home » Psychoanalysis » Rectal prolapse (prolapse of the rectum): stages and treatment. Rectal prolapse: causes, symptoms, treatment Internal rectal prolapse in the initial stage

Rectal prolapse (prolapse of the rectum): stages and treatment. Rectal prolapse: causes, symptoms, treatment Internal rectal prolapse in the initial stage

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

Causes of pathology

Rectal prolapse, or rectal prolapse, is more often observed in children under 3 years of age, and elderly people after 50 years of age. The form is:

internal when the rectum is displaced beyond the anus;
partial in case of displacement of a separate fragment of the mucous membrane in the intestine;
complete when the intestine prolapses outward against the background of the movement of the mucous membrane of the muscles, exiting through the anus.

One of the main reasons when the intestine has partially or completely come out is chronic constipation. Typically, factors that provoke hair loss 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 the anal area, decreased 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 straining 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 mucous membrane in the intestine against the background of decreased estrogen production or in the postmenopausal period due to prolapse of the vagina and uterus.

Bowel prolapse

In men, rectal prolapse is caused by heavy physical labor and heavy lifting.

Symptoms of hair loss

Externally, the pathology looks like a blue-red protrusion from the rectum. Signs of prolapse differ depending on the acute or chronic course of the disease. During moments of exacerbation against the background of strong efforts or heavy lifting, the following is clearly expressed:

stretching of the muscles of the peritoneal walls in the anterior part;
sharp pain near the anus;
discomfort in the perineal area;
pain when urinating.

The transition of the disease to a chronic condition leads to bleeding from prolapsed nodes, difficulty urinating, and pain in the abdomen.

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

Externally, the prolapsed intestine has a characteristic shine. It protrudes from the anus when walking or coughing. With chronic prolapse, itching, moisture, mucus, and blood discharge may appear, when the intestine is no longer able to move inward on its own and falls out completely.

Elimination of prolapse

Other signs of loss:

increased intracranial pressure;
acute pain at the time of defecation;
inability to manually reduce the intestine;
foreign body sensation;
bowel dysfunction, constipation followed by diarrhea;
uncontrolled stool passage;
false urge to defecate.

Over time, the mucous membrane falls out completely. Due to the weakening of the sphincter, it can no longer move inwards on its own. Even slight tension leads to loss.

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

Treatment at home

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

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

It is traditional methods that help get rid of annoying unpleasant symptoms. Useful to combine traditional methods with medication treatment.

Therapeutic exercises for hair loss

Rectal prolapse caused by decreased sphincter muscle tone can be eliminated through therapeutic exercises using simple exercises for the pelvic floor.

Therapeutic exercises for prolapse

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

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

Carrying out therapeutic exercises daily will help significantly strengthen the pelvic floor muscles and improve well-being.

Traditional methods of therapy

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

Steam bath for prolapse of the mucous membrane from the rectum with the addition of chamomile, oak bark, dope leaves. 1 tbsp. 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 300 ml of boiling water over a tablespoon of the mixture, boil and leave for 2 hours. Fill the enema with 100 ml of decoction and insert 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. This option is effective for partial (complete) prolapse and in the treatment of hemorrhoids.
A sessile bath with the addition of medicinal herbs to soothe the intestines, relieve inflammation and pain, eliminate swelling of the anus, and stimulate blood circulation. You can add essential oils (juniper, rosemary, lavender, lemon).
Herb tea. Plantain and nettle. 1 tsp. pour boiling water (1 glass), leave for 0.5 hours, take until painful signs disappear.
Infusion: pour vodka (0.5 l) over a shepherd's purse (0.5 kg), keep in a dark place for 2 weeks, shaking the container periodically. Strain and wipe the affected areas with a swab.

Before treatment folk remedies It is better to first consult a doctor to avoid worsening the prolapse and causing more harm.

To eliminate prolapse completely, you need to stop excessive straining during bowel movements and 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 surgical removal of intestinal pathology.

Medicinal herbs for the treatment of prolapse

Possible consequences of prolapse

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

peritonitis;
intestinal obstruction;
intestinal 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.

Prevention of prolapse

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 during bowel movements;
stop lifting heavy objects;
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. The risk of rectal prolapse and the development of serious diseases will be minimized.

It is important to reconsider your lifestyle, eliminate bad habits, adjust your diet. These measures will allow you to avoid surgical intervention for intestinal problems.

