Prolapse

Introduction Partial or full-thickness of the rectal wall is referred to as rectal prolapse. Part of the rectal wall moves down, that is, the rectal mucosa moves down, which is called mucosal prolapse or incomplete prolapse; the whole layer of the rectal wall is called full prolapse. If the rectal wall is moved down in the rectal cavity, it is called prolapse; when it is moved down to the anus, it is called external prolapse. Rectal prolapse or rectal prolapse refers to the rectal valgus of the anal canal and prolapse outside the anus. Epidemiology: more common in children under the age of 3, the incidence of men and women equal with age can be self-healing. The recent decline in the incidence rate <1 year old and >8 years old is rare.

Cause

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

1. Systemic factors malnutrition The loss of fat in the rectal fossa of children's ischial, the rectum loses the surrounding support and fixation, the contractile force of the sphincter group 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 enough, the rectum is vertical, and the pressure of the rectum is increased when the pressure of the rectum is increased in a straight line with the anal canal. It acts on the anal canal and is 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 easier to slide off the muscle layer than the loose mucosa.

3. Contributing factors Any situation that causes long-term increase or sudden increase in intra-abdominal pressure can contribute to rectal prolapse. Such as frequent 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 injuries (including accidental and surgical damage) caused by sphincters and rectum In patients with peripheral muscle function or neurological dysfunction, rectal prolapse can occur when the rectum loses support for increased abdominal pressure.

Pathogenesis:

The receding can be divided into two types: completeness and incompleteness. Only mucosal prolapse is called incomplete prolapse, and the simultaneous rectal prolapse of the rectum is called complete prolapse. The latter part of the rectum that is out of the anus is longer than the incomplete prolapse.

Divided into 3 or 3 degrees:

1. Type I is the increase of rectal mucosa when the bowel movement or abdominal pressure is increased. It is caused by the adhesion of the mucous membrane of the lower rectum and the muscle layer. The longest 3~4cm is a unique type of pediatrics. Partially exfoliated in a semi-annular manner for a full-circle, rounded, reddish color. From the center of the anus, the radial longitudinal groove has an inverted groove between the anal canal and the mucosa, which can touch the two layers of folded mucosa. The mucous membrane that is released after the soft stool is self-sufficient. If the prolapsed time is long, the mucous membrane is dark purple and dull. Repeated prolapse, mucosal edema is thick, rough, and even ulcers or bleeding points.

2. Type II When the defecation or abdominal pressure increases, the whole layer of the rectum is 5~12cm outside the anus, which is conical and slightly curved toward the back. The surface of the concave surface has a plurality of ring-shaped mucosal folds, and the color is reddish or dark red. Thick and flexible. Anal relaxation prolapse requires hand-retraction type I long-term prolapse can develop into this type.

3. Type III rare bowel movements or increased abdominal pressure when the anal canal straight tube full or partial sigmoid colon out of the anus. It is oval. The anus is extremely slack, the mucous membrane is erosive, and there are more secretions.

an examination

Related inspection

Anorectal examination of rectal-anal motor function

Examination of the rectal examination:

According to the history and appearance, you can diagnose the cases that can be retracted after the stool. The children in the sputum are forced to have a bowel movement after the bowel movement. The anal sphincter relaxation, such as incomplete rectal prolapse, is often found. The groove pattern, such as the rectum completely prolapsed, has an annular fold on the surface of the mucosa.

Laboratory inspection:

General hematuria, routine examinations are normal.

Other auxiliary examinations: an anoscope can be performed if necessary, and can be confirmed.

Differential diagnosis

Identification of rectal prolapse:

Need to be with the intensive intussusception from the anal prolapse and rectal polyps, rectal polyps can also be prolapsed from the anus, a small round smooth mass. It must be noted that intussusception can sometimes be turned out from the anus, such as rectal prolapse III degree prolapse, such as finger examination can touch the mucosa between the rectal anal canal and the prolapsed intestine, according to the history and physical signs are not difficult to identify.

According to the history and appearance, you can diagnose the cases that can be retracted after the stool. The children in the sputum are forced to have a bowel movement after the bowel movement. The anal sphincter relaxation, such as incomplete rectal prolapse, is often found. The groove pattern, such as the rectum completely prolapsed, has an annular fold on the surface of the mucosa.

Laboratory examination: general hematuria, routine examinations are normal.

Other auxiliary examinations: an anoscope can be performed if necessary, and can be confirmed.

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