The rectum prolapsed. Prolapse of the rectum (rectal prolapse): signs and complications, diagnosis, methods of treatment. Predictions of conservative treatment for rectal prolapse

The prolapse of the rectum accounts for a tenth of all. In medicine, the term "rectal prolapse" is used. Proctologists distinguish between different types, but in fact all of them are accompanied by an eversion of the inside of the final section of the rectum through the anus.

The length of the dropped segment ranges from 2 cm to 20 cm or more. The disease occurs in children under four years of age. This is due to the anatomical features of the development of the intestine in children. Among adult patients, men are about 70%, women are 2 times less. Most often, people of working age 20-50 years old get sick.

What changes occur in the rectum?

Anatomical structure rectum destines it to perform the function of retention and withdrawal stool. In fact, the site is not straight, because it has 2 bends (sacral and perineal). There are 3 sections, from bottom to top: anal, ampullar and nadampulyarny. The ampoule is the widest and longest part.

The mucous membrane that covers inside The walls are lined with epithelium with goblet cells that produce protective mucus. Muscles have a longitudinal and circular direction. Especially powerful in the area of sphincters. With prolapse and other diseases of the rectum, the strength of the sphincters decreases by 4 times.

In front of the rectum in women, the peritoneum forms a pocket, it is limited to the uterus, back wall vagina. On the sides are powerful recto-uterine muscles that attach the organs of the small pelvis to the sacrum, fixing the organs. This space is called Douglas space. It is taken into account by surgeons when suspected of.

Identification of a specific type is carried out during the examination

Prolapse of the rectum can proceed by a hernial mechanism or by invagination (bend). Hernial prolapse is caused by a downward displacement of the pouch of Douglas along with the anterior intestinal wall. Muscle weakness pelvic floor leads to a gradual complete descent and exit into the anus.

All layers, the loop of the small intestine and the sigmoid colon are involved. In the case of intussusception, the process is limited to internal insertion between the direct or sigmoid section. There is no exit to the outside.

Why does fallout occur?

The main causes of rectal prolapse:

weakening of the ligamentous structures of the rectum;
increase in intra-abdominal pressure.

An important role is played by the development of the muscular supporting apparatus in a person. Muscles include:

pelvic floor;
abdominals;
sphincters anus(both internal and external).

Weakening is possible in violation of innervation, blood supply, as a result of the transferred inflammatory process after dysentery, with ulcerative colitis, general dystrophy and sudden weight loss. Anatomical features that increase the risk of rectal prolapse include a long mesentery of the final part of the intestine, a small concavity of the sacrum.

An increase in intra-abdominal pressure occurs:

when lifting weights;
in people suffering from constipation;
in women in childbirth.

The bend is formed by the concavity of the sacrococcygeal spine. With its insufficient severity or absence, the intestine does not linger and slides down.

In the photo, the procedure of rectoscopy

A combination of risk factors causes rectal prolapse even with moderate exertion. Studies have shown that the main cause of prolapse in patients was:

40% - diseases with prolonged constipation;
in 37% of cases - hard work associated with lifting loads;
13% - spinal injuries and spinal cord caused by a fall on the buttocks from a height, landing with a parachute, a strong blow to the sacrum;
7% of women - noticed signs after a difficult birth;
3% - suffered from frequent diarrhea and lost a lot of weight.

Straining can be caused strong cough(especially in children, smokers), polyps and tumors of the rectum, prostate adenoma in men, urolithiasis, phimosis in boys.
frequent pregnancies, generic activity against the background of multiple pregnancy, narrow pelvis, large fruit accompanied by simultaneous prolapse of the vagina and uterus, the development of urinary incontinence.

Proctologists draw attention to the complicating role of anal sex. Prolapse occurs during sneezing, laughing, defecation.

Types and degrees of violations

It is customary to distinguish different types fallout:

mucous membrane;
anus;
all layers of the rectum;
internal invagination;
with access to the outside of the invaginated area.

Prolapse of the rectum is divided into degrees:

I - occurs only during defecation;
II - associated with both defecation and heavy lifting;
III - occurs during walking and during prolonged standing without additional load.

The clinical course of the disease varies in stages:

compensation (initial stage) - prolapse is observed during defecation, is reduced without effort on its own;
subcompensation - observed both during defecation and during moderate physical exertion, reduction is possible only manually, the examination reveals insufficiency of the anus sphincter of the 1st degree;
decompensation - prolapse occurs when coughing, sneezing, laughing, at the same time feces and gases are not retained, sphincter insufficiency of II-III degree is determined.

How does the disease manifest itself?

Symptoms of rectal prolapse develop gradually. Unlike cracks and hemorrhoids, the pain syndrome is less pronounced. Primary prolapse can occur with a sharp rise in weight, during straining during defecation. After a chair, each time you have to manually set the area in place.

There are cases of unexpected loss associated with lifting a load, which are accompanied by such severe pain that a person loses consciousness. The pain syndrome is caused by tension of the mesentery. Most often patients complain:

to moderate pulling and aching, aggravated after defecation, physical work, pass when repositioned;
feeling of a foreign object in the anus;
incontinence of feces and gases;
false urges to emptying (tenesmus);
abundant secretion of mucus, an admixture of blood in the feces (blood is released when the mucous membrane, hemorrhoids are injured);
often urinary incontinence, frequent urination.

Patients feel moisture around the anus, itching of the skin in this area

With internal intussusception in the region of the anterior wall of the intestine, edema and hyperemia are detected, ulceration of a polygonal shape up to 20-30 mm in diameter is possible. It has a shallow bottom without granulations, smooth edges.

If the reduction is performed incorrectly or late, then infringement occurs. Increasing edema worsens the conditions of blood supply. This leads to necrosis of the prolapsed tissues. The most dangerous descent along with the rectum loops of the small intestine in the Douglas pocket. The picture is developing rapidly acute obstruction and peritonitis.