When the rectum prolapses, a separate part located above the anus begins to stretch, leading to a protrusion outward from the anus. The sphincter ceases to be in good shape and can no longer restrain the release of mucus and feces. Women often suffer during complicated childbirth. Partial dissection of the rectum is possible.

The appearance of primary negative symptoms, prolapse of the rectal mucosa from the anus should be a reason to contact a proctologist and undergo full examination. Assign effective treatment, only the attending physicians can select the optimal treatment regimen.

You can learn what prolapse or protrusion of the rectum is from the video:

Most cases of rectal prolapse can be successfully treated, often with surgical operations.

Classification

There are three types of rectal prolapse:

Partial prolapse (prolapse of the rectal mucosa) . The mucous membrane of the rectum slides off its normal position and, as a rule, comes out from the anus. This occurs when a person strains during bowel movements. The most common prolapse of the rectal mucosa is in children under 2 years of age.
Complete loss . The entire wall of the rectum slides out of its normal location, emerging from the anus. At first this only happens during bowel movements. As the disease progresses, the rectal wall falls out while standing or walking. And in some cases, it may remain outside the anus all the time.
Internal rectal prolapse . One section of the wall of the colon or rectum may slide in or out of another, like folding parts of a telescope. At the same time, it does not come out through the anus. Internal rectal prolapse is more common in children, but the causes, as a rule, cannot be determined. In adults, it is usually associated with other intestinal diseases such as polyps or tumors.

There are other classifications of rectal prolapse. But they are difficult to understand, so only doctors use them.

Causes

Rectal prolapse in adults can have various causes and risk factors:

In children, the rectum most often prolapses if:

Cystic fibrosis.
Previously undergone surgery on the anus.
Nutrient deficiency.
Problems with physical development.
Infectious diseases of the digestive tract.

Symptoms of rectal prolapse

Most people can guess what advanced rectal prolapse looks like. However, it is important to detect this problem early in development.

The first symptoms of rectal prolapse:

Leakage of feces from the anus - fecal incontinence.
Leakage of mucus or blood from the anus (constantly wet anus).

As rectal prolapse progresses, the following symptoms appear:

Feeling of fullness in the intestines and the urge to defecate.
Frequent bowel movements with small amounts of stool.
Feeling of incomplete bowel movement.
Pain, itching, irritation in the anal area.
Bleeding from the anus.
Presence of bright red tissue protruding from the anus.

Anyone who experiences these symptoms of rectal prolapse in themselves or their child should consult a doctor.

Diagnostics

To establish a diagnosis, the doctor first asks the patient about his complaints, the presence of other diseases and previous operations, after which he examines the rectum.

To confirm the diagnosis and identify the cause of rectal prolapse, a:

Anal electromyography. This test can determine whether nerve damage is causing the anal sphincter dysfunction. It also examines the coordination between the rectum and anal sphincters.
Anal manometry. The test examines the strength of the anal sphincters.
Ultrasonography. Allows you to evaluate the shape and structure of the anal sphincters and tissues surrounding the rectum.
Proctography. An X-ray method that allows you to evaluate the functioning of the rectum.
. Endoscopic examination of the large intestine using a flexible instrument with light (colonoscope) and a video camera.
Magnetic resonance imaging. Used to examine the pelvic organs.

If a child's rectum prolapses and no cause can be found, he or she may need a sweat test to check for cystic fibrosis.

Treatment

How and with what to treat rectal prolapse depends on many factors, such as the patient’s age, the severity of the disease, and the presence of other problems with the pelvic organs.

It should be noted right away that there are no medicines, which could cure this disease in adults. All treatment comes down to measures carried out at home and surgery.

At home, for the treatment of partial rectal prolapse, adult patients are recommended:

Set the prolapsed intestinal wall back if the doctor allows it.
Avoid constipation. To do this, you should drink plenty of fluids, eat fruits, vegetables and other foods that contain a large number of fiber. These dietary changes are often enough to improve or eliminate rectal prolapse.
Do special gymnastics. If you have rectal prolapse, you should regularly perform Kegel exercises, which help strengthen the muscles of the perineum.
Do not strain during bowel movements. If you need to make stool easier to pass, you need to use stool softeners.

Adults with complete rectal prolapse or partial rectal prolapse that does not improve with home treatment tips require surgery.

There are several types of operations, the choice of which is made by the doctor, taking into account the patient’s gender, bowel function, previous surgical interventions, the severity of other diseases, the degree of prolapse, and the risk of complications.

