Proctoptosis

　　There are many theories about the pathogenesis of rectal mucosal prolapse, and currently there are mainly two kinds of opinions. One is the sliding hernia theory, which believes that during the initial stage of rectal mucosal prolapse, a hernia can be felt through rectal examination. Rectal mucosal prolapse is a process of hernia occurrence, starting with the rectovesical or uterine indentation along the rectum downward through the pelvic floor to become a sliding hernia. When the intra-abdominal pressure increases, the anterior wall of the rectum slides downward along this indentation, eventually prolapsing outside the anus. In children, the sacral-coccygeal curvature is shallower than normal, and the rectum is in a vertical position. When the intra-abdominal pressure increases, the rectum loses the support of the sacrum, making it easy to prolapse. In some adults, the peritoneum at the anterior rectal pouch is lower than normal, and when the intra-abdominal pressure increases, the intestinal loops directly press on the anterior wall of the rectum, pushing it downward, which is easy to lead to rectal mucosal prolapse. In the elderly, muscle relaxation, excessive childbirth and perineal tearing during delivery, and underdevelopment in children can lead to incomplete development and atrophy of the levator ani and pelvic fascia, which cannot support the rectum in a normal position. Another theory is the intussusception theory, which believes that it is caused by intussusception at the connection between the rectum and sigmoid colon. This intussusception is different from the general intussusception, as the starting point of intussusception has no fixed location. Due to repeated descent, it gradually moves downward, such as the distal segment of the sigmoid colon descending, followed by the distal segment of the rectum inversion. There are many forms of rectal mucosal prolapse intussusception commonly seen in clinical practice. In recent years, some scholars believe that the above two theories are basically the same thing. Because the anterior wall of the rectum can also be regarded as a partial intussusception when it sinks into the rectal ampulla, it is just a difference in degree. At the same time, other factors such as long-term constipation, chronic diarrhea, difficulty in urination caused by prostatic hypertrophy, chronic cough caused by chronic bronchitis, and so on, can all lead to rectal mucosal prolapse.

　　1. In the early stage of rectal mucosal prolapse, there is constipation, irregular defecation, a constant feeling of fullness in the rectum and incomplete defecation. When defecating, a mass may prolapse, but it can be retracted spontaneously. As it gradually worsens, in addition to prolapse during defecation with exertion, prolapse can also occur during activities such as coughing and walking when abdominal pressure is slightly applied, and it often cannot be retracted spontaneously, and it is necessary to manually support the prolapsed mass into the anal canal. Due to frequent prolapse, the mucus discharged will often stain the underwear. When the prolapsed mass cannot be retracted, it is easy to cause inflammation and swelling, leading to pain, and further aggravating constipation. The prolapse repeatedly descends and retracts in the rectum, causing mucosal congestion and edema, often with a large amount of mucus and blood-stained material flowing out of the anal canal. Patients often feel a sensation of坠胀 and dragging in the pelvic and lumbar sacral regions, dull pain in the perineum and posterior thigh. In addition, long-term prolapse can lead to injury of the perineal nerve, causing anal incontinence, ulceration, perianal infection, rectal hemorrhage, the risk of edema, stricture, and necrosis of the prolapsed intestinal segment. Occasionally, due to solitary rectal ulcer, massive hemorrhage can occur.

　　2. It also causes anal incontinence, 16% to 20% for gas incontinence, and 17% to 24% complete incontinence.

　　The early symptoms of rectal mucosal prolapse include the mucosa protruding from the anal canal after defecation, which can be retracted spontaneously; later, it cannot be retracted spontaneously and needs to be supported by hand to复位. There is often a small amount of mucus flowing out of the anal canal after defecation, a feeling of坠胀 and incomplete defecation, and an increase in defecation frequency. Later, it can prolapse with a slight exertion during coughing, sneezing, walking, prolonged standing, or even slight effort. After prolapse, there is a feeling of distension locally, and it can also feel a distension and pain in the lumbar sacral region. The prolapsed mucosa has mucus secretion, and the mucosa is often stimulated, leading to congestion, edema, erosion, and ulceration. The secretion may contain blood-stained mucus, stimulating the perianal skin, causing itching. Due to the relaxation of the anal sphincter muscle, prolapse is rarely incarcerated. Once incarcerated, the patient will feel severe local pain, and the mass cannot be manually supported to复位. The prolapsed anal canal quickly becomes swollen, congested, and cyanotic, and the mucosal pleats disappear. If not treated in time, it can lead to strangulation and necrosis. When not prolapsed, physical examination shows the anal orifice to be open, and digital examination often finds the anal sphincter muscle to be relaxed and the contraction force weakened. According to the degree of prolapse, it is divided into partial and complete types.

