “Fifty-two Diseases Formula”, the method of prolapse and its return is recorded: “‘People who are out of the state and cannot enter…’ , ‘Hang the person upside down, splash his heart and abdomen with cold water, and enter.’ ” , belongs to the category of coiled intestinal hemorrhoids, overlapping hemorrhoids, prolapsed hemorrhoids, truncated intestine, etc. in the motherland medicine. This disease is equivalent to rectal prolapse in Western medicine. Modern medicine believes that the cause is: the pelvic floor tissue loses its supporting role in fixing the rectum, resulting in the relaxation of the rectal mucosa layer. According to the degree of prolapse of the rectal wall, it can be divided into incomplete prolapse and complete prolapse.
The spleen and stomach are the origin of the posterior and the source of biochemical energy and blood. If the prolonged illness is damaged, the Yang Qi of the spleen is insufficient, the lift is weak, and the middle qi is sunken; or if the appetite for spicy, fatty, sweet and thick flavors damages the spleen and stomach, damp heat is generated, and damp heat is injected into the large intestine, it can lead to prolapse. Spleen deficiency and qi trapping are mostly due to dietary injury, loss of spleen health, or due to deficiency of endowment and overexertion. If the spleen is weak, it has no power to transport and transform, and if the spleen is not healthy, the Qi and blood are not sufficiently biochemical, resulting in the sinking of the middle qi.
In Zhang’s Medical General – Prolapse, it is said: “It is difficult to understand the cloud, the one who comes out is deficient. The anal prolapse is not deficiency, but what?” Dampness and heat are injected into the large intestine, resulting in constipation or diarrhea, and effort in stool, leading to prolapse.
The Jing Yue Quan Shu records: “There are those who are off because of wine and dampness injury to the spleen and lust injury to the kidneys. However, if there is no heat evidence, it is a deficiency evidence.” It is not difficult to diagnose according to the patient’s symptoms and signs, the main symptom of this disease is prolapse of the rectum, the prolapse of the rectum, there are obvious radial longitudinal grooves or rectal ring, light red, no bleeding. Finger palpation can be done and the anal sphincter is obviously relaxed. Rectal prolapsed mucosa under proctoscopy was uniformly elevated in a circular pattern.
Early stage: the mucosa 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, and there is often a little mucus flowing out from the anus, a feeling of falling and incomplete defecation after defecation, and the frequency of defecation increases.
Late stage: prolapse can be dislodged by coughing, sneezing, walking, standing for a long time or exerting a little force, with a feeling of local distension after dislodgement and painful distension in the lumbosacral region, with mucus secretion from the dislodged mucosa, and the mucosa is often stimulated by congestion, edema, erosion and ulceration, and the secretion can be mixed with bloody mucus, stimulating the perianal skin and causing itching.
Once embedded occurs, the patient feels severe local pain, the swelling cannot be reset by hand, and the prolapsed anal canal soon becomes swollen, congested, and the mucosal folds disappear. If not treated in time, strangulation and necrosis may occur.
Rectal prolapse can be divided into three degrees.
First degree: prolapsed rectal mucosa, light red, prolapsed about 3~5 cm. Soft texture, not easy to bleed, after the stool can naturally return.
Second degree: rectal prolapse, 5~10 cm long, conical, light red, the surface is circular and layered mucosal folds, thicker to touch, elastic, need to use hands to help return after the stool, often accompanied by anal relaxation.
Third degree: prolapse of rectum and part of sigmoid colon, more than 10 cm long, cylindrical in shape, with shallow annular folds, sphincter relaxation and weakness.
Auxiliary examinations include: proctoscopy, x-ray fecography, anorectal manometry .
Differential diagnosis
Internal hemorrhoid prolapse is a congested and swollen hemorrhoid mass, petal-like or granular, with visible bleeding, and on finger palpation: normal anal looseness. On proctoscopic examination, mucous membranes can be seen in the shape of petals and mucosal bulging masses of different sizes. The prolapsed internal hemorrhoid is prolapsed on the tooth line.
Intussusception: This disease usually occurs in the colon and sigmoid colon, with a high site and severe abdominal pain. Treatment The Ulcerology Insight Collection suggests that the treatment of the evidence of prolapse does not exceed the three methods of ascending, consolidating and benefiting Qi. This is in line with the treatment principle of “lifting the lower part of the body” of Huangdi Neijing.
Internal treatment: spleen deficiency qi trapped evidence syndrome God fatigue, yellow face and body fatigue, physical wasting, anal swelling, anal swelling, blood in the stool, poor nourishment, even dizziness and tinnitus, waist and knee weakness; light tongue, thin white coating, weak pulse, or thin. Treatment: Strengthen the spleen, benefit the qi, raise the yang and lift the trap and tonify the kidney essence. The formula tonic zhong yi qi tang combined with san ren tang plus reduction commonly used drugs raw astragalus, dang ginseng, atractylodes, hedgehog, ascending marijuana, Chai Hu, angelica, roasted licorice, large red dates, cypress kernel, whole melon atrophy; cachexia na less add wood fragrance, sand kernel. Damp-heat infusion evidence symptoms physical wasting, red face and body heat, anal swelling prolapse, purple or deep red, or even local mucous membrane erosion, ulceration, anal swelling is obvious; finger diagnosis of anal burning, more secretions; tongue red, yellow greasy coating, pulse string count. Treatment Clearing heat and dampness, raising Yang and lifting traps. The formula is Dioscorea Z percolating dampness soup combined with Sanmiao San plus or minus common drugs Ginseng, Astragalus, Asclepias, Scutellaria, Huanglian, Pueraria lobata, Bupleurum, Jiao Shanzha, roasted licorice, with lumbago, add Semen Cuscutae.
External treatment: cotton pad method: applicable to children, rectal prolapse after the return of the pagoda-shaped dressing stuffed in the anus, and then fixed; fumigation method: 10g of raw aromatic herb, 10g of thorny mustard, 10g of five times the seeds, thick decoction 1000ml fumigation, if inflammation can be added with 10g of silver flower, 10g of cypress. other therapies include anal lifting exercise, acupuncture and surgical treatment. Anal lifting exercise Twice a day, each time the anus is relaxed and tightened 30 times. It has the ability to strengthen the contraction of anorectal muscles and prevent relaxation. Acupuncture Take Baihui, Changqiang, Feet Sanli, Chengshan and Bars, or plum blossom needles to puncture in the external sphincter area around the anus.
Surgery: submucosal injection, perirectal injection, anal tightening, anal loop reduction, rectal mucosal resection can be used. Prognosis of prolapse Actively remove various precipitating factors, such as cough, sedentary standing, diarrhea, long-term cough, enteritis and other diseases. Non-surgical treatment is optional for first degree prolapse, and surgical treatment is available for second and third degree prolapse.
Prevention and care.
① Do not squat on the potty for a long time, develop the habit of regular bowel movements to prevent dry stools;
②Eat more fiber-rich foods and do not use excessive force to defecate;
③Women should take sufficient rest after giving birth, protect the function of the anal sphincter often do anal lifting exercises.