Detection methods

Diagnosis includes examination by a proctologist, functional tests and instrumental views. The patient is asked to strain. The prolapsed portion of the intestine looks like a cone, cylinder or ball with a slit-like hole in the center, the color is bright red or cyanotic. It bleeds when touched.

After reduction, the blood flow is restored, and the mucosa becomes normal. With a digital examination, the proctologist evaluates the strength of the sphincter, reveals hemorrhoids and anal polyps. For women with signs of rectal prolapse, a gynecological examination is mandatory.

Sigmoidoscopy allows you to detect internal invagination, an ulcer of the anterior wall. A colonoscopic examination clarifies the causes of prolapse (diverticulitis, tumors), makes it possible to take suspicious material from the mucosa for biopsy and cytological analysis. Differential diagnosis of cancer is carried out.

The method of irrigoscopy with the introduction of contrast is used to detect intussusception, the long colon (dolichosigma), helps to identify impaired patency, atony. Defectography method specifies the degree of prolapse.

Study with radiopaque agent perform against the background of the simulation of the act of defecation. Anorectal manometry allows you to objectively evaluate the work muscular apparatus pelvic floor.

What to do in different stages of the disease?

Treatment for rectal prolapse includes conservative measures and surgery. Most proctologists are skeptical about drug therapy and especially traditional methods of treatment.

The choice of conservative tactics in the treatment of individuals is considered justified. young age, with partial prolapse, internal invagination. The experts expect positive result only if the disease lasts no longer than three years.

Apply:

special exercises to strengthen the muscles of the pelvic floor;
a diet is chosen depending on the violation of the stool (laxative or fixing);
glycerin rectal suppositories help with constipation, with belladonna - relieve pain and discomfort;
electrical muscle stimulation;
the introduction of sclerosing drugs, temporarily fixing the mucosa.

Candles Anestezol suitable for local anesthesia

Exercises to restore muscle tone are especially suitable for women after childbirth. They are easy to perform, so they are performed at home. Each exercise should be repeated at least 20 times, gradually the load should be increased.

In the supine position, bend and bring the feet to the buttocks as close as possible. Make an exit to the bridge on the shoulder blades while pulling in the buttocks and stomach with force. It is possible after several rises to stand for one minute in statics. It is important not to hold your breath.

From a sitting position with outstretched legs, “look like” on the buttocks back and forth. Compression of the muscles of the perineum can be quietly dealt with at work, sitting on a chair, in transport. When squeezing, linger for a few seconds.

Application of surgery

Only surgery gives a guarantee full recovery and strengthening the rectum. For the operation, perineal access, laparotomy (dissection of the abdomen) is used. In mild cases, laparoscopic techniques are successfully used.

Are used the following types interventions:

Resection (cutting off) of the prolapsing part of the rectum - is performed by circular or patchwork cutting, strengthening of the muscle wall is achieved with a gathering suture.
Plastic surgery of the muscles and the anal canal - is performed to narrow the anus by sewing the levator muscles to the rectum. Fixation with a special wire frame, threads, autoplastic and synthetic materials gives frequent complications, relapses, therefore less practical.
Resection of the colon - is necessary for dolichosigmoid, the presence of ulcers. If necrosis of the strangulated area is detected, a part of the intestine is removed with the formation of a connection with the sigmoid.
Fixation (rectopexy) of the final section - suturing to the longitudinal ligaments of the spine or sacrum. Combined types of intervention combine the removal of a section of the rectum with fixation of the remaining section and plastic surgery of the muscles.

You can learn in detail about the tactics of treating children with rectal prolapse.

How to provide first aid in case of sudden loss?

In the initial stage of the disease in an adult, the prolapsed intestine is reduced with little effort, but on its own. Some patients can use willpower to contract the muscles of the anus and retract the bowel.

Other methods are based on taking a position on the stomach with a raised pelvis, squeezing the buttocks with hands, deep breathing in knee-elbow position. The man is quite capable of managing. In case of severe pain and suspicion of infringement, an ambulance should be called.

Helping a child is best done together. The baby is laid on his back. One person lifts and spreads the child's legs. The other - lubricates the fallen part with petroleum jelly and gently sticks the intestine into the anus with his fingers, starting from the very end. To prevent the intestine from slipping in the hand, it is held with gauze or a clean diaper.

To prevent re-falling out, the child's buttocks are pulled together with a diaper.

Folk methods

sitz baths with the addition of a decoction of sage, horse chestnut, knotweed, oak bark, chamomile flowers;
compresses from quince juice, shepherd's purse decoction;
calamus root for oral administration.

Continued smoking persistent cough worsen prolapse

Consequences of untreated prolapse

In case of refusal of surgical treatment in patients, it is impossible to exclude Negative consequences in the form of: gangrene of the strangulated part of the intestine, ischemic colitis, polyps, local inflammation (proctitis, paraproctitis), trophic ulcers mucosa, rectal cancer.

The effectiveness of treatment

Proctologists achieve complete elimination of prolapse with the help of timely surgery in 75% of patients. It is important that for persistent positive effect the patient must correctly observe the regimen and control nutrition. Physical activity is strictly contraindicated. It is necessary to eliminate all risk factors and causes of the disease.

Prevention

People at risk should use measures to prevent bowel prolapse. This includes:

elimination of chronic constipation through diet, drinking at least 1.5 liters of water per day;
disease treatment, causing cough, smoking cessation;
performing "charging" for the tone of the muscles of the perineum and anus;
avoidance of heavy physical activity, long walking or standing.

When symptoms appear, do not be shy, consult a specialist doctor and follow his advice. Treatment will help to avoid big problems in the future.

A person experiences a decrease in the quality of life, suffers from bleeding, constipation, fecal incontinence, when there is a prolapse of the rectum, home treatment of which can become effective only at the initial stage of the disease. But it is important to adequately assess the existing symptoms, the extent and severity of the disease.

