1 What is rectal prolapse
Rectal prolapse refers to a disease in which the anal canal, rectal mucosa, the entire thickness of the rectum and even the sigmoid colon move downwards and prolapse outside the anus. With the deepening of research on rectal prolapse in the medical field, some scholars have also put forward the concepts of incomplete rectal prolapse, complete rectal prolapse, and rectal mucosal prolapse. That is, only the rectal mucosa prolapses from the anus is called incomplete rectal prolapse; the rectal mucosa is loose and the prolapse is limited to the rectal cavity (not prolapsed from the anus), which is called rectal mucosal prolapse or inner intussusception.
2 "Anus prolapse" is rectal prolapse?
The common folk name "prolapse of the anus" is very wide. Because people have lumps or fats that protrude from the anus to the outside of the anus, it is called "prolapse". This will cause internal hemorrhoids to be prolapsed, incarcerated, and inflammatory external hemorrhoids. Even thrombotic external hemorrhoids are mistaken for "prolapse of the anus", of course, this also includes true rectal prolapse. It can be seen that the popular term "prolapse of the anus" includes rectal prolapse and partial prolapsed hemorrhoids. In modern medicine, rectal prolapse refers to the prolapse of the rectum and rectal mucosa. The two should not be confused.
3 How to distinguish rectal prolapse and hemorrhoid prolapse?
Rectal prolapse and hemorrhoid prolapse are two completely different diseases, but because the two manifestations have something in common, that is, there are tumors that protrude from the anus to the outside, so they are often confused by the patient, so they should be differentiated.
When rectal prolapse, what protrudes from the anus to the outside of the anus is the rectal mucosa or the entire thickness of the rectum, protruding in concentric circles, the color is pink and fresh flesh, without obvious pain. When hemorrhoids prolapse, the internal hemorrhoids that protrude from the anus to outside the anus are enlarged or congested and swollen. They are prolapsed like plum petals, purple or deep purple in color, and painful. In summary, the main points to distinguish between the two are to look at the color, shape and pain of the tumor protruding from the anus.
4 Why does rectal prolapse occur?
Modern medicine believes that rectal prolapse occurs because the supporting tissues around the anorectum have congenital defects, dysplasia, or decline, which cannot provide adequate support to the rectum. As a result, the rectum shifts downward and protrudes out of the anus. Therefore, all factors that can weaken the support and fix the anorectal tissue to support and fix the anorectum are the causes of rectal prolapse. These causes can be summarized in three aspects.
(1) Weakness of supporting tissues: For example, long-term illness, frailty, aging, general malnutrition, etc. can make the supporting tissues weak and weak.
(2) Support tissue fatigue damage: long-term constipation, chronic diarrhea, chronic bronchus cough, multiple childbirths, etc., continuously increase intra-abdominal pressure, support tissue fatigue damage under long-term high pressure, and lose its fixation effect on the anorectum.
(3) Nerve damage or dysfunction: damage to the lumbosacral nerve and the dysfunction of the anal nerve can relax the anal sphincter, cause fecal incontinence, and rectal mucosal prolapse.
5 Why is rectal prolapse common in children?
Rectal prolapse in children is a common disease in children, most of which occur between 2 and 4 years old. However, it is rare within 1 year old and over 5 years old, and there is little gender difference. Rectal prolapse in children is mainly due to the imperfect development of the supporting tissues of the pelvic cavity in children. For example, the curvature of the sacrum has not been formed, leaving the rectum in a vertical state and lacking strong support from the sacrum. In addition, the surrounding tissues of the rectum are weak and unable to fully support the rectum. On the basis of this congenital disadvantage, if coupled with the precipitating factors such as acquired malnutrition, dysentery, diarrhea, dry stool, pertussis, etc., it will make the rectum of children Prone to prolapse. Infants under 1 year old rely on milk as a staple food, rich in nutrition, smooth stools, and innately obtain some antibodies from the mother, so they are not easy to get sick, so rectal prolapse is rare; pelvic support tissues in children over 5 years old are gradually developed and can help The rectum produces strong support and fixation, so rectal prolapse is also rare.
