The intestine emerges from the anus. Rectal prolapse

Rectal prolapse of the rectum is a disease caused by its displacement. A change in the location of the organ provokes painful sensations during bowel movements, involuntary bowel movements and a feeling of significant discomfort.

Rectal prolapse is an anatomical disorder accompanied by the exit of its segment from the anus.

The pathological process occurs gradually with an increase in clinical symptoms. Minor prolapse of an organ fragment, observed in the initial stage of the disease, is easily eliminated and is observed quite rarely. But the lack of timely treatment leads to worsening and more frequent prolapses - with almost every bowel movement.

The progression increases so much that symptoms appear when coughing, sneezing, while walking, and even in the absence of physical activity.

The length of the prolapsed section of the organ can be from 1-2 to 18-20 centimeters. Most often, the disease occurs in children under 4 years of age. Among adults, men are more susceptible to this pathology.

Causes of the phenomenon

Among the causes, two types of factors are considered: predisposing and producing.

Of the first, the main one is the presence of congenital defects, weakening of the anal sphincter and pelvic floor muscles.

Producing factors

The main cause of prolapse is increased intra-abdominal pressure. The provocateurs of this condition are:

In children, the most common factor causing prolapse of the intestinal ampulla is a dry cough, loud crying, even squealing.

In men, this is most often associated with the presence of prostate adenoma; in women, the disease often develops after childbirth.

Basically, the pathogenesis of the disease is characterized by the presence of many factors, so identifying the main one is extremely important for successful treatment.

Symptoms

Clinical manifestations of rectal prolapse develop in different ways. In some cases, the disease begins suddenly and is accompanied by intense pain, which is caused by tension in the mesentery due to increased pressure inside the peritoneum.

In most cases, there is a gradual progression of the disease. In the initial stages of the disease, a slight prolapse of the segment becomes a consequence of straining during bowel movements, but the organ itself still has the ability to return to its normal position.

In the future, you have to perform some manipulations to straighten it. The situation repeats itself more and more often over time, and the condition worsens.

It should be noted that prolapse is often painless. But if strangulation occurs, accompanied by inflammation of the rectal mucosa, then the following symptoms appear:

• painful sensations;
• presence of mucus and blood;
• and gases;
• diarrhea;
• false urge to defecate;
• temperature increase;
• flatulence.

Discomfort increases. The length of the prolapsed segment can be up to 20 cm. Possible urination disturbance: rare or intermittent act. The prolapsed segment causes the sensation of a foreign object in the anus. Unpleasant and painful sensations disappear after the intestine is restored to its place.

First aid

It is required only in case of total prolapse of all layers of the rectum. This situation is more typical for children under three years of age.

To provide first aid to a child, he must be laid on his stomach, his legs raised to the sides and gradually set the fallen part back. To avoid injury, you can lubricate your hands with vegetable oil..

One person cannot cope with this problem, since someone must hold the baby by the legs, and another must carry out the procedure.

An adult should try to push the intestine inward himself.

After this, you must urgently consult a doctor - proctologist or surgeon.

Complications

If a prolapsed organ fragment is reset carelessly or does not pay attention to the prolapse, this may cause it to be injured. Such an injury is fraught with the formation of swelling and disruption of blood flow in the prolapsed segment.

As a result, an inflammatory process will occur, provoking the development of necrotic manifestations in the prolapsed area, intestinal obstruction, and peritonitis.

Classification

Two forms of rectal prolapse are considered: hernial and invaginal. Type 1 prolapse is a consequence of weakening of the pelvic floor muscles with a simultaneous increase in intraperitoneal pressure.

Invagination prolapse is an internal displacement of the intestine without prolapse from the anus.

The stages of the disease according to mechanical and clinical characteristics are as follows:

1. In the first stage (compensated), there is inversion of a small section of the intestine during the process of bowel movement, after which it returns to its normal position painlessly.
2. In the second (subcompensated) process, the prolapse process proceeds similarly, but the return of the organ to its place is associated with the appearance of painful sensations and mucous or bloody discharge. Prolapse occurs not only during bowel movements, but also in the presence of physical stress.
3. In the third case (decompensated, or tense), the intestine does not reduce on its own; it becomes necessary to reduce it by hand. Manifestations occur more often, bleeding increases. Symptoms of gas and fecal incontinence occur.
4. The fourth stage is decompensated, permanent. This degree makes itself felt already in a state of relative peace.

The fourth stage is accompanied by necrotic processes on inflamed intestinal fragments. This provokes increased pain, the appearance of bloody and mucous discharge.