Causes of pathology

Rectal prolapse, or rectal prolapse, is more common in children under 3 years of age, older people over 50 years of age. The form is:

internal when the rectum is displaced outside the anus;
partial in case of displacement of a separate fragment of the mucosa in the intestine;
complete, when the intestine fell out against the background of the movement of the mucous membrane of the muscles, exit through the anus.

One of the main reasons when the intestine crawled out partially or completely outside is chronic constipation. Usually, the provoking factors act in combination:

applying excessive effort at the time of defecation against the background of chronic constipation;
cystic fibrosis (in children) with increased pressure in the peritoneal cavity;
hemorrhoids (in adults) due to weakening of the pelvic muscles in anal area, lowering the support of the rectum;
pregnancy, trauma during childbirth in women;
tumor of the spinal cord, anus;
digestive problems;
multiple sclerosis;
polyposis;
phimosis in boys with impaired urination, prolonged attempts during defecation, leading to dysfunction of the sphincter.

Often, the condition is observed in pregnant women in the form of direct prolapse of individual layers of the mucosa in the intestine against the background of a decrease in estrogen production or in the postmenopausal period due to the prolapse of the vagina and uterus.

bowel prolapse

In men, the rectal form of prolapse is caused by hard physical labor, weight lifting.

Symptoms of prolapse

Outwardly, the pathology looks like a blue-red protrusion from the rectum. Signs of prolapse differ according to acute or chronic course illness. In moments of exacerbations against the background of strong attempts or heavy lifting, the following is pronounced:

stretching of the muscles of the walls of the peritoneum in the anterior part;
sharp pain near the anus;
discomfort in the perineum;
pain when urinating.

The transition of the disease to a chronic state leads to bleeding from protruding nodes, impaired urination, and pain in the abdomen.

Symptoms of rectal prolapse may appear spontaneously if provoked by strong attempts during childbirth in women or by defecation, severe coughing, heavy lifting.

Outwardly, the prolapsed intestine has a characteristic sheen. It protrudes from the anus when walking, coughing. In chronic prolapse, itching, moisture, mucus, blood secretions, when the intestine is no longer able to independently set inward, it falls out completely.

Elimination of prolapse

Other signs of falling out:

increased intracranial pressure;
acute pain at the time of defecation;
the impossibility of repositioning the intestine manually;
feeling of a foreign body;
violation of the stool, constipation with a change to diarrhea;
uncontrolled passage of feces;
false urge to defecate.

Over time, the mucous membrane falls out completely. Due to the weakening of the sphincter, it can no longer be set inward by itself. Even slight stress leads to loss.

Necrotic areas appear, erosion on the mucous membrane. The intestine falls out at rest, in a standing position. Outside the anus, areas are clearly visible sigmoid colon.

Treatment at home

There are many proven old methods of treating a prolapsed rectum. These are tinctures, decoctions, ointments, suppositories. Enemas, poultices, steam baths help well at the initial stage.

Poultices, steam baths with decoctions of medicinal herbs, massage, gymnastics to minimize the risk of segment prolapse, increased muscle tone of the sphincter, perineum will help to have a wound healing, analgesic anti-inflammatory effect.

Exactly folk methods help to get rid of annoying unpleasant symptoms. It is useful to combine folk ways with drug treatment.

Therapeutic exercises for prolapse

Rectal prolapse caused by a decrease in the tone of the sphincter muscles can be eliminated by therapeutic exercises using simple exercises for the pelvic floor.

Physiotherapy with prolapse

The main goal of treatment is to increase muscle tone, prevent segments from falling out of the rectum and anus.

Tighten your muscles, fix for 8-10 seconds, then relax. Repeat up to 10 times.
Lie on your back, place your hands at the seams, bend your legs at the knees. Do exercises to raise the pelvis from the floor, raising and lowering alternately, while leaving the arms, legs and other parts of the body in the same position. Carry out up to 10 repetitions.

Holding therapeutic exercises daily will help to significantly strengthen the muscles of the pelvic floor and improve well-being.

Alternative methods of therapy

It is hardly possible to cure a prolapsed intestine with completely folk recipes. However, it is possible to help eliminate spasm, strengthen the muscular layer of the intestine at the initial stage of prolapse.

Steam bath for prolapse of the mucosa from the rectum with the addition of chamomile, oak bark, dope leaves. 1 st. l. collection, pour 250 ml of boiling water, pour into a metal container, sit down, covering yourself with a towel so that the steam acts directly on the affected area and does not go beyond. Carry out procedures for 15 minutes.
Enema with the addition of medicinal herbs (cinquefoil, fennel, oregano, chamomile) to relieve pain, inflammation, heal cracks and wounds. Pour a tablespoon of the collection with 300 ml of boiling water, boil, leave for 2 hours. Fill the enema with 100 ml of decoction, enter into the rectum. Carry out procedures up to 2 times a day, 10 days.
Poultice: heat quince juice, moisten gauze, apply to the prolapsed intestine. The variant is effective in partial (complete) prolapse and in the treatment of hemorrhoids.
Sedentary bath with the addition of medicinal herbs to soothe the intestines, relieve inflammation and pain, eliminate swelling of the anus, stimulate blood circulation. You can add essential oils (juniper, rosemary, lavender, lemon).
Herbal tea. Plantain and nettle. 1 tsp pour boiling water (1 glass), leave for 0.5 hours, take until the symptoms disappear.
Infusion: Pour vodka (0.5 l) with shepherd's bag (0.5 kg), keep in a dark place for 2 weeks, periodically shaking the container. Strain, wipe the affected areas with a swab.

Before treatment with folk remedies, it is better to first consult a doctor in order to avoid aggravating prolapse, causing more harm.

To eliminate prolapse completely, you need to stop excessive attempts at the time of defecation, take measures to get rid of constipation. Folk recipes are not able to cure rectal prolapse and will only alleviate unpleasant symptoms. This is a complex disease, fraught with complications. Requires the elimination of pathology of the intestine surgically.