6 How does TCM recognize rectal prolapse?
Rectal prolapse is a term in western medicine, and it is called prolapse in Chinese medicine. Chinese medicine believes that rectal prolapse is a local manifestation of the loss of blood and qi throughout the body. Qi has the five functions of promotion, warmth, defense, solidification, and gasification. The blood has nourishing and nourishing functions, and the qi and blood can also regenerate each other. Prolapse of anus is mainly caused by problems with the function of qi's solidification. Due to the deficiency of qi, it is impossible to effectively control and fix the anorectum. Therefore, when there are predisposing factors such as dry stool and diarrhea, it is easy to cause anorectal prolapse. Traditional Chinese medicine believes that the spleen and stomach in Zhongjiao have the function of metaplasia and control of qi and blood, and the spleen will rise. During the diagnosis and treatment, the prolapsed anus is returned to the spleen and stomach, which is considered to be caused by the deficiency and cold of the spleen and the stomach or the depression of the spleen. This theory of traditional Chinese medicine better explains the reason why the elderly and children are prone to prolapse of the anus, that is, "the blood of the elderly is weak, and the blood of the children is not strong."
7 What is the incidence of rectal prolapse?
In 1977, China conducted a survey on anorectal diseases. Among 30,378 patients with anorectal diseases, 176 were suffering from rectal prolapse, and the incidence was only 0.58%. The incidence of anorectal diseases such as hemorrhoids, fissures and fistulas is significantly lower. However, the incidence of rectal prolapse is closely related to age. As we have said before, due to poor development of the supporting and fixed tissues around the anorectum, congenital defects, acquired recession, etc., it is easy to dislocate the rectum downward, so rectal prolapse The morbidity rate is higher in children, elderly and weak, and menstrual women. There is no significant difference in the morbidity between men and women.
Understanding the incidence and etiology can enable us to prevent rectal prolapse in a targeted manner.
8 What are the clinical manifestations of rectal prolapse?
There are four main clinical manifestations of rectal prolapse, namely prolapse, bleeding, dampness and swelling. Prolapse of rectal or rectal mucosa from the anus to outside the anus is the most important symptom. At first, the rectal mucosa is prolapsed during defecation, and it can be repaid by itself after defecation. For a long time, it is not only during defecation, but also increases the abdomen when coughing, walking, and working hard. When pressed, the rectum can also protrude outside the anus. Rectal prolapse has a small amount of bleeding, only when the stool is bloody or stained on the toilet paper, it is not necessary to bleed. In patients with rectal prolapse, the anal sphincter muscles are generally loose or weak, so mucus will often overflow from the anus, causing the anal mouth to be moist or even itch. If the sigmoid colon is invaded with the rectum, it presses on the anus and affects the return of blood and lymph, and it also produces a feeling of bulging.
In addition, patients with rectal prolapse can also see symptoms such as lumbosacral soreness.
9 How many degrees is rectal prolapse?
In the past, rectal prolapse was divided into two types: complete rectal prolapse and incomplete rectal prolapse. In order to better guide clinical practice, the National Anorectal Conference in 1975 unified standards and divided rectal prolapse into three degrees. details as follows.
Degree I prolapse: When defecation or increased abdominal pressure, the rectal mucosa protrudes out of the anus, within 3 cm in length, and the prolapsed part can be absorbed by itself after defecation, and there is generally no obvious conscious I symptoms.
Second-degree prolapse: full-thickness rectal prolapse when defecation or increased abdominal pressure. The length is 4-8 cm. It cannot be repaid by itself, and it needs to be repaid by hand. It is often accompanied by anal sphincter relaxation.
Ⅲ degree prolapse: The anal canal, rectum, and part of the sigmoid colon protrude outside the anus when defecation or increase abdominal pressure, and the length is more than 8 cm. It is difficult to reset by hand. May be accompanied by anal sphincter relaxation, rectal mucosal erosion, hypertrophy, blood in the stool, fecal incontinence and other symptoms.
10 How many ways are there to treat rectal prolapse?
There are three types of treatment for rectal prolapse: conservative treatment, injection treatment, and surgical treatment. Which method is used depends on the degree and condition of the patient's rectal prolapse. Both conservative treatment and injection treatment are non-surgical treatment methods, and are currently the main treatment methods used in clinical treatment of rectal prolapse.
11 How to treat rectal prolapse conservatively?
The conservative treatment of rectal prolapse is actually the treatment method of traditional Chinese medicine; specifically, it is divided into four types: oral Chinese medicine, external washing of Chinese medicine, acupuncture and acupoint injection.