Diagnostic measures

A visual examination by a proctologist allows one to draw a conclusion about the presence of pathology. However, to clarify the diagnosis, the following instrumental studies are carried out:

• defectography;
• sigmoidoscopy;
• colonoscopy;
• manometry.

To exclude oncological formation, an endoscopic biopsy is performed.

With the help of diagnostic measures, the typology is revealed and the stage of the disease is determined, as well as the mechanism that drives the pathological processes.

Treatment methods

The therapeutic course aimed at eliminating rectal prolapse includes the possibility of using both conservative and surgical methods.

Conservative therapy

Treatment without surgery is used for intussusception type of pathology. It is applicable exclusively at the first stage of the disease. High effectiveness of taking medications is rarely observed.

Therapeutic treatment in this case is aimed at:

• elimination of problems with bowel movements;
• treatment of existing intestinal diseases;
• prevention of further progression of pathology.

The result of proper nutrition is the normalization of stool, eliminating unnecessary stress during bowel movements. Anal sex is prohibited.

Conservative methods used

Among the attempts being made to cope with the disease non-surgically, the following procedures have proven themselves to be effective:

• massotherapy;
• physiotherapy (iontophoresis with strychnine);
• alcohol injections performed directly into the tissue located around the rectum;
• using electrical current to stimulate muscle tone.

Wearing a special bandage and using rectal suppositories also makes it possible to prevent further progression of prolapse.

Help from therapeutic exercises

A good effect is observed with regular exercise therapy. Performing special exercises helps strengthen the pelvic muscles.

The most effective exercise is to train the muscles of the perineum and intestinal sphincter. To do this, you should rhythmically squeeze and relax your muscles.

The exercise resembles clenching the muscles during an intense urge to defecate, when this is not possible due to lack of conditions. It has a positive effect on the condition of the ligamentous apparatus.

The advantage of this exercise over others is the ability to perform it anytime and anywhere without attracting the attention of others.

The essence of the second exercise is as follows: while lying on your back, you need to raise the pelvic area as high as possible. At the same time, you should tense and tighten the anal sphincter muscles.

Such simple gymnastics helps strengthen the pelvic muscles, which prevents the further development of the pathological process.

On the advisability of using traditional methods

It should be noted that for this disease they are not often recommended, but as an auxiliary therapy they can have a positive effect.

To get rid of slight hair loss, it is recommended to use infusions from plants such as:

1. The cuff is ordinary. To prepare the product, you will need 1 teaspoon of pharmaceutical medicinal raw materials, poured with a glass of boiling water. It is necessary to infuse the homemade medicine for 15 minutes and strain. The resulting infusion should be drunk in small portions throughout the day.
2. Swamp calamus. Grind 1 tbsp in a blender. spoon of calamus and soak in a glass of cold water. The product is infused for a day, and the container must be tightly closed. Warm to room temperature before use. Drink three sips after meals.
3. Shepherd's purse. The infusion, prepared in the manner described in the first recipe, is used to rinse the anus (take two tablespoons of raw material).

The use of folk remedies is permissible only after mandatory consultation with a doctor.

Surgery

The indication for surgical treatment is the lack of positive dynamics as a result of the therapeutic course. Most often it is recommended for external manifestations of pathology.

Modern medicine has a wide variety of surgical methods. Among them, the most commonly used are:

• resection of the prolapsed segment;
• plastic;
• fixing tightening, intestinal suturing;
• combined methods.

In most cases, laparoscopic operations are performed. They are characterized by painlessness, simple and short rehabilitation, and a minimal risk of complications.

Features of treatment in some patients

Methods for eliminating pathology in adults are not always suitable for children. Choosing therapy methods for children requires special approaches and great responsibility.

Rectal prolapse in a child can be treated using conservative methods. The treatment course is long and is accompanied by the mandatory elimination of all factors that provoke the pathology.

The occurrence of a problematic situation during pregnancy allows the use of similar treatment. If it does not give the desired result, then surgery is recommended, but only after childbirth.

For elderly patients, these methods are useless. In this case, a sparing Delorme operation is performed. It consists of cutting off the prolapsed fragment of the intestine and applying sutures to assemble the intestine.

The prerogative of deciding on the choice of methods is given to the proctologist, who, based on a thorough examination, selects the necessary treatment tactics.

Preventive measures

To prevent the risk of developing a dangerous disease, you must:

• dose physical activity;
• adhere to healthy eating standards;
• Avoid having multiple bowel movements, which relaxes the sphincter muscles.

It is necessary to consult a doctor at the first signs of discomfort, discarding false ideas about shame.

