Proctoptosis

　　1. Underdevelopment factors

　　Children whose sacrum has not yet matured or adults with developmental defects, with a small forward bending angle of the sacrum, developing in a straight line, the rectum runs in a downward position, the position of the bladder or uterine陷窝 is higher, the rectum loses the supporting function of the sacral curve, and it is easy to shift downward when the intra-abdominal pressure increases, leading to rectal prolapse.

　　2. Pathological factors

　　This is the most common cause of disease in clinical practice. In a sense, prolapse is a complication or secondary disease. Conditions such as chronic consumptive diseases or malabsorption, malnutrition, internal hemorrhoids, rectal polyps, tumors protruding from the intestinal wall for a long time, elderly physical weakness, lumbar sacral nerve injury, are prone to weaken and relax the pelvic muscle groups and anal sphincter muscles, losing their supporting function for the anal canal and rectum. The submucosal tissue of the rectum becomes loose, and the mucosal layer and muscle layer lose their adhesive fixed function, causing the rectal mucosa to slip and shift downward.

　　3. Physical factors

　　Due to various reasons causing persistent intra-abdominal hypertension, the supporting tissues such as muscle groups, ligaments, and fascia around the rectum or pelvic floor cannot bear the pressure and become relaxed. Conditions such as urethral stricture, bladder stones, benign prostatic hyperplasia, difficulty in urination, heavy physical labor, obstinate constipation, chronic diarrhea, and multiple pregnancies are prone to cause rectal prolapse downward, which is known as rectal prolapse.

　　1. Underdevelopment factors
　　Children whose sacrum has not yet matured or adults with developmental defects, with a small forward bending angle of the sacrum, developing in a straight line, the rectum runs in a downward position, the position of the bladder or uterine陷窝 is higher, the rectum loses the supporting function of the sacral curve, and it is easy to shift downward when the intra-abdominal pressure increases, leading to rectal prolapse.
　　2. Pathological factors
　　This is the most common cause of disease in clinical practice. In a sense, prolapse is a complication or secondary disease. Conditions such as chronic consumptive diseases or malabsorption, malnutrition, internal hemorrhoids, rectal polyps, tumors protruding from the intestinal wall for a long time, elderly physical weakness, lumbar sacral nerve injury, are prone to weaken and relax the pelvic muscle groups and anal sphincter muscles, losing their supporting function for the anal canal and rectum. The submucosal tissue of the rectum becomes loose, and the mucosal layer and muscle layer lose their adhesive fixed function, causing the rectal mucosa to slip and shift downward.
　　3. Physical factors
　　Due to various reasons causing persistent intra-abdominal hypertension, the supporting tissues such as muscle groups, ligaments, and fascia around the rectum or pelvic floor cannot bear the pressure and become relaxed. Conditions such as urethral stricture, bladder stones, benign prostatic hyperplasia, difficulty in urination, heavy physical labor, obstinate constipation, chronic diarrhea, and multiple pregnancies are prone to cause rectal prolapse downward, which is known as rectal prolapse.

　　What complications are easily caused by rectal prolapse

　　First, bleeding

　　Occasionally, due to solitary rectal ulcer, massive hemorrhage may occur.

　　Second, anal incontinence

　　16% to 20% of gas incontinence, 17% to 24% complete incontinence. The causes of incontinence caused by rectal prolapse include:

　　1. Rectal prolapse causes substantial rectal dilation, leading to a persistent reflexive inhibition and relaxation of the internal anal sphincter, especially in the elderly due to weak puborectalis muscle, when the valve does not play a major role, if there is dysfunction of the internal sphincter muscle, it will cause incontinence;

　　1. Prolapse

　　This is the most common symptom of rectal prolapse. In the early stage, the rectal mucosa prolapses during defecation and returns to its original position spontaneously after defecation; as the condition progresses, the body's resistance gradually weakens, and if left untreated for a long time, the entire rectum or part of the sigmoid colon may prolapse, even during coughing, carrying heavy loads, walking, or squatting. It is not easy to return to its original position and needs to be pushed back by hand or after lying down for a rest before it can be复位.

