Rectal prolapse in children

Introduction to rectal prolapse in children Rectal prolapse refers to the anal canal and rectal valgus and prolapse outside the anus. Rectal prolapse can be divided into occult prolapse (internal prolapse), mucosal prolapse and complete prolapse. Occult prolapse does not involve the anal canal, which is often an early manifestation of complete prolapse. Mucosal prolapse only affects the mucosa, while the muscle layer is in a normal position. Complete prolapse is a rectal intussusception involving the anal canal. basic knowledge The proportion of illness: 0.001% Susceptible people: children Mode of infection: non-infectious Complications: sciatic rectal abscess

Causes of rectal prolapse in children

(1) Causes of the disease

There are three important factors in the occurrence of rectal prolapse:

Systemic factor

Malnutrition, the fat in the rectal fossa disappears, causing the rectum to lose its support and fixation. The contractile force of the sphincter is also weakened, and the rectum is easy to escape from the anus.

2. Local tissue anatomical factors

(1) The curvature of the tibia is not formed: the curvature of the tibia of the infant is not formed. The pelvis is not tilted forward. The rectum is vertical and is in a straight line with the anal canal. When the downward pressure in the abdominal cavity increases, the rectum does not support the humerus. Directly applied to the anal canal, easy to slide down.

(2) The surrounding muscle support is weak: the support force of the levator ani muscle and the pelvic floor muscle is weak.

(3) Mucosal relaxation: The rectal mucosa adheres to the muscle layer and is loose, and the mucous membrane is easy to slip off the muscle layer.

3. Contributing factors

Any increase in intra-abdominal pressure for a long time or sudden increase can cause rectal prolapse, such as constipation, diarrhea, whooping cough, phimosis and bladder stones, long-term chronic cough and other diseases, often the cause of rectal prolapse, some diseases (such as lumbosacral Spinal meningocele or injury (including accidental and surgical injury) caused by sphincter and rectal muscle function or neurological dysfunction, rectal loss of support, increased abdominal pressure can occur rectal prolapse.

(two) pathogenesis

The rectal prolapse can be divided into completeness and incompleteness. Only the mucosa prolapse is called incomplete prolapse. The rectal layer is called full sagging, and the latter is out of the anus. Completely prolapsed, long-term prolapsed anal, anal sphincter relaxation, easy to reset after rectal prolapse, accidental due to sudden increase in intra-abdominal pressure to cause rectal prolapse, if not timely reset, anal sphincter contraction can cause prolapsed intestine Narrow necrosis, about half of patients with rectal prolapse, anal sphincter dysfunction, defecation dysfunction, Japanese Suzuki rectal anal canal pressure measurement also found that nearly half of patients with anal canal pressure decreased, voluntary muscle systolic blood pressure decreased, and rectum Anal canal reflex and rectal internal pressure were normal. Some scholars measured the electromyogram of the external sphincter and puborectal muscle of rectal prolapse patients, and found that the discharge caused by anal contraction increased significantly, proving the occurrence of anorectal prolapse and basin. Related to the reflex disorder of the bottom muscle, not local muscle paralysis, Parks and other external sphincter, pathological section and histochemical examination of the puborectalis and levator ani muscle, almost all Cases have changes in muscle tissue, of which the external sphincter is the most obvious, and the levator ani muscle is light. He believes that long-term constipation causes the muscles and nerves of the department to overstretch and damage, resulting in sphincter dysfunction and rectal prolapse. As for anal sphincter function Not all of them are reasons or results, opinions are still inconsistent, divided into 3 or 3 degrees:

1. Type I

When the bowel movement or abdominal pressure is increased, the rectal mucosa is removed from the anus, which is caused by the adhesion of the mucous membrane of the lower rectum and the muscle layer. The longest is 3 to 4 cm, which is a peculiar type of the child. It is ring-shaped red, forming a radial longitudinal groove from the center of the anus. There is a reverse groove between the anal canal and the mucosa. It can touch the two layers of folded mucous membranes. It is soft and the mucosa that is released after the stool is self-retained, such as prolonged time. The mucous membrane is dark purple, dull, repeated prolapse, mucosal edema, hypertrophy, roughness, and even ulcers or bleeding points.

2. Type II

When the bowel movement or abdominal pressure increases, the whole layer of the rectum is 5~12cm outside the anus, which is conical, slightly curved to the back, and the top is concave. The surface has a ring of multiple mucosal folds, the color is reddish or dark red, and the touch is thicker. It is elastic, the anus is slack, and the prolapse needs to be retrieved by hand. The type I long-term prolapse can develop into this type.