A timely and thorough examination, facilitating the formulation of an adequate diagnosis and the choice of an effective technique, will make it possible to bring the condition of the diseased organ back to normal.

is a violation of the anatomical position of the rectum, in which its distal part is displaced beyond the anal sphincter. May be accompanied by pain, incontinence of intestinal contents, mucous and bloody discharge, sensation of a foreign body in the anus, false urge to defecate. Diagnosis of rectal prolapse is based on examination data, rectal digital examination, sigmoidoscopy, irrigoscopy, and manometry. Treatment is usually surgical, consisting of resection and fixation of the rectum, and sphincter plastic surgery.

ICD-10

K62.3

General information

In proctology, prolapse of the rectum (rectal prolapse) refers to the exit through the anus to the outside of all layers of the distal colon. The length of the prolapsed segment of the intestine can range from 2 to 20 cm or more. Quite often, rectal prolapse occurs in children under 3-4 years of age, which is explained by the anatomical and physiological specifics of the child’s body. Among adults, rectal prolapse develops more often in men (70%) than in women (30%), mainly in working age (20-50 years). This is due to heavy physical labor, which is mainly performed by men, as well as the anatomy of the female pelvis, which helps maintain the rectum in a normal position.

Causes

The causes of rectal prolapse can be predisposing and producing. Predisposing factors are disturbances in the anatomical structure of the pelvic bones, the shape and length of the sigmoid and rectum, and pathological changes in the pelvic floor muscles. A special role is played by the structure of the sacrococcygeal spine, which is a curve with a concavity facing anteriorly. Normally, the rectum is located in the area of ​​this curvature. When the curvature is weak or absent, which is often found in children, the rectum slides down along the bone frame, which is accompanied by its prolapse.

Another predisposing factor may be dolichosigma - an elongated sigmoid colon and its mesentery. It has been noted that in patients with rectal prolapse, the length of the sigmoid colon is on average 15 cm longer, and the mesentery is 6 cm longer than in healthy people. Also, weakening of the pelvic floor muscles and anal sphincter can contribute to rectal prolapse.

The producing factors of rectal prolapse include those moments that directly provoke prolapse. First of all, this is physical stress: prolapse can be caused either by a single excessive effort (for example, lifting something heavy), or by constant hard work, which is accompanied by an increase in intra-abdominal pressure. Sometimes the pathology is a consequence of injury - a fall on the buttocks from a height, a strong blow to the sacrum, a hard landing with a parachute, damage to the spinal cord.

In children, frequent direct causes are diseases of the respiratory system that occur with a persistent, painful cough - pneumonia, whooping cough, bronchitis, etc. Polyps and tumors of the rectum also often lead to rectal prolapse; gastrointestinal diseases accompanied by chronic diarrhea, constipation, flatulence; pathology of the genitourinary system - urolithiasis, prostate adenoma, phimosis, etc. In all these cases, there is constant straining, tension in the abdominal wall and increased intra-abdominal pressure.

In women, rectal prolapse can develop after numerous or difficult births (with a narrow pelvis in a woman in labor, a large fetus, multiple births) and be combined with uterine and vaginal prolapse, and urinary incontinence. In addition, proctologists warn that the cause of rectal prolapse may be a passion for anal sex and anal masturbation. Most often, the etiology of the disease is multifactorial in nature with a predominance of the leading cause, the identification of which is extremely important for the treatment of the pathology.

Classification

Diagnostics

Rectal prolapse is recognized based on the results of an examination by a proctologist, functional tests and instrumental studies (sigmoidoscopy, colonoscopy, irrigoscopy, defectography, manometry, etc.). Upon examination, the prolapsed section of the rectum has the shape of a cone, cylinder or ball of a bright red or bluish tint with the presence in the center of a slit-like or stellate hole. There is moderate swelling of the mucous membrane and slight bleeding on contact. Reduction of the prolapsed intestine leads to the restoration of blood flow and the normal appearance of the mucous membrane. If rectal prolapse is not detected at the time of examination, the patient is asked to strain, as if defecating.

Carrying out a digital rectal examination allows you to assess the tone of the sphincter, distinguish rectal prolapse from hemorrhoids, low-lying anal polyps and protruding through the anus. With the help of endoscopic examination (sigmoidoscopy), intestinal intussusception and the presence of a solitary ulcer on the anterior wall of the rectum are easily detected. A colonoscopy is necessary to determine the causes of rectal prolapse - diverticular disease, tumors, etc. If a solitary ulcer is detected, an endoscopic biopsy is performed with a cytomorphological examination of the biopsy to exclude endophytic rectal cancer.