The oral administration of traditional Chinese medicine is based on the differentiation of symptoms and signs of traditional Chinese medicine. Since rectal prolapse is mainly caused by spleen deficiency and subsidence of middle qi, the treatment principle of Chinese medicine is to invigorate the middle and replenish qi and raise the yang. Common medicines include Buzhong Yiqi Pill and Shiquan Dabu Pills, Jinkui Shenqi Pills, etc., can also be taken orally in decoctions based on the treatment principle. Chinese medicine external washing method uses Chinese medicine decoction to wash the sitz bath. Because the rectum is out of the anus, the treatment principle of external sitz bath is to astringent, dry dampness and relieve itching. Commonly used medicines include gallnut, pomegranate peel, alum, borneol, and atractylodes. , Jingping, Lushen, Kochia scoparia, Cnidium, Qianghuo, etc. Acupuncture is often referred to as acupuncture. The treatment principle is also ascending and lifting, fixing the support, and commonly used acupoints are Baihui, Changqiang, Zusanli, Chengshan, Cimu, and Dachangshu. The acupoint injection method can also be said to be a combination of traditional Chinese and western medicine. Generally, the western medicine vitamin B12 injection is used for closed injection (vitamin B12 500 micrograms) at the Changqiang point, once a day for three consecutive times, which has a better effect on children with rectal prolapse. In short, conservative therapy is only suitable for first-degree prolapse, mucosal prolapse and rectal prolapse in children.
12 What are the surgical methods to treat rectal prolapse?
Rectal scar support and fixation is also called columnar ligation of rectal prolapsed mucosa, which is about ligating the prolapsed mucosa, and after the necrosis falls off, multiple columnar scars are formed to support fixed points to prevent rectal prolapse. Clinically, this method is often used in combination with injection, and the effect is very good.
In addition, in recent years, there is a PPH method at home and abroad to treat rectal mucosal prolapse, that is, the prolapsed rectal mucosa is bandaged with a stapler. This method has a good effect on prolapse within the rectal mucosa and first-degree rectal prolapse.
13 What are the advantages and disadvantages of the various methods for treating rectal prolapse?
The advantages of conservative treatment are low cost and no obvious pain; the disadvantage is that the curative effect is not very high, and the effect of rectal prolapse of more than Ⅱ degree is not good.The advantage of injection therapy is that the cost is relatively low, the pain is less, and the effect is better; the disadvantage is that the low concentration of injection sclerosant affects the curative effect, and the high concentration is prone to local necrosis and bleeding. In addition, in terms of operation technology, the effect of shallow injection is not good. , Injecting too deeply into the muscle layer will cause severe pain and other serious consequences. There is also a perirectal space injection method, which is difficult to operate and has a good effect; but it is prone to infection, resulting in complications such as high perianal abscess and high anal fistula. The advantage of the surgical method is that the cure rate is high, but the disadvantage is that the cost is high, and there are relatively more complications and sequelae. The advantages of PPH treatment are less postoperative pain and quick recovery; the disadvantage is that there are many complications, such as postoperative bleeding, submucosal hematoma, anastomotic stenosis, etc., and it is expensive and requires rich operating experience.
In summary, none of the methods are perfect. The best way is to prevent the disease first, see if the disease occurs early, and actively treat the rectal mucosa with first degree prolapse. The more severe the prolapse, the better the treatment effect. difference.
14 What preparations should be made before rectal prolapse surgery?
As a patient, some necessary preparations should be made to cooperate with the operation the day before the rectal prolapse operation. First of all, relax and don't be nervous, because rectal prolapse surgery is not life-threatening and generally does not bleed. Because the rectum is innervated by autonomic nerves, it is not sensitive to pain; therefore, there is no obvious pain after surgery. Second, eat semi-liquid food at lunch on the previous day, and have liquid food or no food for dinner, so that no bowel movement is allowed within 48 hours after surgery. Third, cooperate with other preoperative work such as skin preparation before soil protection operation. In addition, during the operation, if you have any discomfort, such as nervousness, palpitation, nausea, pain, improper posture, etc., you should tell the medical staff in time so that the medical staff can know your physical condition at any time and take prompt measures. To avoid unnecessary troubles and accidents.