　　2. Moisture

　　Some patients may experience relaxation and weak contraction of the anal sphincter muscle, with mucus often溢出 from the anus, causing a moist feeling. Or because of its prolapse, it is not timely复位, the rectal mucosa becomes congested, edematous, or eroded, and the mucus stimulates the perianal skin, causing itching.

　　3. Distension

　　Due to submucosal prolapse, it causes intussusception of the rectum or colon, compresses the anal area, produces distension, and some may feel distension in the groin and lumbar sacral area.

　　4. Bleeding

　　There are usually no bleeding symptoms, but occasionally during constipation, there may be oozing from the injured mucosa, blood in the stool, or blood when wiping with toilet paper, but the amount of bleeding is usually small.

　　5. Incarceration

　　When defecating, if the anal and rectal prolapse is not timely复位, the local venous return is obstructed for a longer period of time, leading to inflammation and swelling, and even incarceration. At this time, the mucosa gradually turns from red to dark red, and even superficial mucosal erosion and necrosis may occur, or the prolapsed intestinal segment may be strangulated and necrotic due to the contraction of the anal sphincter muscle. The symptoms of the patient also develop from local reactions to systemic symptoms, with fever, decreased appetite, difficulty in urination, constipation, intensified pain and distension, restlessness, and in severe cases, symptoms of intestinal obstruction may occur.

　　Patients with rectal prolapse should persist in physical exercise and strengthen abdominal muscle exercises to improve the condition of Qi and blood deficiency and insufficient middle Qi, which is of great practical significance for consolidating the efficacy and preventing rectal prolapse. Specific preventive measures include:

　　1. Actively eliminate various triggering factors, such as cough, prolonged sitting or standing, diarrhea, chronic cough, enteritis, and other diseases, especially for infants and young children.

　　2. Pay attention to increasing nutrition and regularizing life, do not sit on the toilet pot for a long time, develop the habit of regular defecation, prevent constipation, and take a hot water sitz bath after defecation and before going to bed to stimulate the contraction of the anal sphincter muscle, which has a positive effect on preventing rectal prolapse.

　　3. Patients with habitual constipation or difficulty defecating should eat more fiber-rich foods and do not strain too hard during defecation.

　　4. Women should rest sufficiently during childbirth and postpartum to protect the normal function of the anal sphincter muscle. Those with uterine prolapse and visceral prolapse should be treated in a timely manner.

　　5. Regularly do anal exercises to promote the movement of the analis muscle group, which has the effect of enhancing the anal sphincter muscle function and has a certain preventive effect on this disease.

　　The above are the preventive measures for rectal prolapse, which are very effective for physical health. Prevention is better than treatment, and combination of prevention and treatment is better.

　　1. Abdominal fluoroscopy or plain film

　　Abdominal fluoroscopy or plain film can give a general understanding of abdominal organs, especially it can see whether there is free gas under the diaphragm, and can detect air and fluid in the intestinal lumen, which is very helpful for diagnosing colonic perforation, colonic obstruction, and the degree of anal canal atresia, and is also a commonly used examination method for acute abdominal pain.

　　2. Barium enema

　　This method is mainly used to observe the lesions of the large intestine, such as polyps, cancer, diverticula, and inflammation, etc. It is contraindicated for intestinal perforation, acute hemorrhage, and infectious diseases. This method is a method of examining the colon by oral administration of barium or barium enema. Since this method shows the physiological state of the colon more ideally, it has great diagnostic value for colonic lesions. Gas-barium double contrast examination is beneficial for the display of minor lesions.

　　3. Defecation造影 examination

　　Defecation造影 is a physiological state examination used to determine the possible functional or organic lesions of the rectum, mainly applicable to difficulties in defecation, fecal incontinence, rectal constipation, urgency, non-diarrheal mucous or bloody stools, abdominal pain or perineal pain during defecation, and patients with clinical suspicion of rectal prolapse.