Treatment of rectal prolapse

Manual repositioning of the organ brings only temporary improvement and does not solve the problem of rectal prolapse. Pararectal administration of sclerosing drugs, electrical stimulation of the pelvic floor and sphincter muscles also do not guarantee a complete cure for the patient. Conservative tactics can be used for internal prolapse (intussusception) in young people with a history of rectal prolapse no longer than 3 years.

Radical treatment of rectal prolapse is carried out only surgically. Many methods have been proposed for radical elimination of rectal prolapse, which can be performed through the perineal approach, through transection or laparoscopy. The choice of surgical technique is dictated by the age, physical condition of the patient, causes and degree of rectal prolapse.

Currently, in proctological practice, operations are used for resection of a prolapsed segment of the rectum, plastic surgery of the pelvic floor and anal canal, resection of the colon, fixation of the distal rectum and combined techniques. Resection of the prolapsed section of the rectum can be carried out by its circular cutting (according to Mikulicz), patch cutting (according to Nelaton), cutting off with the application of a collecting suture to the muscle wall (Delorme operation), and other methods.

Anal canal plastic surgery for rectal prolapse is aimed at narrowing the anus using special wire, silk and lavsan threads, synthetic and autoplastic materials. All these methods are used quite rarely due to the high rate of recurrence of rectal prolapse and postoperative complications. The best results are achieved by suturing the edges of the levator muscles and fixing them to the rectum.

For inert rectum, solitary ulcer or dolichosigma, various types of intra-abdominal and abdominal-anal resection of the distal colon are performed, which are often combined with fixation operations. In case of necrosis of a section of the intestine, abdominoperineal resection with the application of a sigmostoma is performed. Among the methods of fixation, rectopexy, the most widely used is suturing the rectum using sutures or mesh to the longitudinal ligaments of the spine or the sacrum. Combined surgical techniques for the treatment of rectal prolapse involve a combination of resection, plastic surgery and fixation of the distal parts of the intestine.

Prognosis and prevention

The correct choice of surgical treatment allows eliminating rectal prolapse and restoring the evacuation capacity of the large intestine in 75% of patients. A persistent, relapse-free effect can be achieved only by excluding the etiological factors of rectal prolapse (constipation, diarrhea, physical stress, etc.).

Rectal prolapse is a disease in which the lower portion of the intestine falls out of the canal as it progresses. The clinical picture of the disease is always very pronounced - there is severe pain, sphincter incontinence, and the appearance of bloody or mucous discharge from the anus. Rectal prolapse is a dangerous condition that requires timely and complete treatment. It is worth noting that the disease has no restrictions regarding gender and age.

Etiology

The causes of rectal prolapse are divided into producing and presumptive. Prospective causes are those that directly provoke the progression of the pathology. These include:

• surgical interventions on the intestines;
• strong and regular straining during bowel movements (often observed in chronic cases);
• difficult childbirth, during which injuries to the pelvic muscles occurred;
• injuries to the sacral area of ​​the spinal column;
• ulcerative lesions of the intestinal mucosa;
• difficult work, due to which the muscular system of the peritoneum is constantly tense.

Predisposing causes of rectal prolapse:

• pathologies of the muscular structures of the pelvic floor;
• stretching of intestinal muscles;
• increased pressure inside the peritoneum;
• decreased sphincter muscle tone;
• lengthening of the rectum;
• complicated pregnancy;
• The coccyx is anatomically located in a vertical position.

Classification

• hernia type. In this case, there is a downward displacement of the anterior wall of the rectum. This pathological condition occurs due to increased pressure in the peritoneum, as well as due to the weakness of the muscular structures of the pelvis. As a result, the mucous membrane is squeezed and brought out;
• intussusception type. Indentation of a certain part of the intestine is observed only in the anus. The mucous membrane does not extend beyond its boundaries.

Degrees

Clinicians distinguish only 4 degrees of rectal prolapse:

1. compensated. During the act of defecation, slight loss of mucous membrane is observed. At the end of bowel movement, it returns to its physiological position;
2. subcompensated. The mucous membrane turns out at the same level as during the compensated stage. Only it returns slowly to its original position. This process is accompanied by pain and minor bleeding;
3. decompensated. Rectal prolapse is observed not only during bowel movements, but also with any other strain. She does not return to her place on her own. Bleeding from the anus appears more and more often, and sometimes there is incontinence of feces and gases;
4. decompensated deep. Loss is observed even with minor physical activity. load. Also, the intestine can fall out even while sitting or standing. The mucous membrane is damaged, and necrotic processes begin to progress on it, which provoke severe itching and bleeding.