Medicinal herbs for the treatment of prolapse

Possible consequences of prolapse

If not treated prolapse, do not take emergency measures to eliminate the prolapsed rectum, then rectal prolapse of stage 3-4 will lead to the following complications:

peritonitis;
intestinal obstruction;
bowel necrosis;
infringement of individual parts of the anus with constant protrusion.

Complications of prolapse are not only painful, but also pose a serious threat to life. Only surgical intervention in advanced cases will avoid serious consequences.

prolapse prevention

To avoid rectal prolapse, you need to maintain normal intestinal microflora, regulate digestion and nutrition. Doctors advise:

include fiber (vegetables, fruits, dairy products);
reduce the consumption of spicy, fried, salty foods, spices;
do not strain at the time of defecation;
refuse to lift weights;
dose physical activity, do not overdo it;
eliminate a passive lifestyle, move more;
do regular exercise;
strengthen the muscles of the anus in the rectum and perineum;
avoid chronic constipation;
identify and eliminate the causes that provoke muscle tension in the peritoneal cavity.

Intestinal obstruction

Prevention measures are simple but effective. Risk of rectal prolapse and development serious illnesses will be kept to a minimum.

It is important to reconsider the way of life, eliminate bad habits adjust your diet. measures to avoid surgical intervention for bowel problems.

When the rectum prolapses, a separate part located above the anus begins to stretch, leading to a protrusion outward from anal passage. The sphincter ceases to be in good shape and can no longer restrain the release of mucus and feces to the outside. Often women suffer from complicated childbirth. Possible partial dissection of the rectum.

The appearance of primary negative symptoms, prolapse of the rectal mucosa from the anus should be the reason for contacting a proctologist, passing complete examination. Only attending physicians can prescribe effective treatment, choose the optimal therapy regimen.

What is a prolapse or outward protrusion of the rectum, you can learn from the video:

A person often has a prolapse of the rectum, which is associated with various reasons. When the rectum prolapses, the anatomical position is disturbed, as a result of which the organ is displaced beyond the limits of the sphincter of the posterior canal. The prolapse of the rectum is painful, while the person is not able to hold feces. When a patient goes to the toilet, blood and mucus are noted, and false urges to defecate are often felt.

Rectal prolapse can occur in a number of ways. external factors, diseases, anatomical features in people of different ages.

Varieties

Inversion of the rectum in medicine is usually divided into 2 types:

Invagination. Bias rectum occurs exclusively within the anus and the organ does not fall out of the anus.
Hernia. The anterior wall of the rectum moves down, which is associated with increased intra-abdominal pressure. In this case, there is a partial or complete prolapse of the intestine from the posterior opening.

Sometimes patients themselves try to straighten the rectum, which is absolutely impossible to do. Such manipulations are dangerous and during defecation, the intestine will fall back out.

Main reasons

All sources of rectal prolapse are divided into 2 groups: producing and assuming. Suggestive ones include causes that indirectly affect the development of prolapse. In this case, the problem develops with such violations:

Operations, frequent stress, constipation, ulcers can provoke rectal prolapse

after surgery on the intestines;
as a result of strong straining due to chronic constipation;
after childbirth, which took place with complications and provoked damage to the muscles localized in the pelvic floor;
injury to the sacral zone spinal column;
intestinal ulcer;
haemorrhoids;
exhausting physical labor, requiring constant voltage abdominal muscles.

Predisposing sources that affect the prolapse of the rectal mucosa from the anus include:

impaired function of muscle structures located in the pelvis;
stretching of the muscles of the rectum;
increased pressure inside the peritoneum;
weakened muscle tone of the sphincter;
elongated rectum;
complicated pregnancy;
the anatomical location of the coccyx is vertical.

Degrees of pathology

Stage	Name	Peculiarities
1	Compensated	The mucous membrane protrudes a little from the anal canal
		Self recovery after a bowel movement
2	Subcompressed	Minor shedding and slow recovery back
		Pain in the anus and blood in the stool
3	Decompensated	Prolapse during bowel movements, during sex and minor straining
		The intestinal mucosa does not return to its original position
		Significant discharge of blood from the anus
		Fecal and gas incontinence
4	Deep decompensated	Permanent shedding without previous loads
		Damage to the rectal mucosa
		The occurrence of tissue necrosis with increased itching sensations

Characteristic symptoms

Rectal prolapse will cause frequent urination, pain, bloating, and the sensation of a foreign object.

Rectal prolapse occurs gradually or suddenly, without concomitant symptoms. When the organ suddenly crawled out, this indicates increased intra-abdominal pressure due to physical exertion or attempts. With a sharp prolapse, a person feels severe pain in the abdomen. But, as a rule, sudden prolapse is rare, more often diagnosed gradual development rectal prolapse. First, the mucous membrane falls out, which soon itself goes back into the anus. As the pathology progresses, the patient is concerned about the following symptoms:

feeling of a foreign body in the anus;
false trips to the toilet, in which there is no bowel movement;
pain and discomfort in the peritoneum;
flatulence;
insufficiency of the anal sphincter.

When prolapsed, the vascular plexuses are affected, due to which bloody and mucous impurities are found in the feces. At untimely treatment in a person, the process of excreting urine is disrupted, in which urges are becoming more frequent in a small way, and urine intermittently comes out. As it rises pathological signs, the loops of the small intestine are infringed. Against the background of pathology, the patient weakens defense mechanisms immune system and work capacity decreases.

Often patients confuse prolapse of the rectum and protrusion of cones with hemorrhoids. hallmark hemorrhoids from prolapse are longitudinal folds on the prolapsed formation. When prolapsed, the folds of the mucous membrane are located transversely.

Features during pregnancy

Weak muscles and bearing a fetus can cause prolapse of the rectum in a pregnant woman.

In pregnant women, prolapse is associated with weakened muscle tone, as a result of which the rectum comes out. Often the problem appears after childbirth, which is associated with attempts during the birth of the baby. In this case, the rectum can exit through the vagina. A similar pathology often manifests itself in women during menopause. If the prolapse of the rectum into the vagina occurred during pregnancy, then a supporting drug treatment. After delivery, the woman undergoes an operative reduction of the rectum into place.