15 What is the prolapse of the rectal mucosa?
Intrarectal mucosal prolapse refers to the rectal mucosa that is loose, soft, and hangs in the rectal cavity, but does not protrude outside the anus, so the prolapsed mucosa cannot be seen during anal inspection. A digital anal examination can touch the soft mucous membrane that has accumulated in the intestinal cavity, and it feels like a handshake when moving the fingers. Anoscopy can see that the rectal mucosa is loose and prolapsed, and it is not easy to see the opening of the intestinal cavity.
Clinically, there is no classification or grade for rectal mucosal prolapse, but it is classified into the range of I degree prolapse in rectal prolapse.
The cause of rectal mucosal prolapse is not completely understood. It is currently considered to be a degenerative change of the rectum itself, because the incidence of rectal mucosal prolapse increases with age.
16 Is the cause of rectal mucosal prolapse the same as rectal prolapse?
Rectal prolapse is a congenital defect, dysplasia or decline of the supporting tissues around the anorectum, which cannot provide adequate support to the rectum, causing the rectum to shift downward and prolapse out of the anus. There are two points to pay attention to here. One is that the cause of rectal prolapse has congenital factors, and the other is that the rectum or rectal mucosa prolapses outside the anus. Therefore, children, the elderly and the infirm are the main targets in clinical practice.
The cause of prolapse in the rectal mucosa is a degenerative change of the rectum itself, and has no obvious relationship with the supporting tissues around the rectum. Due to degenerative changes, the rectal mucosa gradually loses its elasticity and becomes loose and droops with age. However, the loose and drooping mucosa only blocks the intestinal cavity and does not fall outside the anus. Therefore, intrarectal mucosal prolapse is more common in the age of 40. The above crowd is rarely seen by people under 40. According to our observations, there are more prolapses in the rectal mucosa of women than men. We speculate that there are two reasons: one is that the muscle strength of women is weaker than that of men, such as the strength of abdominal muscles; The wall is the posterior wall of the vagina, which is relatively weak. When stool enters the rectum, it hits this wall forward. Over time, the anterior wall of the rectum is strained and relaxed, so there are more cases of prolapse of the rectal mucosa. For men.
Does rectal mucosal prolapse occur at the age of 17 and over 40?
In theory, the older the age, the greater the chance of prolapse in the rectal mucosa, but not everyone will happen. Judging from the actual clinical situation, the degree of prolapse within the rectal mucosa varies from mild to severe, and the clinical symptoms are also mild to severe. We found that some people are not too old but the degree of intramucosal prolapse is heavier and the symptoms are more obvious; some people are very old, but the degree of intramucosal prolapse is obvious. This shows that age is not directly proportional to the degree of intramucosal prolapse, and not every person over 40 years old will have rectal mucosal prolapse, but it is a fact that the incidence is high in older people. Rectal intramucosal prolapse There is no statistical data on the incidence of, especially the incidence of people over the age of l.
18 What are the clinical manifestations of prolapse in the rectal mucosa?
The clinical manifestations of prolapse in the rectal mucosa are mainly uncomfortable stools. The patients often have stools that are not dry, or the stools are first dry and then soft, the stool is not painful, the stool is difficult to pass, the defecation time is significantly prolonged, and there are people who want to defecate after defecation. Feel or feel that there is no toilet clean. This symptom occurs because the rectal cavity is filled with loose and soft mucous membranes, which makes it difficult for stool to pass through. It takes a lot of effort to pass stool. It is like walking in soft sand is more laborious than walking on asphalt roads. same. Therefore, patients with prolapse of the rectal mucosa are more painful when defecation.
19 How does traditional Chinese medicine recognize the prolapse of the rectal mucosa?
Traditional Chinese medicine does not have the name of "rectal mucosal prolapse". According to the clinical manifestations of rectal mucosal prolapse, the stool is not dry but difficult to get out. The patient's physique is obese, muscle relaxation, abdominal muscle relaxation, etc., which should belong to the category of spleen-qi deficiency, insufficient middle-qi, and subsidence of middle-qi. Traditional Chinese medicine believes that the spleen controls the limbs and muscles, which can dissipate qi and blood. If the spleen is strong, the qi and blood are sufficient. The muscles of the limbs rise. The fixed position of the organs of the body is the result of the rise and support of the spleen. The organ may fall out of position and sag. Therefore, the TCM syndrome differentiation of the rectal mucosal prolapse should belong to the syndrome of spleen deficiency and qi depression.