Symptoms

Rectal prolapse can occur either gradually or suddenly. But still, more often the pathological process progresses gradually. In stage 1, rectal prolapse occurs only during bowel movements. But as the disease progresses, the mucous membrane falls out even with slight tension, and the patient is forced to reduce it.

Sudden rectal prolapse develops after a sharp increase in intra-abdominal pressure during increased stress (for example, lifting heavy objects). At the moment, the symptoms of prolapse are clearly manifested - sharp pain, which can lead to collapse, as well as bleeding.

Common symptoms of rectal prolapse:

• false urge to defecate;
• characteristic symptom - the patient has a feeling that there is a foreign body in his anus;
• it is difficult for the patient to retain feces and gases;
• pain syndrome;
• bleeding.

When the first symptoms appear, you should immediately contact a highly qualified proctologist for diagnosis and treatment of the disease.

Diagnostics

Diagnosing rectal prolapse in children and adults begins with a visual examination. It is worth noting an important point - visually marking the loss can only be done in advanced stages of the disease. If the doctor suspects that the patient has the initial stage of the disease, then he usually asks him to sit down and strain. The appearance of mucous membrane confirms the diagnosis.

A standard diagnostic plan for rectal prolapse includes:

• finger examination;
• sigmoidoscopy;
• defecography.

Treatment

Treatment of rectal prolapse involves both conservative and surgical methods. A specific technique is selected only by the attending physician, taking into account the symptoms of the disease, the stage of progression, and the cause of its occurrence.

Conservative therapy for rectal prolapse:

• physiotherapy;
• special massage through the rectum;
• injection administration of sclerosing drugs.

Surgical techniques for treating rectal prolapse:

• plastic surgery of the muscular structures of the pelvis;
• resection (surgeons extract the prolapsed area);
• operations, the essence of which is to stitch the mucosa;
• resection of a certain area of ​​the colon.

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Diseases with similar symptoms:

Internal hemorrhoids are a disease characterized by inflammation of hemorrhoids in the human rectum. This pathological process often develops in older people, but its progression is possible in people aged 25 to 45 years. It is sometimes difficult to determine its presence in the early stages, since the inflamed nodes are localized not outside the rectum, but inside.

Hemorrhoids, the disease that will be discussed in our article today, cannot be called anything other than a delicate problem. Moreover, hemorrhoids, the symptoms of which we will consider today, in many cases patients try to cure on their own, which, unfortunately, in no way favors its course and the consequences that arise due to such an attitude towards it.

Rectal prolapse (rectal prolapse) is a pathology of the rectum, during the development of which the intestine exits through the anus. The severity of the disease depends on how much the rectum prolapses (only the mucous membrane or all the walls) and under what conditions. The main treatment method for rectal prolapse is surgical. Anyone can suffer from rectal prolapse, regardless of gender and age, but in childhood and old age this disease is much more common.

Causes of rectal prolapse

The main cause of rectal prolapse is weakness of the pelvic floor muscles, the development of which is facilitated by a number of predisposing factors:

• difficult delivery. Quite often, with improper straining, prolonged and difficult labor, women experience complications of labor in the form of rectal prolapse;
• genetic predisposition. In patients who have a history of close relatives with this pathology, the risk of rectal prolapse increases significantly;
• unconventional sex life. In conditions of non-traditional sexual intercourse, rectal injuries very often occur, which cause rectal prolapse;
• diseases of a neurological nature that are closely related to injuries or diseases of the spinal cord;
• decreased sphincter tone and stretched ligaments that support the rectum. Most often, this cause of rectal prolapse occurs in older people;
• general dysfunction of the pelvic organs, acute and chronic diseases of the gastrointestinal tract;
• the habit of straining heavily during defecation, sitting for a long time on the potty (children) or on the toilet (adults);
• increased pressure inside the peritoneum;
• vertical position of the sacrum and coccyx;
• very deep rectouterine cavity;
• surgical interventions on the pelvic organs.

Very often, the cause of this pathology is not one factor, but several at the same time, which greatly complicates treatment.

Identification and elimination of predisposing factors is a very important point on the path to proper treatment of this pathology.

Classification of types and degrees of rectal prolapse

Like most pathologies known to medicine, rectal prolapse does not have a single classification, but there is still a classification that doctors most often use in their practice. This classification was developed based on the quantitative ratio of the prolapsed section of the rectum, as well as the degree of inclusion in the process of the nearest parts of the colon or only the anus. This classification implies that each of the forms of rectal prolapse is a certain degree of a single pathological process. To date, there are four degrees of rectal prolapse:

• partial prolapse of the rectum (mainly its mucous membrane);
• complete prolapse of the colon with eversion of the dentate line (mucocutaneous border) of the anal canal;
• prolapse of the rectum, as well as intussusception of the higher located parts of the large intestine.