Diagnostics

It is important to identify pathology in adults and children at an early stage in order to prevent complications. To this end, it is necessary at the first pathological manifestations see a doctor and go complex diagnostics. First, the doctor will examine the affected area, then prescribe the following diagnostic manipulations:

x-ray examination or defectography, which allows to assess the features of the structure and functioning of the organ;
sigmoidoscopy, examining the condition of the mucosa;
colonoscopy, in which a deviation is detected that causes prolapse;
anorectal manometry, which evaluates the contractility of the sphincter.

How to treat?

The prolapse of the rectal mucosa does not look good and brings pain and discomfort to the patient, so it is necessary to get rid of the problem as soon as possible. For each patient, the treatment of rectal prolapse is prescribed individually and depends on the severity of the disease. In the early stages, it is possible to cure the pathology with the help of medicines and special exercises. Late stages require surgical treatment and adherence to a strict diet.

Preparations

First aid is to eliminate constipation, so as not to aggravate the situation. To this end, the doctor prescribes special medications that normalize the stool and eliminate problems with the large and small intestines. Patients are recommended rectal suppositories, which normalize the stool and eliminate pain. Injections with the use of sclerosing medicines are also carried out. The use of pharmaceuticals is not effective in severe stages diseases. In this case, conservative therapy is used as an auxiliary in surgical intervention.

Treatment with folk remedies

It is allowed to treat rectal prolapse with folk remedies only after the approval of the attending physician. Such therapy will bring results at the initial stage of prolapse or in combination with other therapeutic activities. Natural ingredients eliminate painful symptoms. For this purpose, it is shown to do therapeutic compresses, baths and other procedures. At home, you can use folk recipes against rectal prolapse:

Healing decoctions for rectal prolapse will reduce discomfort and relieve swelling.

swamp calamus. An infusion is prepared from the component, which is taken orally. It is required to take 1 tsp. crushed calamus pour 200 ml cold water. Leave the medicine to infuse for 12 hours, then strain and drink 2 sips after meals.
Regular cuff. To prepare the infusion, you need 1 tsp. the main component and 200 ml of boiling water. The remedy is infused for half a day, after which they drink the infusion throughout the day in small sips.
Chamomile. The herb is used for steam baths, for the preparation of which you need 1 tsp. chamomile, diluted in boiling water. Then they sit down over the steam for a quarter of an hour and wrap themselves in a towel to create the effect of a bath.
Shepherd's bag. An infusion is prepared from the component, which is used to treat the injured area.

One of the most rare pathologies associated with the rectum is rectal prolapse. This condition is often referred to as rectal prolapse. This disease, even with enough severe course does not threaten the life of the patient, but is accompanied by very unpleasant, debilitating symptoms that negatively affect mental state patient.

Physiology

Of all proctological patients, rectal prolapse is recorded only in 0.5%. The disease can develop in people belonging to all age groups. It is twice as rare in women as in men. Experts explain this by the fact that the representatives of the stronger sex are much more likely to undergo heavy physical exertion.

Prolapse of the rectum is a pathology in which the rectum completely or partially protrudes beyond the anus.

With rectal prolapse, the thermal, lower segment of the intestine becomes mobile, gradually stretches and eventually begins to fall out of the anus. The drop-down area can have different lengths, usually it varies from 1 to 20 cm.

Causes of rectal prolapse

Not always one specific reason leads to bowel prolapse, a combination of the most various factors. This pathology can be caused by:

constant strong straining during bowel movements, usually this happens with constipation;
diarrhea, in most cases it causes rectal prolapse in children, as a rule, they are accompanied by intestinal infections (salmonellosis, dysentery), dysbacteriosis, enterocolitis or dyspepsia;
- tumors, polyps;
transferred early operations, injuries of the pelvic organs, systematic non-traditional sex is also capable of leading to this pathology;
rectal prolapse in women can be a consequence of difficult childbirth, complications in them, for example, trauma to the muscles of the anus, rupture of the perineum;
lifting heavy objects, which is precisely why such a violation is characteristic of athletes and people engaged in heavy physical labor;
neuralgic disorders - inflammation, paresis, paralysis, brain tumors, injuries, can cause a violation of the innervation of the muscles of the rectal sphincter and pelvis.

The causes of prolapse of the colonic lavage may lie in the individual anatomical features of the pelvis and intestines. They include:

vertical position of the sacrum and coccyx;
elongated mesentery and sigmoid colon;
stretching of the muscles that hold the rectum;
increased intra-abdominal pressure;
abnormal changes in the pelvic floor muscles;
decreased sphincter muscle tone.

Symptoms of rectal prolapse

Pathology can develop both suddenly and gradually. Sudden prolapse is usually caused by a sharp increase in intra-abdominal pressure. Excessive physical exertion, severe straining, even coughing or sneezing can lead to this. In this case, the prolapse is accompanied by such severe pain that it can lead a person into a state of shock.

Most often, rectal prolapse develops gradually. Initially, mucosal prolapse occurs only during the act of defecation, while it is reduced independently. After some time, the intestine ceases to adjust itself and the patient has to do it manually.

Symptoms of rectal prolapse are as follows:

constant sensation of a foreign body in the intestines, false urge to defecate;
feeling of discomfort, pain that increases with bowel movements, heavy loads, walking, with sudden prolapse severe pain in the lower abdomen;
gas incontinence, feces, they are associated with weakness of the sphincter;
mucous or bloody issues from the anus, they arise due to a violation of the integrity of the vessels;
possible formation of edema, redness, ulcers on the intestinal wall.

With a long course of the disease and no treatment, there are problems with the functioning of the urinary system - intermittent, difficult urination, frequent urges. In case of incorrect or untimely reduction of the intestine, its infringement is not excluded. In such cases, blood circulation is disturbed in it, edema rapidly increases, which can lead to tissue necrosis.