All these operations can be divided into two types, based on the surgical approach:

Abdominal surgeries (surgical access through the abdominal cavity). As a rule, during these interventions, fixation of the rectum or resection of part of it is performed with subsequent fixation. They are performed in most cases under general anesthesia. Sometimes fixation of the rectum is done laparoscopically - through several small holes in the abdominal wall.
Rectal (perineal) operations . These surgeries are more often performed in older adults and patients with serious underlying medical conditions. During such operations, an incision is not made in the wall of the abdominal cavity; resection and fixation of the rectum is carried out through the anus.

Features of treatment in children

Parents who see a small protrusion of bright red tissue from their baby's anus should consult a doctor immediately. Only he can explain to them in detail what to do if a child’s rectum prolapses. The good news is that this problem is proper treatment may disappear completely without surgery.

The doctor should teach parents how to properly reduce a child's rectal prolapse using a water-soluble lubricant. You should also buy a special potty on which the baby does not strain during bowel movements.

You need to strive to eliminate constipation, which can be achieved through a balanced diet, the use of stool softeners and laxatives. Very rarely, submucosal injections of a sclerosing agent are used to treat rectal prolapse in children.

If these conservative methods are ineffective and complications of rectal prolapse develop, surgery.

Complications of bowel prolapse

Complications of rectal prolapse include:

Formation of ulcers on the rectal mucosa.
Necrosis of the rectal wall.

The following complications may also develop during surgical treatment:

Bleeding.
Divergence of the edges of the anastomosis is the connection of the two edges of the rectum after resection of its prolapsed part.
Worsening or appearance of fecal incontinence.
Worsening or appearance of constipation.
Recurrence of rectal prolapse.

Forecast

90% of children with rectal prolapse under the age of 3 years only need conservative treatment; their disease resolves. Only 10% of them continue to have this problem into adulthood. For children whose prolapse appears after age 4, spontaneous recovery is much less common.

In adult patients, the prognosis depends on the cause of the disease, age and general health. Unfortunately, even after surgery, relapses occur in 30-40% of patients.

Prevention

You can reduce your risk of developing rectal prolapse by reducing constipation. This is achieved by eating a high fiber diet and drinking enough fluids. You should also avoid straining during bowel movements.

People with long-term diarrhea, chronic constipation, or hemorrhoids need treatment for these conditions to reduce the risk of developing the condition.

Although rectal prolapse is thought to be a rare condition, its incidence may be underestimated, especially in older people who do not seek treatment. medical care for this problem.

Having this disease can greatly reduce your quality of life. In the later stages of prolapse, there is no effective conservative treatment; surgical interventions are necessary.

Useful video about rectal prolapse

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 with everyday problems and factors affecting the mental state.

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 you understand the essence of the disease, you will be able to suspect its first warning signs in time and consult a doctor in time.

With rectal prolapse, this part of the intestine comes out partially or completely from the anus. The disease is caused by mobility of the lower segment of the intestine. Because of this, the rectum stretches and begins to “fall” into the anus, coming out. With this pathology, the patient may lose from 1 to 20 cm of intestine.

According to statistics, the disease is detected with the same frequency in people different ages. Rectal prolapse is twice as common in men, and this fact is explained by the fact that it is the stronger sex who are forced to engage in heavy 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. This polyetiology of this disease is associated with the structural features of this part of the intestine.

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

elongated mesentery;
vertical location of the sacrococcygeal part of the spinal column;
elongated sigmoid colon;
overstretching or abnormal changes in the pelvic floor muscles that hold the distal parts of the intestine in a physiological position;
increased intra-abdominal pressure;
decreased contractility of the anal sphincter or gaping anus.

Some pathological conditions and illnesses can also cause rectal prolapse:

or ;
tendency to diarrhea, leading to frequent straining during bowel movements;
injuries and previous operations for diseases of the pelvic organs;
severe labor, accompanied by perineal rupture or anal injuries;
neurological pathologies: paresis, nerve injuries, paralysis, neoplasms of the brain or spinal cord;
sports or professional activities associated with heavy lifting or heavy physical activity;
frequent sexual intercourse in the rectum.

Forms

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

I – loss of part of the intestine from the lumen of the anus occurs only when straining, and after it stops, the intestine is pulled back 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 occurs extremely slowly, 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 activities, and the rectum can no longer be reduced on its own and the patient often experiences 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

Rectal prolapse can develop gradually or, in more rare cases, occur 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 during bowel movements;
cough, severe sneezing;
lifting a heavy object.