As for the typology of rectal prolapse, it is presented in two options:

• the hernial type of rectal prolapse is caused by the displacement of the anterior wall of the rectum downward and its exit through the anus;
• The intussusception type is characterized by indentation of the sigmoid or rectum between the walls of the anus.

Symptoms of rectal prolapse

Symptoms of the disease depend on the nature of the pathology. The acute course of the disease is characterized by the sudden appearance of symptoms of rectal prolapse, which, as a rule, occurs after an increase in intraperitoneal pressure as a result of childbirth or heavy physical exertion, as well as in conditions of weakening of the anal sphincter and muscles of the bottom of the peritoneum, after sneezing, sharp coughing, etc. d. As a result of such episodes, the rectum may prolapse over a significant extent (about 8-10 cm). The process of prolapse is accompanied by severe sharp pain, which often provokes a state of collapse or shock in the patient.

With a gradual (chronic) course of the process, there is a slow gradation of difficulty in defecation, turning into a chronic process that minimizes the effectiveness of cleansing enemas and taking laxatives. In this case, any bowel movement becomes painful for the patient, and intraperitoneal pressure constantly increases. Over time, the rectum falls out more and more, although at first it is possible to easily, even independently, reposition it behind the anal canal. After some time, after acts of defecation, the intestine has to be adjusted manually. As the disease progresses, the intestine begins to fall out not only during bowel movements, but also during sneezing, coughing, and even when getting out of bed or from a chair. In both variants of the development of the disease (acute and chronic), the main complaint of patients is the prolapse of the rectum from the anus.

80% of patients with rectal prolapse experience incontinence of intestinal contents, which especially often happens in the chronic course of this disease in women. Half of all patients develop various dysfunctional disorders of the rectum, the clinical manifestation of which may be chronic constipation, which forces patients to constantly use cleansing enemas or take laxatives. Chronic diarrhea can also be a symptom of this disease, but it is much less common.

The pain syndrome is pronounced in the case of an acute disease; with chronic rectal prolapse, patients feel a dull pain in the lower abdomen, which intensifies with significant physical activity, walking or during defecation. The pain may decrease or disappear after rectal reduction.

Also, with rectal prolapse, mucous or bloody discharge often appears. Bloody discharge may occur due to constant injury to the small vessels of the rectum.

Patients often complain of a subjective sensation of a foreign body in the rectal area and the presence of a false urge to defecate. Rectal prolapse can be combined with uterine prolapse, and patients experience a urge to urinate frequently, which can sometimes be intermittent.

Diagnosis of rectal prolapse

Diagnosis of this pathology begins with anamnesis and examination of the patient. When examining the patient's anus, a thickening of the anus is visualized, often a gaping of the anus, which indicates a weakening of the structures of the bottom of the peritoneum, which is responsible for maintaining the rectum and sphincter. During this examination, the nature of intestinal prolapse is determined, as well as the condition of the skin of the perianal area, thighs and perineum; very often the skin is inflamed.

Digital examination makes it possible to determine hypotonicity and weakness of sphincter contractions, as well as straightening of the anorectal angle. This study can diagnose internal intussusception of the sigmoid or rectum. If the patient has a concomitant inflammatory pathology (proctitis), during the digital examination the patient will complain about the pain of the procedure, and the doctor will determine thickening of the walls of the anal canal.

It is advisable to determine the size and shape of rectal prolapse, as well as the condition of its mucous membrane, when the patient strains over the tray, in a squatting position. The length of the prolapsed intestinal fragment can vary - from a slight inversion of its mucous membrane (1-2 cm) to complete prolapse of the rectum and part of the sigmoid colon. The prolapsed intestine can have different shapes: spherical, cone-shaped, cylindrical, ovoid. Ovoid prolapse of the intestine indicates hypotonicity of the distended intestinal wall.

Colonic prolapse most often occurs in children. The prolapsed part of the intestine has the shape of a roller or a knot. When the anus prolapses, a circular protrusion of all the walls of the anus is visualized; it looks as if turned inside out, and the mucous membrane does not have a circular depression and passes into the skin of the anus. In the case of complete prolapse of the rectum, all its layers turn outward, accompanied by atony of the sphincter. The prolapsed intestine is presented in the form of a cone or cylinder of different sizes, most often about 20 cm, the anal canal does not move. The surface of the deformed part of the intestine can be smooth (if only the mucous membrane has fallen out) or folded (if all layers have fallen out). A feature of this form of prolapse is the presence of a circular groove (fold), the depth of which reaches from 1 to 6 cm, and it is localized between the skin of the anus and the wall of the rectum. Such a groove does not occur when the rectum prolapses along with the anus. If there is a jagged line on the conglomerate, this is a sign of prolapse of the walls of the anal canal.