What is the difference between hemorrhoids and rectal prolapse

It is worth noting that hemorrhoids and rectal prolapse have similar symptoms. Both for this and for the other disease is characterized by bleeding and prolapse of tissues from the anus. However, the difference between them is significant:

with hemorrhoids of the rectum, formed near the anus;
with prolapse, a part of the rectum, located above the anal canal, comes out.

One pathology can be distinguished from another by the placement of mucosal folds. With prolapse of the intestine, they are transverse, while with hemorrhoids, longitudinal folds are observed.

Rectal prolapse significantly impairs the quality of human life. In addition to local manifestations, the disease leads to a decrease in immunity, making the patient vulnerable to other diseases, he becomes irritable, nervous, and may lose interest in life.

Stages and forms of rectal prolapse

First of all, the disease is usually divided according to the mechanism of development. Specialists distinguish 4 degrees:

Prolapse of the rectal mucosa occurs only during emptying, while it immediately returns to its place.
The mucosa turns out during a bowel movement, it returns back itself, but very slowly. At given state minor bleeding occurs.
Prolapse is observed not only during bowel movements, but also during physical exertion. The bowel itself is no longer set. In this case, the condition is usually accompanied by frequent bleeding, gas and fecal incontinence.
The bowel may prolapse when the person is simply walking or standing upright. Necrotic processes can be seen on the mucous membrane, itching of the anus occurs, its sensitivity is disturbed.

There are also 4 stages of rectal prolapse:

only the intestinal mucosa falls out, a small part of its membrane turns out when the intestines are emptied;
there is a prolapse of all layers of the anal intestine;
the intestine falls out completely;
along with the intestine, the anus also falls out.

Almost all people suffering from rectal prolapse develop rectal sphincter insufficiency. This pathology is initially manifested only by gas incontinence. Gradually, the sphincter loses its ability to hold even liquid feces, and with a neglected degree, already dense stools.

Diagnostics

Rectal prolapse is usually easy to diagnose. It is often possible to establish the diagnosis after examining the anorectal region. If the disease is in the initial stages, in which the intestine is not visible, the doctor suggests the patient to strain, emitting bowel movements. If the intestine at the same time appears from the anus, the diagnosis is confirmed. In addition, to assess the relief and elasticity of the mucosa, muscle tone and the state of the sphincter, a finger examination is performed.

An instrumental examination may be required to clarify the diagnosis. The most commonly used for rectal prolapse is:

X-ray examination . It makes it possible to evaluate the work of the rectum and its anatomical features, tone and condition of the muscles of the organ;
. With the help of it, the condition of the mucosa is visually assessed, the presence of complications is determined;
anorectal manometry. Allows you to determine the quality of the anal sphincter;
Colonoscopy. It is usually done in order to detect diseases that could lead to prolapse of the intestine.

: how is the procedure and how to prepare for it?

Treatment Methods

For the treatment of rectal prolapse, both conservative and surgical methods are used. Conservative therapy can give a positive result only in the initial stages of the disease. Surgical treatment of rectal prolapse is recommended when external protrusion is present or when conservative therapy fails.

conservative therapy. First of all, it is aimed at eliminating the causes of the disease - problems with stools, diseases of the colon, non-traditional sex, excessive physical exertion. The second task of therapy is to strengthen the muscles of the perineum and pelvic floor. This is done with the help of special exercises. Also, the patient may be prescribed physiotherapy to stimulate the necessary muscles. electric shock and rectal massage. Injections into the tissues surrounding the rectum are possible. Any special medicines There is no cure for bowel prolapse.
Surgery. On the this moment There are many different operations and their modifications that are used to treat rectal prolapse. These include hanging the rectum, removing part of the intestine, removing a prolapsed area, plastic surgery of the muscles of the intestinal canal or pelvic floor, etc. Surgery can be performed through an incision made in the abdomen or through the anus. The choice of one or another method of treatment depends on the individual characteristics of the patient, the degree of the disease, the presence of complications, etc.

Rectal prolapse (or rectal prolapse) is an uncommon proctological pathology and is detected in only 0.5% of patients. At the initial stages of its development, it does not pose a significant threat to the health and life of the patient, but its presence significantly burdens life and worsens its quality, annoying both domestic problems and factors affecting the state of the psyche.

In this article, we will introduce you to a number of causes, forms and stages, signs, methods of diagnosis, conservative, surgical treatment and prevention of rectal prolapse. This information will help to understand the essence of the disease, you will be able to suspect its first warning signs and consult a doctor in time.

With rectal prolapse, this part of the intestine protrudes partially or completely from the anus. The disease is caused by the mobility of the lower segment of the intestine. Because of this, the rectum stretches and begins to "fall through" into the anus, going out. With such a pathology, the patient may fall out from 1 to 20 cm of the intestine.

According to statistics, the disease is detected with the same frequency in people different ages. Twice as often, prolapse of the rectum is observed in men, and this fact is explained by the fact that it is the representatives of the stronger sex who are forced to engage in hard physical labor.

Causes

One of the causes of rectal prolapse is hemorrhoids.

In most cases, rectal prolapse is caused by several causes and predisposing factors. Such a polyetiology of this disease is associated with the structural features of this part of the intestine.

The main predisposing factors for the appearance of prolapse are the following constitutional and anatomical features:

elongated mesentery;
vertical location of the sacrococcygeal section of the spinal column;
elongated sigmoid colon;
overstretching or abnormal change in the pelvic floor muscles that hold the distal intestines in a physiological position;
increased intra-abdominal pressure;
decreased contractile properties of the anal sphincter or gaping anus.

Some pathological conditions and ailments can also cause rectal prolapse:

or ;
a tendency to or diarrhea, leading to frequent straining during the act of defecation;
injuries and previous operations for diseases of the pelvic organs;
severe course of childbirth, accompanied by rupture of the perineum or trauma to the anus;
neurological pathologies: paresis, nerve injuries, paralysis, neoplasms of the brain or spinal cord;
associated with heavy lifting or heavy physical exertion sports or professional activities;
frequent sexual intercourse in the rectum.

