Prolapse

　　What are the causes of prolapse?

　　1. Congenital deficiency, incomplete development, lack of surrounding soft tissue support for the rectum, and insufficient support from the sacral curvature;

　　2. Long-standing illness, malnutrition, or chronic diarrhea and dysentery can absorb the fat in the ischiorectal fossa, causing the rectum to lose support

　　3. Deficiency of Qi and blood, weakness of the aging body, multiple deliveries in women, relaxation of pelvic muscles, difficulty in retention, bladder stones, chronic cough, and other diseases that increase abdominal pressure persistently can lead to relaxation of the submucosal tissue of the rectum, separation of mucosa and muscular layer, resulting in prolapse;

　　4. Third-degree hemorrhoids, rectal and anal polyps, rectal and anal tumors, and other diseases often lead to relaxation of the anal canal sphincter, downward traction of rectal mucosa, and also occur after hemorrhoid ligation surgery, damaging the anal canal skin, forming prolapse of rectal mucosa outside the anal canal.

　　Complications of prolapse

　　1) In the early stage of prolapse, there is constipation, irregular defecation, a constant feeling of fullness in the rectum and incomplete defecation. A mass may prolapse during defecation but can be spontaneously retracted.

　　2) As prolapse gradually worsens, in addition to prolapse caused by straining during defecation, prolapse can also occur during coughing, walking, or other situations where abdominal pressure is slightly increased. It often cannot be spontaneously retracted and must be manually pushed back into the anus. Due to frequent prolapse, the discharge of mucus can frequently stain the underwear.

　　3) When the rectal mucosa is damaged and ulcers occur due to prolapse, bleeding and diarrhea may also occur. If the prolapsed mass cannot be retracted, it is prone to inflammation and swelling, leading to pain and further exacerbating constipation.

　　4) Repeated descent and retraction of prolapse within the rectum, causing mucosal congestion and edema. Often, a large amount of mucus and bloody material is discharged from the anus. Patients often feel a sense of sagging and dragging in the pelvic and lumbar sacral regions, dull pain in the perineum and posterior thigh, etc.

　　Typical symptoms of prolapse

　　Main symptoms: Repeated prolapse of rectal mucosa and rectum. Clinically, anal relaxation and prolapse can be divided into three degrees, with symptoms including:

　　First-degree prolapse:Rectal mucosal prolapse, with prolapsed material appearing pale red, 2 to 6 centimeters in length, soft to the touch, without elasticity, not prone to bleeding, and can be spontaneously retracted after defecation.

　　Second-degree prolapse:It is the complete prolapse of the rectum, with a prolapsed length of 6 to 10 centimeters, cone-shaped, pale red, with annular and stratified mucosal wrinkles on the surface, thick to the touch, elastic, the anus is relaxed, and sometimes you need to use your hand to recover after defecation.

　　Third-degree prolapse:Rectum and part of the sigmoid colon prolapse, more than 9 centimeters long, cylindrical, thick to the touch, and the anus is relaxed and weak.

　　Prolapse should be distinguished from some diseases: the first-degree rectal prolapse should be distinguished from internal hemorrhoid prolapse. When internal hemorrhoids prolapse, the hemorrhoids are in pieces, without annular mucosal wrinkles, dark red or purple, and easy to bleed.

　　In addition, some diseases should be distinguished from prolapse. Distinguish among the three types of rectal prolapse: rectal prolapse outside, rectal mucosal prolapse, and rectal prolapse inside.

　　1. Rectal prolapse outside:The patient squats down to perform defecation, and the abdominal muscles contract, and prolapse will occur. Partial prolapse can see round, red, smooth tumors, with mucosa呈放射状皱纹, soft texture, and retract spontaneously after defecation. If it is complete rectal prolapse, it will prolapse longer, with a pyramid-like or spherical shape, with visible annular rectal mucosal wrinkles on the surface. If there is an ileum in the prolapse, sometimes you can hear bowel sounds.