3. Type III

Rarely, when the bowel movement or abdominal pressure is increased, the anal canal, the whole tube or part of the sigmoid colon is out of the anus, and it is oval, the anus is extremely slack, the mucous membrane is erosive, and the secretion is more.

Prevention of rectal prolapse in children

The disease is caused by the interaction of congenital and acquired factors, enhance the physical fitness of children, ensure reasonable nutrition, and promote the growth and development of children.

1. It is necessary to treat diarrhea, infectious enteritis, chronic dysentery and other diseases in a timely manner, and pay special attention to children's diarrhea and dysentery.

2. Eat more vegetables to prevent constipation.

3. Develop a good toilet habit, avoid squatting for a long time, and forcefully defecate.

4. Should actively prevent and treat whooping cough, chronic bronchitis, emphysema and so on.

5. Pay due attention to rest.

6. Regular levator ani exercise to increase the function of the anal sphincter.

In short, there are many reasons for the formation of rectal prolapse, and it is very important to develop good habits in life to prevent the formation of the disease.

Pediatric rectal prolapse complications Complications sciatic rectal abscess

Can be complicated by strangulated rectal prolapse and incarceration, can be complicated by rectal stenosis. The rectum out of the anus is clamped by the sphincter, the venous return is blocked, and the volume is continuously increased until the artery is compressed. It is painful and cannot be returned to the anus. After the incarceration, different degrees of infection will occur. The patient has symptoms such as urgency and heavy anal bulge. At this time, the infection is mostly confined to the anus. If the treatment is improper, it may cause the infection to spread, causing submucosal, perianal or ischial rectal abscess.

Symptoms of rectal prolapse in children Common symptoms Rectal prolapse, blood circulation disorder, edema, anal sphincter relaxation, congestion

In the early stage, when the child has a bowel movement, the mucous membrane is prolapsed from the anus, and then automatically retracted after the recurrence. After repeated episodes, each time after the stool, it must be hand-backed, and often has a small amount of mucus, such as crying, coughing, exerting force, the intestines Prolapse, such as long-term rectal prolapse, can not be reset, can occur congestion, edema, ulcers, bleeding, so that resetting difficulties, sometimes can be incarcerated, intestinal tube is purple-black, local intestinal blood supply disorders, even reset Rectal stenosis occurs.

Pediatric rectal prolapse examination

General blood, urine, and stool routine examinations are normal. If necessary, an anoscope can be performed to confirm. After the patient squats, he vigorously suffocates and makes the rectum prolapse. Partial prolapse shows a round, red, smooth surface mass, mucosal folds are "radial"; the length of the prolapse is generally less than 3cm; the diagnosis only touches the two layers of folded mucosa; the rectal examination shows the anal sphincter contraction weakness. When the patient is forced to contract, there is only a slight contraction. In the case of complete rectal prolapse, the surface mucosa has a "concentric ring" fold; the prolapse is longer, the prolapsed part is a two-layered intestinal wall fold, and the palpation is thicker; when the rectal examination is performed, the anal opening is enlarged, and the anal sphincter is relaxed. When the anal canal does not prolapse, there is a circular deep groove between the anus and the intestine. Distal rectal congestion and edema were seen in the sigmoidoscopy. The proximal rectum can be seen in the distal cecum during angiography.

Diagnosis and diagnosis of rectal prolapse in children

diagnosis

According to the history and appearance of the diagnosis, after the case of self-retraction, the child is observed after forced defecation in the position, parallel rectal examination, often found anal sphincter relaxation, such as incomplete rectal prolapse, prolapsed mucosa The surface is longitudinally grooved, such as the rectum completely prolapsed, and the surface of the mucosa is annularly creased.

Differential diagnosis

It needs to be differentiated from the intestines of the intestines and the rectal polyps. The rectal polyps can also be removed from the anus. It is a small round and smooth mass. It must be noted that the intussusception can sometimes be combined with severe intussusception. The incision is differentiated from the anus and the rectal polyps. The rectal polyps can also be removed from the anus. It is a small round and smooth mass. The III degree prolapse can be touched by the finger. The mucosa between the rectal anal canal and the prolapsed intestine can be touched. Reflexion, based on medical history and physical signs is not difficult to identify.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.