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

More often, rectal prolapse does not occur suddenly, but gradually. Usually, for the first time, part of the mucous membrane falls out of the anus during the release of feces, but after this the intestine returns on its own. The appearance of this symptom may go unnoticed for some patients, but is assessed by others as discomfort and a cause for concern.

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

feeling of discomfort and/or foreign body in the anal area;
feeling of a false urge to defecate;
the appearance of pain, which intensifies with more intense exercise and the release of feces;
intensive pain syndrome(up to shock reactions) with sudden prolapse of part of the intestine;
the appearance of traces on the underwear due to the release of mucous or bloody discharge from the intestinal lumen;
the appearance of swelling, redness and destructive processes in the form of ulcers on the rectal mucosa.

If rectal prolapse continues for a long time and the patient does not see a 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 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 pinched. 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 complicate further treatment.

In some cases, the following situations arise:

rectal prolapse is combined with a proctological disease such 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 will be accompanied by more frequent and heavy bleeding. In addition, when trying to palpate part of the prolapsed intestine, the patient will be able to detect the presence of small compactions - hemorrhoids - on its surface.

In case of 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 palpating the prolapsed part of the intestine due to prolapse, the transverse placement of grooves on the mucosa is felt, and in case of hemorrhoids, they are felt as longitudinal folds.

Stages of the disease

The patient is concerned about discomfort in the anus, false urges, and 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 is visible only during the act of defecation;
II – all parts of the rectum fall out of the anus, but they can be reduced independently;
III – the entire rectum falls out of the anus, and it can no longer be reduced without assistance;
IV – not only the rectum, but also some parts of the sigmoid colon fall out of the anus.

Diagnostics

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

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

radiography with a barium suspension - allows you to evaluate the anatomical features, functioning, tone and condition of the muscle tissue 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 today - rectal cancer - may be revealed. If the presence of neoplasms in this part of the intestine is suspected, 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, age and general condition health of the patient. In children in whom this disease is often caused, it is often enough to eliminate the causes of stool disorder and carry out 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 conservative treatment plan may include the following recommendations:

elimination of stool disorders (for example, changing the diet, treating diseases leading to stool disorders, etc.);
exclusion of heavy physical activity;
refusal of anal sexual intercourse;
strengthening the pelvic floor muscles with the help of special physical exercises: alternately squeezing the sphincter muscles and the perineal area and lifting the pelvis upward in a lying position with legs bent at the knees (the feet should be on the floor);
physiotherapy: rectal massage, stimulation muscle fibers electric shock, ozone therapy, balneotherapy;
administration of injectable drugs to strengthen tissue in the rectal area.

In addition, the patient may be prescribed various symptomatic medications: analgesics, vitamins, restoratives 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 if this method of treatment is effective, the patient may subsequently experience relapses. Therefore, most patients undergo surgical operations performed using various techniques to get rid of problems associated with rectal prolapse and prevent fecal incontinence.

The choice of surgical technique for rectal prolapse depends on the nature of the disturbances in the structure of the rectum and surrounding tissues. To eliminate them the following can be used:

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

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

Mikulicz method – circular excision of part of the intestine;
Delorom's method - excision of the intestinal mucosa with the application of a series of sutures to the muscular wall, which collect it and are placed above the anus in the form of a roller;
Nelaton's method - patchwork excision of part of the prolapsed intestine.

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

Plastic surgery on the pelvic floor with suturing of the levators, accompanied or not accompanied by suturing to the rectum. Such an intervention is rarely performed as an independent method, but in combination with other surgical methods it gives good results.
Resection of the rectum and sigmoid colon. They are carried out only for special indications. Performed as a complement to other methods.
Intra-abdominal resection of the distal intestine. They are the most radical methods, but due to high trauma, they are performed only on a small number of patients.
Fixing interventions. Such operations involve the use of various means to support the intestine in the correct position (for example, Teflon mesh).

The most widely used classical surgical techniques are:

Ripstein method – fixation of the intestine with a Teflon mesh to the promontorium;
modification of the Ripstein technique – posterior loop fixation to the sacral area with a synthetic mesh;
Zerenin-Kümmel method - fixation of the intestine to the longitudinal ligament of the spinal column with interrupted sutures in the promontory area (as a rule, this method is most appropriate for patients under 35 years of age).