　　1. Partial prolapse (incomplete prolapse)

　　The prolapsed part is only the mucosa of the lower end of the rectum, hence also known as mucosal prolapse. The prolapse length is 2-3cm, generally not more than 7cm, with mucosal folds arranged in a radial manner. The prolapsed part is composed of two layers of mucosa. There is no grooved space between the prolapsed mucosa and the anus.

　　2. Complete prolapse

　　It is the complete prolapse of the rectum. In severe cases, both the rectum and anal canal can prolapse outside the anus. The prolapse length often exceeds 10cm, even up to 20cm, presenting a pyramid shape, with mucosal folds arranged in a circular manner. The prolapsed part is composed of two folded intestinal walls, which are thicker when touched, and there is an abdominal cavity space between the two intestinal walls. The onset is slow. In the early stage, a mass may prolapse from the anus during defecation, which can be spontaneously retracted after defecation. As the condition progresses, due to the lack of contraction force of the levator ani and anal canal sphincter muscles, manual assistance is needed to return it. In severe cases, prolapse can also occur during coughing, sneezing, exertion, or walking, and it is not easy to return. If it is not复位 in time, the prolapsed intestinal segment may swell, strangle, and even have the risk of necrosis. In addition, there are often symptoms such as incomplete defecation, a feeling of坠 and acid distension in the anal area, some may appear lower abdominal pain, frequent urination, and other phenomena. Incarceration is accompanied by severe pain.

　　Protrusion of the rectal mucosa refers to the mucosa of the stomach wall prolapsing through the pylorus to the bulb of the duodenum. This disease is mainly related to inflammation of the gastric antrum and is more common in male patients aged 30-66. Therefore, it is important to pay attention to increasing nutrition, living a regular lifestyle, and not sitting for a long time on the toilet bowl, forming the habit of defecating at regular intervals to prevent constipation. Hot water sitz baths can be used after defecation and before bedtime to stimulate the contraction of the anal sphincter muscles, which has a positive effect on preventing rectal prolapse. 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 seek treatment in a timely manner. Patients with habitual constipation or difficulty defecating should not strain too hard during defecation, in addition to eating more fiber-rich foods. Regularly performing anal muscle exercises can promote the movement of the anal muscle group, enhance the function of the anal sphincter muscles, and have a certain effect on preventing this disease. Actively eliminate various triggering factors, such as coughing, prolonged sitting or standing, diarrhea, chronic cough, enteritis, etc., especially in infants and young children. Timely treatment of diarrhea, dysentery, and constipation can prevent frequent squatting for defecation. When the anus prolapses, the prolapsed object should be immediately repositioned to prevent swelling and incarceration. Strengthen physical exercise, do anal muscle exercises in the morning and evening, about 30 times each time, to increase anal contraction function. The disease of rectal mucosal prolapse is mainly related to inflammation of the gastric antrum and is more common in male patients aged 30-66. Most patients with rectal prolapse have insufficient middle qi and are mostly虚证. Pay attention to diet and nutrition in daily life, and eat more foods such as black fungus, eggplant, yam, coix seed, chicken, mutton, figs, coriander, etc. to increase nutrition and make up for deficiencies.

　　During the rectal mucosal prolapse examination, anal inspection can reveal soft mass-like intestinal mucosa prolapsing out of the anus during defecation, and the rectal mucosa can be seen to prolapse from the anus during defecation. In rectal palpation, soft mass-like objects can be felt, and the anterior wall of the upper end of the anal canal can be palpated for indentation protruding into the vagina. Barium enema examination is a method to understand whether there is an overly long sigmoid colon. Defecation contrast examination can show the width and depth of rectal anterior protrusion. X-ray defecation contrast examination can show the width and depth of rectal anterior protrusion. Colon transport test excludes colon disease. Anal-rectal intrapressure measurement shows increased rectal intrapressure and increased anal reflex systolic pressure. Routine blood, urine, and stool tests, as well as rectoscopy. During barium enema examination, defecation contrast examination can show that the forceful defecation first appears in the rectal intussusception, and then develops into rectal extrusion. Defecation contrast examination is a test performed under physiological conditions to determine the possible functional or organic lesions of the rectum, mainly suitable for patients with difficulty in defecation, fecal incontinence, rectal constipation, urgency, non-diarrheal mucous stools or bloody stools, abdominal pain or perineal pain during defecation, and clinical suspicion of rectal prolapse.