　　2. Rectal mucosal prolapse:It needs to be distinguished from circumferential internal hemorrhoids. What should be done if there is anal pain after defecation? The history is different, and when the circumferential internal hemorrhoids prolapse, you can see inflamed and swollen hemorrhoids,呈梅状, easy to bleed, and normal mucosa between the hemorrhoids. Rectal examination shows strong contraction of the sphincter muscle, while rectal mucosal prolapse is relaxed, which is an important differential point.

　　3. Rectal prolapse inside:Anorectal contrast study is needed to assist in diagnosis. What should be done if there is anal pain after defecation? When the patient reports a blockage in the rectal ampulla and a feeling of incomplete defecation, this disease should be suspected.

　　What methods can prevent prolapse?

　　1. Anal lifting exercise: Sit quietly, relax, tighten your buttocks and thighs, close your eyes, and lift the anus upwards while inhaling. After lifting the anus, hold your breath for a moment, then relax the whole body while exhaling. Perform 90 times each time. Do it three times a day, once after defecation and before going to bed. It has the effect of enhancing the anal sphincter muscle function and has a certain preventive effect on the disease.

　　2. Supine knee bending exercise: Lie on your back, bend your knees, lift your head, extend your right hand to the left knee, then relax and return; then bend your knees, lift your head, extend your left hand to the right knee, and relax and return. Perform 30 times each time.

　　3. Quick contraction exercise: Quickly contract the anus, perform 30 times per minute, and do 2-3 times a day.

　　4. Anal dilatation exercise: Apply a moderate amount of lubricant to the index finger of the right hand, massage the anal orifice for 1 minute, then slowly insert it into the anus to reach 2 phalanges, and dilate the anus in all four directions (front, back, left, and right) for 3 minutes. Use even force and avoid using inappropriate violence. Perform once after defecation and before going to bed.

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

　　6. Pay attention to increase nutrition and maintain a regular lifestyle. Avoid sitting on the toilet for a long time, develop the habit of defecating at regular times to prevent constipation. You can use hot water to sit in the 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.

　　7. For patients with habitual constipation or difficult defecation, in addition to eating more fiber-rich foods, do not strain too hard during defecation.

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

　　What to check for rectal prolapse

　　1. Anal inspection: it can be found that soft mass-like intestinal mucosa prolapses out of the anus during defecation, and the intestinal mucosa can be seen to prolapse from the anus during the patient's defecation movement.

　　2. Rectal examination: it is a simple, easy, and very important clinical examination method in which the doctor inserts a finger into the patient's anus.

　　3. Routine blood, urine, and stool tests.

　　4. Rectal endoscopy: it is the examination of the rectum using a rectoscope.

　　5. Barium enema: to understand whether there is an overly long sigmoid colon.

　　6. Defecation contrast study: the rectal intussusception appears first during forceful defecation, and then develops into rectal extrusion.

　　Dietary health care for rectal prolapse patients

　　Mung bean and glutinous rice pig's large intestine

　　Ingredients: 60 grams of mung beans, 30 grams of glutinous rice, 300 grams of pig's large intestine.

　　Preparation: First, clean the pig's large intestine thoroughly, soak mung beans and glutinous rice in water for half an hour, then put the mung beans and glutinous rice into the large intestine and add an appropriate amount of water, tie the ends of the intestine with thread, and boil it in a pot with water for about 2 hours. Take once every other day, and take 7 to 8 days as one course.

　　Effects: tonify the middle, benefit Qi, clear heat and detoxify, and relieve constipation and dysentery. Suitable for damp-heat dysentery, hematochezia, early hemorrhoids, and rectal prolapse.

　　Boiled jujube with old vinegar

　　Ingredients: 250 milliliters of old vinegar, 120 grams of jujube.

　　Preparation: First, wash the jujube clean, and put it in a pot with old vinegar, add water and boil over high heat until the vinegar water is dry. Eat the jujube in 2 to 3 doses, one dose per day.