In most cases, the anterior wall of the prolapsed intestine is longer than the posterior wall and visually the entire intestine faces slightly behind, the opening of the rectum has the same direction. If the size of the prolapsed colon is more than fifteen centimeters, there is a high probability that part of the sigmoid colon has also prolapsed.

If the prolapsed intestine is large, a small intestinal loop may protrude into the peritoneal pocket, similar to a perineal hernia. The prolapsed area takes on a spherical shape, up to 30 cm long and about 30-40 cm in circumference. For differential diagnosis of the conglomerate, palpation examination, percussion, and also X-ray contrast examination are performed.

Upon examination, the mucous membrane of the prolapsed intestine is swollen and hyperemic; in conditions of prolonged prolapse, significant changes occur on it; it can become dry, with fibropurulent overlays, extensive ulcerations and profuse hemorrhage. At the initial stage, with preserved tone of the muscles of the bottom of the peritoneum, repositioning the intestine is very painful and requires some effort. Over time, the muscles lose tone and the intestine is reduced by retracting the muscles or manually. Patients do this on their own; to do this, they only need to lean forward, but sometimes the reduction becomes possible only with outside help. The difficulty of reduction is caused by the development of edema of the intestinal walls.

At the onset of the disease, strangulation of the prolapsed rectum may occur, which is fraught with impaired circulation in the strangulated area and necrosis of the tissue of the prolapsed rectum. In severe cases, in the absence of timely treatment, the patient may develop peritonitis. Sometimes rectal strangulation is complicated by the development of symptoms of intestinal obstruction (fecal vomiting, pain), which can cause death.

Other complications of rectal prolapse include bleeding from the pathological area, as well as ulceration of the prolapsed colon.

Treatment of rectal prolapse

Rectal prolapse requires timely treatment and how to properly perform it is decided by the proctologist. The treatment tactics for this pathology depend on the degree and form of rectal prolapse, as well as on the etiology of the disease. The main methods of therapy are conservative and surgical treatment.

Conservative therapy is appropriate during pregnancy in women and in the initial stages of the disease. In this case, the complex of treatment measures includes the elimination of heavy physical activity, medication elimination of constipation, and also the selection of individual physical exercises to strengthen the pelvic floor muscles. Today, almost all experts are inclined to believe that treatment of external rectal prolapse should be carried out only surgically (except for the presence of direct contraindications). And in case of internal prolapses (invaginations), a set of conservative therapeutic measures should first be carried out. There are many approaches to the surgical treatment of this pathology, which differ in the technique of the operation, the choice of anesthesia and the features of the instruments involved. All operations to eliminate rectal prolapse can be divided into the following types:

• rectal resection (removal of part of the rectum);
• suturing the rectum;
• plastic surgery on the rectal canal and pelvic muscles;
• a combination of several types of operations.

The most common operations for colon prolapse today are surgical interventions aimed at fixing the prolapsed colon. They also have a number of variations. For example, the intestine can be sutured to the anterior longitudinal vertebral ligament or it can be fixed to the sacrum using a special Teflon mesh. Plastic surgery is appropriate only at the second stage of surgery, after the intestine has already been fixed. Also, modern medical practice actively includes the use of laparoscopic surgical methods, which minimize the risk of complications and shorten the rehabilitation period.

Prognosis for rectal prolapse

The prognosis for the treatment of rectal prolapse is favorable in 75% of cases; success depends on many factors, among which timely diagnosis of the disease, elimination of the cause, the patient’s age and the presence of concomitant diseases are of particular importance. In order to prevent the disease, it is necessary to lead a healthy lifestyle, be attentive to your body and undergo regular medical examinations.

Rectal prolapse is also called rectal prolapse. This is a pathological condition that is characterized by partial or complete protrusion of the rectum beyond the anus. The disease is characterized by the development of mobility of the terminal section of the last section of the digestive tract, its further stretching and prolapse from the anal canal. The disease, even in an advanced stage, does not threaten the patient’s life, but the unpleasant symptoms debilitate the condition.

The disease is common in 0.5% of patients with proctological diseases. Pathology develops regardless of gender and age. Although, according to statistics, men are more susceptible to the disease due to frequent heavy physical activity.