　　Rectal mucosal prolapse refers to the mucosa of the stomach wall prolapsing through the pylorus to the bulb of the duodenum. This disease is mainly related to inflammation of the antrum; it is more common in male patients aged 30-66 years. Most rectal prolapse patients have insufficient middle qi and are mostly虚证. It is advisable to eat more foods such as black fungus, eggplant, yam, chestnut, chicken, mutton, figs, coriander, etc. to increase nutrition and make up for deficiencies. For patients with habitual constipation or difficulty in defecation, in addition to eating more fiber-rich foods, do not strain too hard during defecation. Common food therapy prescriptions include:

　　1. Recipe: Astragalus 30 grams, 1 head of pork large intestine. Preparation: Wash the fresh pork large intestine head, clean repeatedly and remove the smell, then set aside. Then wash the Astragalus and wrap it in gauze, cook it with the prepared pork large intestine head in cold water, until the large intestine head is soft, discard the medicine residue, add salt, wine and other seasonings, and then eat. Suitable for children with rectal prolapse.

　　2, Recipe: 1 eel, 60 grams of lean pork, 30 grams of Astragalus. Preparation: Clean the eel and remove the internal organs, then cook with lean pork and Astragalus, add appropriate amount of salt, sugar, and yellow wine, eat after removing the Astragalus. Suitable for adults with rectal prolapse.

　　3, Recipe: 60 grams of rice and 60 grams of millet. Preparation: Wash rice and millet clean, add water to cook to half-ripe, then add 1 jin of soy milk, stir well and cook, it can be eaten. Function: strengthens the spleen and stomach, tonifies deficiency. Suitable for the elderly with rectal prolapse. Finally, if there is pyloric obstruction and massive hemorrhage, surgical treatment should be considered.

　　1, Manifestation of Gastrointestinal Dryness and Heat

　　Dry and hard stools, defecation difficult for several days, difficult defecation, short and red urine, accompanied by irritability, or fever, dry mouth and bad breath, abdominal distension and abdominal pain. Red tongue, yellow fur, rapid pulse or wiry rapid pulse.

　　Treatment Method: Clear Heat and Promote Defecation.

　　Main Formula: Pi Yao Maziren Pill with modifications.

　　2, Stagnation of Qi

　　Dry and hard stools, difficult defecation, chest oppression and side distension, frequent belching, irritability, red tongue, thin white fur slightly greasy, wiry pulse.

　　Treatment Method: Harmonize Qi and Dredge Stagnation.

　　Main Formula: Li Mo Decoction with modifications.

　　3, Deficiency of Qi and Blood, Insufficient Yin and Jing

　　Dry stools difficult to pass, palpitations, shortness of breath, pale complexion, dizziness and dizziness, fatigue all over the body, feverish sensation in the five centers, dry eyes. Pale red tip, thin white fur or little fur, thin and rapid pulse or deep and thin pulse.

　　Treatment Method: Harmonize Qi and Dredge Stagnation.

　　Main Formula: Li Mo Decoction with modifications.

　　4, Spleen Qi Deficiency Syndrome

　　Perianal mass prolapse during defecation, pale red color, cone-shaped, accompanied by anal prolapse, fatigue, lack of appetite, dizziness and tinnitus, pale tongue, thin white fur, weak pulse.

　　Treatment Method: Invigorate Qi and Lift.

　　Main Formula: Bu Zhong Yi Qi Decoction.

　　5, Anal Damp-Heat Syndrome

　　Perianal bile mass prolapse, purple and dark or deep red in color, even with partial ulceration and ulceration on the surface, anal prolapse pain, finger examination of the anal area has a burning sensation, red tongue, yellow greasy fur, wiry and rapid pulse.

　　Treatment Method: Clear Heat and Dampness.

　　Main Formula: Xianxie Shen Shi Decoction.

　　6, Kidney Qi Deficiency Syndrome

　　Perianal mass prolapse, anal prolapse, soreness in the loins and knees, dizziness and blurred vision, anal relaxation, pale red tongue, thin white fur, deep and thin pulse.

　　Treatment Method:补肾固涩.

　　Main Formula: Jinkui Shenqi Pill combined with Semen Cuscutae Pill.