　　Effects: tonify Qi, dissipate blood stasis, and detoxify. Suitable for chronic rectal prolapse that does not respond to treatment.

　　Astragalus and Cimicifuga four herbs tea

　　Ingredients: 30 grams of raw Astragalus, 3 grams of Cimicifuga and Apis mellifera, 10 grams of Prunus salicina.

　　Preparation: Grind the above four herbs into coarse powder, place them in a thermos flask, pour boiling water over them, cover and steam for 20 minutes. Drink frequently as tea, one dose per day.

　　Effects: tonify Qi and elevate, moisten intestines and promote defecation. Suitable for children with Qi deficiency and prolapse of the rectum, manifested as frequent prolapse, inability to self-retract, dry stools, yellow urine, loss of appetite, and weak pulse. (As the husk of Prunus salicina has a strong effect on moistening intestines and promoting defecation, it should not be used for children with spleen deficiency and Qi sinking with loose stools; 10 grams of Fructus tsaoko can be used instead).

　　How to treat prolapse of the rectum

　　Surgical methods

　　The treatment of adult rectal prolapse mainly relies on surgical treatment. Different surgical methods can be adopted according to the degree of anal prolapse and the condition of anal sphincter muscles: for example, for grade II to III prolapse with obvious mucosal relaxation, it is advisable to perform anal tightening or anal ring reduction surgery. For grade III prolapse with complete anal incontinence, methods such as external sphincter plication should be adopted. Surgical treatment is relatively complex and requires high conditions, so patients must go to a regular hospital's anorectal department for treatment.

　　Western Medicine Treatment

　　The conservative treatment of internal medication, external medication, and adhesive medication can improve symptoms, but it is not only slow in taking effect but also difficult to eliminate the focus, not thorough. Long-term use is expensive and has side effects on the body.

　　Common methods for treating rectal prolapse: First, surgical treatment; second, injection therapy; third, internal and external application of traditional Chinese medicine, all of which have their limitations. Surgical treatment has definite efficacy, but the conditions required for implementation are high, and the trauma is large, with many complications and high risk. Injection therapy has reliable efficacy, no wound injury, and is widely used in clinical applications, but it is very difficult to master the injection method and dosage. With the increase of concentration and dosage, the efficacy also increases significantly, but adverse reactions (temperature and white blood cells) also increase, so it is generally based on this,

　　The Xuezhi Injection Therapy is the method with the least trauma, the least pain, and the least risk. The maximum total injection volume per time is 70 ml, with reliable efficacy and widely used in the clinical treatment of hemorrhoids and rectal prolapse, especially for the treatment of rectal prolapse. This treatment method does not cause any trauma to the human body, injects the drug into the rectum inside and outside the prolapse, relies on the sterile inflammation caused by the drug to produce adhesion and fixation, and repositions the prolapsed rectum. This method has an efficacy rate of 100% for internal prolapse and first-degree rectal prolapse, and the cure rate can reach 85%, with a recurrence rate of less than 10%, especially effective for children, combined with internal and external treatment of traditional Chinese medicine.

　　Special Attention:Children with rectal prolapse have a tendency to self-heal, usually before the age of 5, and should be mainly treated without surgery. This includes a diet rich in nutrition, drinking plenty of water, eating more fibrous foods, and avoiding constipation or diarrhea. When the intestinal tract prolapses, it should be immediately retracted and temporarily sealed at the buttocks with adhesive tape to reduce the frequency of prolapse. At the same time, the bad defecation method should be corrected, and the child should be allowed to self-heal during the growth process. Injection therapy can also be considered, including submucosal injection of the rectum and perirectal injection, which is to inject the drug into the intestinal wall, produce fibrosis through sterile inflammation caused by the drug, and make the rectum adhere to the surrounding tissues, thus achieving a fixing effect. Of course, this method is also applicable to adult rectal prolapse.