Forms

Depending on the expression clinical manifestations experts distinguish 4 degrees of severity of rectal prolapse:

I - prolapse of part of the intestine from the lumen of the anus occurs only when straining, and after its termination, the intestine is again drawn into place;
II - the mucous part of the intestine becomes visible only during the act of defecation and it is able to return to its place on its own, but only this process is extremely slow, and the resulting pathological condition may be accompanied by minor bleeding caused by rupture of small vessels when parts of the intestine are pinched into folds;
III - prolapse of part of the intestine occurs not only during defecation, but also during other physical exertion, and the rectum can no longer be reduced on its own, and the patient often has bleeding, incontinence of feces and gases;
IV - part of the intestine falls out even during normal activities (walking, trying to get up from a chair, etc.), it cannot be reduced on its own, signs of necrotic lesions appear on its mucosa and the patient complains of impaired sensitivity and itching of the anus.

Symptoms

Prolapse of the rectum can develop gradually or, in more rare cases, occurs suddenly, since the rate of occurrence of this pathology depends on the severity and combination of the causes that cause it.

The reason for the appearance of sudden first signs of the disease may be:

excessive straining when emptying the intestines;
cough, severe sneezing;
lifting a heavy object.

In such cases, the exit of part of the intestine from the anus is accompanied by a pronounced pain syndrome, and in some patients, due to such intense pain, a shock reaction may develop.

More often, prolapse of the rectum does not occur abruptly, but gradually. Usually, for the first time, part of the mucosa falls out of the anus during the excretion of feces, but after that the intestine returns on its own. The appearance of this symptom may go unnoticed for some patients, while others are assessed as uncomfortable sensations and cause for unrest.

After a certain period of time, its duration may be different for different patients and is determined by the combination of causes that caused the disease, the prolapsed part of the rectum is no longer set on its own, and the patient has to set it back with the help of hands. In addition, one or another set appears the following signs diseases:

sensation of discomfort and / or foreign body in the anus;
feeling of false urge to defecate;
the appearance of pain, aggravated by more intense loads and the release of feces to the outside;
intense pain syndrome (up to shock reactions) with a sudden prolapse of part of the intestine;
the appearance of traces on linen due to the discharge from the intestinal lumen of secretions of a mucous or bloody nature;
the appearance of swelling, redness and destructive processes in the form of ulcers on the mucous membrane of the rectum.

If the prolapse of the rectum proceeds for a long time and the patient does not go to the doctor for adequate treatment, then the pathology is aggravated by disturbances in the functioning of the urinary system. These signs are manifested by the following symptoms:

frequent urge to go to the toilet to urinate;
difficulty in passing urine;
intermittent urination.

If the prolapsed part of the intestine is set untimely or incorrectly, then its parts may be infringed. As a result, ischemia and edema develop in such areas. Further, such a malnutrition of a part of the rectum can result in its necrosis and significantly complicates further treatment.

In some cases, the following situations arise:

prolapse of the rectum is combined with such a proctological disease as hemorrhoids;
people whose profession is not related to medicine confuse these two pathologies of the distal intestine, which have similar manifestations.

In the first case, the symptoms of the disease will be felt much more acutely and accompanied by more frequent and heavy bleeding. In addition, when trying to probe a part of the prolapsed intestine, the patient will be able to detect the presence of small seals - hemorrhoids - on its surface.

With erroneous self-diagnosis, that is, in the second case, patients usually confuse these two proctological pathologies due to the similarity of their symptoms, since with prolapse, part of the intestine falls out of the anus, and with hemorrhoids, only hemorrhoids. The following fact can eliminate the error in recognizing such diseases: when probing the prolapsed part of the intestine due to prolapse, the transverse placement of grooves on the mucosa is felt, and with hemorrhoids, they are felt as longitudinal folds.

Stages of the disease

The patient is concerned about discomfort in the anus, false urges, pain during defecation.

Depending on the severity of clinical symptoms, proctologists distinguish 4 main stages during rectal prolapse:

I - only the mucous membrane of the distal intestine falls out of the anus and it is visible only during the act of defecation;
II - all sections of the rectum fall out of the anus, but they can be independently reduced;
III - the entire rectum falls out of the anus, and it can no longer be set without outside help;
IV - not only the rectum falls out of the anus, but also some parts of the sigmoid.

Diagnostics

In most cases, there are no difficulties in diagnosing rectal prolapse, since this disease is easily detected and rarely requires differentiation from other pathologies. If the patient turns to a proctologist at the earliest stages of the disease, then during the examination on a special chair, the doctor asks him to simulate the process of defecation (that is, to strain). When a part of the mucosa of the distal rectum appears, the diagnosis is confirmed. After that, the doctor performs a digital examination of the rectum and assesses the state of the relief of the mucous membrane.

In some cases, to confirm the diagnosis and clarify the degree of tissue damage in the anus and rectum, the following types of examinations are prescribed:

radiography with barium suspension - allows you to evaluate the anatomical features, functioning, tone and condition of the muscle tissues of the rectum;
- makes it possible to visually assess the condition of the mucosa and determine the severity of complications arising from prolapse;
anorectal anoscopy - performed to assess the functions of the anal sphincter;
- performed to identify pathological changes that caused rectal prolapse.

When performing the above studies, signs of a fairly common pathology now - rectal cancer can be detected. If you suspect the presence of neoplasms in this part of the intestine, a tissue biopsy is performed from suspicious areas and a histological analysis is performed to confirm or refute this disease.

Treatment

The treatment plan for rectal prolapse is determined by the severity of the pathology, the age and general health of the patient. In children who this disease often called, it is often enough to eliminate the causes of stool disorder and conduct conservative therapy aimed at eliminating signs of inflammation of the rectal mucosa. The same treatment plan may be prescribed for some mild clinical cases in adult patients.