After the advent of laparoscopic methods in surgery, proctologists began to increasingly introduce them into practice to eliminate rectal prolapse. Using laparoscopy, interventions can be performed using the principle of posterior loop fixation with Teflon mesh. The low invasiveness of this technique significantly reduces the patient’s rehabilitation time after surgery and reduces the number of days he will have to spend in hospital treatment.

An example of a combination of different surgical techniques is the Venglovsky operation. It combines the method of levatoroplasty and excision of the prolapsed part of the intestine. And another technique according to the author V. Vishnevsky involves narrowing the anus with parallel intra-abdominal fixation of the intestine to the bladder/uterus and fixation of 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, who takes into account all the features of the disease when choosing a method, can better explain the essence of the intervention.

Upon completion of postoperative treatment, the patient is given recommendations for rehabilitation. Their volume depends on the type of intervention performed.

Prevention methods

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

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

Correctly compiling a 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 foods.
Complete treatment of stool disorders.
Timely detection and treatment of diseases that contribute to the development of rectal prolapse.
Rational dosing of physical activity. In this case, sudden 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 children teach their children from a young age that bowel movements should be regular, and during bowel movements the perineal area should not be overstrained.

Forecasts

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

Which doctor should I contact?

If signs of rectal prolapse appear, which can be detected by the patient using 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 to study the nature of tissue changes (X-ray, sigmoidoscopy, anorectal anoscopy, colonoscopy). If the presence of a tumor in the rectum is suspected, the patient undergoes a tissue biopsy from suspicious areas, a histological analysis of the resulting biopsy, 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 can develop various complications that aggravate its outcome and significantly disrupt the usual way of life. In some cases, it is sufficient to eliminate the causes of prolapse of this part of the intestine and carry out conservative therapy, but in most clinical situations, patients are recommended surgical treatment, which allows solving the existing problem more radically and providing long-term remissions or complete cure.

Rectal prolapse is one of the most common pathologies associated with the rectum. Despite the fact that such a problem even in the case severe course does not pose a serious danger to the patient’s life, it can overshadow his condition with a number of unpleasant debilitating symptoms.

At increased risk are older people and men whose work involves physical activity. Women and children suffer from rectal prolapse much less frequently. Knowing the causes, symptoms and methods of treating prolapse, you can promptly help your own body or prevent the occurrence of pathology.

The anatomical structure of the rectum in men and women has a slight number of differences. Despite its name, the rectum is a very tortuous organ, and makes a lot of bends as it descends towards the pelvic area. It is formed from muscle tissue, mucous membrane of the submucosal part.

The rectum consists of two parts: perineal and pelvic.

The first is the anal canal, which is located under the sphere of the pelvic diaphragm, the second is located directly above it, and consists, in turn, of a wide ampulla of the rectum and a narrow supra-ampullary section.

Covers the mucous membrane epithelial tissue, which contains large quantities of liberkühn crypts (glands), consisting of cells that produce mucus necessary to maintain normal life functions gastrointestinal tract.

In the female body, the walls of the rectum are in close proximity to the vagina, so the inflammatory process of one of the organs somehow affects the other.

The end of the rectum is the sphincter, the structure of which varies depending on gender: men most often have anus funnel-shaped, women have a flatter and slightly protruding sphincter.

A similar structure is observed in the case of severe stretching of the muscles supporting the anus. In front of the rectum in men there is a bladder and ducts responsible for the removal of semen. The anus is protected by special layers consisting of fat and connective fiber.

Why does it fall out?

Prolapse of the intestine from the anus in humans is called rectal prolapse. This problem is characterized by stretching of the anus and decreased tone of the muscles surrounding the sphincter. For this reason, patients may have difficulty retaining stool and gases. Both older people and children suffer from this pathology.

The causes of rectal prolapse are most often ambiguous and depend on a number of factors. The reasons that provoke the occurrence of rectal prolapse are predisposing and producing.

The first group includes:

Predisposing factors also include the presence of anatomical defects in the structure of the pelvis (for example, an elongated rectum or a vertical tailbone).

Most common producing causes, which entail rectal prolapse, are considered to be:

ulcers and inflammatory foci located on the surface of the intestinal mucous membranes;
sacral injuries;
the presence of frequent constipation and problems with bowel movements, forcing a person to push with effort.

Producing causes include the consequences of surgical operations affecting the intestines or stomach, as well as injuries in women that were received during childbirth.