　　4. Fistulography

　　This method is mainly used for the examination and diagnosis of complex anal-rectal fistulas. It often uses iodine oil or iodine-containing water solutions for contrast, which can clearly show the direction of the fistula or sinus tract.

　　5. CT examination

　　The CT examination of the large intestine is mainly applicable to: preoperative staging and prognosis evaluation of malignant tumors; differentiation of intraluminal and extraluminal masses; the presence or absence of metastasis and recurrence after treatment of malignant tumors; in cases where no definite lesions are found in gastrointestinal contrast studies and endoscopic examinations, but there are unexplained symptoms of the colon; difficulty defecating, fecal incontinence, rectal constipation, urgency, non-diarrheal mucous or bloody stools, abdominal pain or perineal pain during defecation, and clinical suspicion of rectal prolapse.

　　6. Colonic angiography examination

　　Colonic angiography is mainly used for differential diagnosis of colorectal tumors, inflammation, and hemorrhage, especially malignant tumors. Angiography can show the extent of lesion spread and extraintestinal infiltration, as well as whether there is metastasis to other organs, which is of great significance for determining the indications for surgery and judging the prognosis.

　　7. Lymphography

　　Lymphography can predict the presence and location, extent, and degree of lymph node metastasis in colorectal cancer, which is an auxiliary method for judging the progression of the tumor and a strong indication for lymph node dissection during surgery.

　　8. Ultrasound Examination

　　Mainly used for patients diagnosed with rectal cancer and colon cancer to understand whether there is liver, pancreas, and biliary metastasis. B-ultrasound examination can detect metastatic foci with a diameter of 1.5-2 cm.

　　Patients with rectal prolapse should adjust their diet, especially the elderly should take a balanced intake of various nutritional ingredients, including moderate amounts of fat, protein, starch, vitamins, minerals, etc. Avoid excessive drinking and smoking, and live a regular life. Secondly, drink more water, eat more vegetables and fruits, and avoid cold and spicy, fried and fried foods that help fire. For those with spleen deficiency and qi collapse, the diet should be warm and hot, and cold and hard foods should be avoided.食疗方可有黄芪党参大枣粥，海参瘦肉汤。For those with downward injection of damp heat, foods such as watermelons, mung beans, celery, etc., can be given, and食疗方可有猪大肠炖糯米绿豆，鳝鱼。Eat more vegetables and fruits, and less spicy and刺激性 foods.

　　First, General Treatment

　　Regular defecation, do not squat for too long, avoid constipation or diarrhea, and immediately return to normal after defecation to improve the local condition. Instruct the patient to contract the anus multiple times a day to increase the ability of the anal sphincter muscle.

　　Second, Injection Therapy

　　Submucosal injection of hardening agent for the treatment of some prolapse patients, injecting medicine at four points (front, back, left, right) under the rectal mucosa, 1-2 ml per point. Injection around the rectum can treat complete prolapse, cause aseptic inflammation, and fix the rectum. Common drugs include 5% phenol vegetable oil or glycerin solution, etc.

　　Third, Surgical Treatment

　　1. Mucosal Prolapse Excision

　　For patients with partial mucosal prolapse, the prolapsed mucosa is excised and sutured.

　　2. Anal Ring Suture

　　Under anesthesia, two small incisions are made in front and behind the anus. A hemostat is used to make subcutaneous incisions around the anus to make the two incisions communicate, and a metal wire (or polyester tape) is inserted to form a ring, allowing the anus to pass through one finger, to stop rectal prolapse.

　　3. Rectal Sling Surgery

　　For patients with severe complete rectal prolapse, an abdominal operation is performed. Two aponeuroses (rectus sheath, silk, nylon, etc.) are used to suspend and fix the rectum on the sacral aponeurosis, and the rectal fossa is sealed to strengthen the support of the rectum.