The following recommendations may be included in the conservative treatment plan:

elimination of stool disorders (for example, diet changes, treatment of diseases leading to stool disorders, etc.);
exclusion of heavy physical exertion;
refusal of anal sexual contacts;
strengthening the muscles of the pelvic floor with the help of special physical exercises: alternately squeezing the muscles of the sphincter and the perineal region and lifting the pelvis up in a prone position with legs bent at the knees (while the feet should be on the floor);
physiotherapy: rectal massage, stimulation muscle fibers current, ozone therapy, balneotherapy;
the introduction of injectable drugs to strengthen tissues in the rectum.

In addition, the patient may be prescribed various symptomatic remedies: analgesics, vitamin, tonic or anti-inflammatory drugs.

Most experts note that conservative therapy is effective only when rectal prolapse lasts no more than 3 years and the patient has no pronounced changes in the constitutional and anatomical structure of this area. Even with the effectiveness of this method of treatment, the patient may subsequently experience relapses. Therefore, most patients are prescribed to get rid of problems associated with rectal prolapse and prevent fecal incontinence. surgical operations performed using various methods.

The choice of surgical technique for rectal prolapse depends on the nature of the disorders in the structure of the rectum and its surrounding tissues. To eliminate them, you can use:

plastic surgery of the pelvic floor and anus canal;
correction of the prolapsed part of the intestine;
fixation of the distal rectum;
intra-abdominal resection of the colon;
a combination of the above methods.

Now, to correct prolapse, various operations performed through an incision on the abdominal wall or through the anus can be performed:

Mikulich method - circular excision of part of the intestine;
the Delorome method - excision of the intestinal mucosa with the imposition on the muscular wall of a number of sutures that collect it, located above the anus in the form of a roller;
Nelaton's method - patchwork excision of a part of the prolapsed intestine.

The Delorom operation is most often performed, as it is the safest in terms of postoperative complications, gives long-term results and is technically easy to perform. However, it is not universal and many patients are recommended other types. surgical interventions to eliminate prolapse. These include the following:

Pelvic floor plastic surgery with levator suturing, with or without suturing to the rectum. Such an intervention is rarely independent method, but in combination with other surgical methods gives good results.
Resections of the rectum and sigmoid colon. Available only for special indications. They are performed as an addition to other methods.
Intra-abdominal resections of the distal intestines. Are the most radical methods, but due to high traumatization, only a small number of patients are performed.
fixative interventions. Such operations involve various means to support the bowel in the correct position (for example, Teflon mesh).

The following classical surgical techniques are most widely used:

the Ripstein method - fixing the intestine with a Teflon mesh to the promontorium;
modification of the Ripstein technique - back-loop fixation to the sacrum area with a synthetic mesh;
Zerenin-Kummel method - fixation of the intestine to the longitudinal ligament of the spinal column with interrupted sutures in the cape area (as a rule, this method is most appropriate for patients under 35 years old).

After the advent of laparoscopic methods in surgery, proctologists began to increasingly introduce them into practice to eliminate rectal prolapse. With the help of laparoscopy, interventions can be performed according to the principle of back-loop fixation with Teflon mesh. The low traumatic nature of this technique significantly reduces the time of rehabilitation of the patient after surgery and reduces the number of days that he has to spend while in hospital.

An example of a combination of different surgical techniques may be an operation according to Venglovsky. It combines the method of levatoroplasty and excision of the prolapsed part of the intestine. And another technique, according to the author Vishnevsky V., involves narrowing the anus with parallel intra-abdominal fixation of the intestine to the bladder / uterus and fixing the intestine to the distal border of the sacral ligaments.

Within the framework of this article, only the most popular methods were considered, and in proctological practice there can be more than 200 of them. That is why only the attending physician can better explain the essence of the intervention, who, when choosing a method, takes into account all the features of the disease.

Finishing postoperative treatment the patient is given recommendations for rehabilitation. Their volume depends on the type of intervention.

Prevention methods

Proper nutrition, which prevents the development of constipation or diarrhea, is one of the measures to prevent prolapse of the rectum.

To prevent rectal prolapse, which is especially important for people at risk of this proctological disease, the following measures can be recommended:

Correctly compiling the menu and including in it those products that help eliminate constipation or diarrhea. Exclusion from the diet of semi-finished products, fatty, smoked and salty dishes.
A complete treatment for stool disorders.
Timely detection and treatment of diseases that contribute to the development of rectal prolapse.
Rational dosing of physical activity. In this case, sharp cases of overstrain of the pelvic floor muscles (for example, when lifting weights) are especially dangerous.
Refusal of anal sex.

Pediatricians and pediatric proctologists recommend that parents of toddlers teach children from an early age that the stool should be regular, and during the act of defecation, the perineal area should not be overstressed.

Forecasts

The prognosis for rectal prolapse largely depends on the severity of anatomical changes, the timeliness and correctness of treatment. According to some statistics, the elimination of prolapse and the improvement of the evacuation function of the intestine is possible in approximately 75% of patients.

Which doctor to contact

If there are signs of prolapse of the rectum, which can be detected by the patient with the help of fingers or visually, a consultation with a proctologist is necessary. For diagnosis, the doctor conducts a digital examination and prescribes a number of examination methods that allow to study the nature of tissue changes (X-ray, sigmoidoscopy, anorectal anoscopy, colonoscopy). If a tumor in the rectum is suspected, the patient undergoes a tissue biopsy from suspicious areas, a histological analysis of the biopsy obtained, and consultation with an oncologist is recommended.

Rectal prolapse is a rare proctological pathology and requires timely treatment, since with a long course of this disease, the patient may develop various complications, aggravating its outcome and significantly violating the usual way of life. In some cases, it is enough to eliminate the causes that cause prolapse of this part of the intestine and conduct conservative therapy, but in most clinical situations, patients are recommended surgical treatment, which allows them to solve the existing problem more radically and give long-term remissions or a complete cure.