Symptoms of rectal prolapse

Symptoms are influenced by the stage of the pathological process: with rectal prolapse first degree There is a slight eversion of the mucous membrane at the time of bowel movement. When the defecation process is completed, the segment manages to return to its “original position.” This stage is called compensated.

Second(subcompensated) stage is characterized by a significantly slower return of the inverted rectum, bloody discharge and pain.

At the decompensated stage pathological process, the segment ceases to return to its “original position,” which brings a number of serious inconveniences to the patient.

In the case of rectal prolapse, the symptoms in women and men are largely identical.

Such a loss may have hernia form when the anterior wall of the organ has to shift due to weak pelvic muscles and high blood pressure in the abdominal area.

Intussusception form diagnosed if the pathological segment has not left the anal canal.

The main symptoms of loss are:

mucous or bloody discharge from the anus resulting from injuries and damage;
prolapse of a segment of the rectum, which, during an acute inflammatory process, protrudes from the anus by 8-10 cm;
increased urge to defecate and painful constipation.

The main symptoms of rectal prolapse also include the presence of a constant urge to urinate in combination with an intermittent stream. If a woman has a similar illness accompanied by uterine prolapse, she experiences discomfort associated with the feeling of incomplete emptying of the bladder.

What does prolapse look like?

Of the total number of proctological diseases, prolapse is diagnosed only in half a percent of all cases.

With rectal prolapse, the vessels located in the submucosal layer are subject to compression, which entails a number of negative changes in the mucous membranes of the prolapsed segment.

They acquire signs of swelling while maintaining their inherent shine. Compression of the vessels feeding the tissue leads to a bluish tint, and due to prolonged compression, necrotic processes occur.

Rectal prolapse - what is it and what does such a pathology look like? Based on the contractile capabilities and tone of various muscle groups, the prolapsed segment may have the shape of a ball, cone or cylinder. When the rectum is reduced, blood flow functions are stabilized and the mucous membranes return to normal.

The patient experiences severe discomfort while walking or exercising. A sudden sudden prolapse causes severe pain in the lower abdominal cavity. By looking at a photo of rectal prolapse in women, one can determine that prolapse differs from hemorrhoids in the prolapse of not the nodes, but the part of the rectum located slightly above the anal canal.

Treatment

Rectal prolapse is treated through both conservative and surgical methods. Conservative therapy is used mainly in the first stages of the disease. The objectives of this method of treatment include:

Elimination of the causes that provoked the occurrence of the disease ( chronic diseases colon, excessive physical activity, unconventional sex).
Exercises aimed at strengthening the muscles that support the normal functioning of the pelvic floor and perineum.
A series of physical treatments, such as rectal massage and stimulation of certain muscles using electric current.

Treatment of rectal prolapse without surgery does not involve the use of any pharmaceutical drugs, since none of them is capable of returning the prolapsed segment to its place. About 30% of the total number of all patients note positive results of conservative treatment, which is most effective in the case of intussusception (internal prolapse).

Important! Conservative therapy is usually carried out only for a disease that began no more than 3 years ago. An important role in the task of restoring health is played by regular performance of a set of exercises, such as lifting the pelvis from a supine position with the knees bent at the joints, alternately relaxing the muscles of the sphincter and perineum, followed by tension, and others.

Operational

Surgical intervention is resorted to in case of chronic disease and the presence of serious complications. Today, anal prolapse is treated mainly by the following surgical methods:

hemming fabrics;
intra-abdominal resection of segments;
plastic surgery that restores lost tone of the pelvic and sphincter muscles.

In some cases the doctor can choose a combined operation or the method of surgical excision of a segment of the rectum.

Today's surgery has the ability to perform fixation-type operations, when the affected area is attached directly to the spinal ligaments.

Occasionally, a special mesh made of Teflon is used for such operations.

To choose the optimal method, the doctor must take into account such important parameters as the stage and duration of the disease, the general health of the patient, age and the presence of contraindications.

Conclusion

In order to prevent prolapse of the rectal mucosa in women and men, it is necessary to make your diet balanced and rich in foods that do not cause constipation. Fiber intake plant origin has the best effect on the prevention of the disease; it is recommended to abstain completely from salty, fried, smoked and fatty foods.

Most experts advise minimizing the number of heavy physical activities, but activity in the form of walking and performing a set of specially designed exercises should be regular. Anal sex and other factors that provoke rectal prolapse should be excluded.

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