20 How does TCM treat rectal mucosal prolapse? How's the effect?
Prolapse of the rectal mucosa belongs to the syndrome of spleen deficiency and qi depression. The treatment principle is to replenish qi and promote yang. The classic prescription is Buzhong Yiqi Decoction or Buzhong Yiqi Pill, but the problem that the patient needs to solve is difficulty in defecation, so it is difficult for the rectal mucosa. For patients with spleen deficiency and qi depression such as prolapse, the treatment principle should be to replenish qi and moisturize the intestines. It is better to add a laxative to moisturize the intestines on the basis of replenishing qi, but it is easy to repeat after stopping the drug. The topical Chinese medicine sitz bath is ineffective in treating rectal mucosal prolapse.
The recommended oral prescriptions for traditional Chinese medicine are as follows: Codonopsis 10g, Atractylodes macrocephala 10g, Astragalus 10g, Tangerine peel 12g, Angelica 10g, Cohosh 3g, Chaihu 6g, Roasted licorice 3g, Hemp seed 30g, Baiziren 10g , Yu Liren 10 grams, almonds 6 grams, decoction and warm, one dose a day. If the stool is dry, you can add 6 grams of rhubarb or 6 grams of sodium sulfate.
21 What else is there to treat prolapse of the rectal mucosa?
To treat rectal mucosal prolapse, in addition to taking Chinese medicine, acupuncture and Xiaozhiling injection can also be used.
The principle of acupuncture for the treatment of rectal mucosal prolapse is the same as the commonly used acupoints and acupuncture for the treatment of rectal prolapse. However, due to the scarce clinical data in this area, its therapeutic effect cannot be evaluated at present.
The injection of Xiaozhiling (also Shaobei injection) is the most commonly used method in clinical practice. The operation method and procedure are basically the same as the injection method for the treatment of hemorrhoids, but the treatment of hemorrhoids is to choose three The female hemorrhoids area is injected columnar from top to bottom. In the treatment of rectal mucosal prolapse, it is injected wherever the prolapse is loose. In general, the treatment of rectal mucosal prolapse is mainly injected into the anterior wall of the rectum (especially in women), so the anterior wall of the rectum is the key area for injection treatment.
In addition, PPH method can also be used to treat rectal mucosal prolapse, which has been reported.
There is no report about the treatment of rectal mucosal prolapse with oral western medicine.
22 How to care for rectal prolapse after surgery?
(1) Prolapse occurs in stereo position or walking. After surgical treatment, although the prolapsed mucosa is fixed, the firmness of the fixation has to go through a process, so within a week after rectal prolapse surgery, stay in bed more and less exercise to consolidate the effect.
(2) Prohibition of bowel movements within 2-3 days after surgery, because bowel movements are not good for the recovery of rectal prolapse surgery, so bowel movements should be forbidden in the first few days to consolidate the effect.
(3) 3 days after the operation: semi-liquid or liquid food should be eaten to reduce the amount of feces. After 3 days, you can eat general food, but you should eat more vegetables and fruits to avoid dry stool and affect the effect of surgery.
(4) For the first bowel movement after the operation, it is best to use 1-2 bottles of Kesai Lotion 20-40ml for laxative. The advantage is that even if the stool is dry, you can go down smoothly. If the bowel movement is normal, the second bowel movement is OK. No need to Kaisailu.
23 How to prevent rectal prolapse?
The prevention of rectal prolapse mainly starts from the following three aspects.
(1) Insist on physical exercise: Physical exercise can strengthen the muscles, and special attention should be paid to exercise the strength of the abdominal muscles, such as sit-ups; and do levator ani exercises every day to strengthen the strength of the anal sphincter. These exercises have direct benefits in preventing rectal prolapse. The exercise method of the levator ani exercise is very simple. Tighten and relax the anus once, do 20 times continuously as a group, and do 1-2 groups from time to time every day.
(2) Pay attention to rest and strengthen nutrition: excessive fatigue, especially physical labor, consumes gas and blood in the elderly, and also reduces the body's resistance, which easily leads to a loss of qi and blood and sinks in the qi. Resting can restore physical strength; strengthening nutrition can make Qi and blood vigorous and prevent qi depression.
(3) Active treatment of some diseases that may lead to rectal prolapse: such as dry stool, constipation, diarrhea, cough with chronic bronchus, etc.