Provoking factors

The causes of the disease can be varied. The disease can be provoked by both severe straining during defecation and difficult childbirth or previous operations. Anatomical reasons are:

• changes in the pelvic floor muscles of a pathological nature;
• relaxation of the anal sphincter muscles;
• increased intra-abdominal pressure;
• finding the coccyx and sacrum in a vertical position;
• a stretched state of the muscles that help hold the last section of the digestive tract.

Rectal prolapse can be caused by genetic factors and the patient's sexual orientation. It is non-traditional sexual relations that in most cases injure the rectum and provoke its prolapse.

Rectal prolapse can be caused by dysfunction of the pelvic organs, neurological diseases that damage the spinal cord. As a rule, the reasons are considered together.

Stages of the disease

Rectal prolapse is divided into several degrees:

1. The intestine falls out only during bowel movements, but returns to its place on its own.
2. The mucous membrane is everted during the act of defecation, which then returns to its place, but this happens for quite a long time. During this period, bleeding may occur.
3. Intestinal prolapse occurs not only during bowel movements, but also during physical activity. Anal bleeding occurs more often. The patient is concerned about flatulence and fecal incontinence. There is no way to return to the place on your own - you have to do it manually.
4. Loss occurs while walking or standing. Necrosis progresses, a feeling of itching occurs in the anus, its sensitivity is impaired. It’s problematic to straighten it yourself.

Rectal prolapse has similar symptoms to hemorrhoids. The difference is that with hemorrhoids, the hemorrhoids fall out. If the folds of the mucous membrane are located longitudinally and not transversely, it means that the patient has hemorrhoids.

Clinical picture

Symptoms may occur spontaneously or develop gradually.

If the intestinal mucosa comes out spontaneously, the cause may be an increase in intra-abdominal pressure as a result of strong physical exertion and straining. This process is accompanied by severe pain in the abdominal area..

In most cases, rectal prolapse does not develop immediately. Prolapse begins with loss of mucous membrane, which easily retracts on its own. Over time, the disease progresses.

Symptoms of prolapse:

• constant sensation of a foreign object in the anus;
• false urge to have a bowel movement;
• soreness and discomfort;
• flatulence;
• insufficiency of the anal sphincter.

Rectal prolapse is accompanied by injury to blood vessels, release of blood and mucus. If the pathological process is not treated for a long time, symptoms appear that characterize a violation of the urinary system (frequent urge to urinate, intermittent bladder emptying). Over time, symptoms increase, and strangulation of a loop of the small intestine becomes possible. A. The disease weakens the immune system and reduces ability to work. The patient loses interest in life and becomes irritable.

Diagnostic methods

A specialist will tell you what to do if your intestine comes out. To begin with, the doctor conducts an examination, finds out the clinical symptoms, and examines the anus area. If the patient has the initial stage of the disease, rectal prolapse is not visually noticeable. Therefore, the doctor asks the patient to squat down and strain.

Instrumental research methods:

1. Defectography. Allows you to evaluate the anatomical structure and functioning of the final part of the digestive tract, the condition and tone of the muscles.
2. Sigmoidoscopy. Allows you to visually diagnose the condition of the mucous membrane and identify complications.
3. Colonoscopy. Finds out the provoking factors that caused the development of pathology. If an ulcer is detected, the doctor prescribes a biopsy to rule out the presence of oncology.
4. Anorectal manometry. Allows you to evaluate the ability of the sphincter to contract.

Principles of therapy

A specialist will tell you how to treat rectal prolapse after diagnosis and identification of the stage of the pathology. Treatment can be carried out both conservatively and surgically. Conservative treatment is advisable to use at the initial stage of development in young and middle-aged patients.

Such treatment consists of eliminating provoking factors: stool is brought back to normal, constipation is prevented, provoking diseases are identified and treated. It is also necessary to avoid heavy physical activity and anal sex.

The doctor advises patients to do therapeutic exercises that help strengthen the muscles of the perineum and pelvic floor, which can be performed at home. Other methods of conservative therapy include injections of sclerosing drugs, a course of therapeutic massage, and physiotherapy.

Conservative treatment is effective for about a third of patients. In other cases, the only method of treating the pathology is surgical treatment.. The earlier the operation is performed, the higher the chances of getting rid of prolapse without complications.

Surgical treatment involves about 50 operations. Depending on the therapeutic task, surgical intervention is divided into several types:

• removal of the prolapsed section of the last section of the digestive tract;
• partial elimination of the colon;
• plastic surgery. It consists of suturing the last section of the digestive tract, plasticizing the muscles located in the pelvic floor;
• combined operation.

In most cases, the doctor tries to perform operations that involve stitching. This surgical treatment is less traumatic. It is easier to tolerate by patients. The intervention method depends on the stage of rectal prolapse, age, health status, clinical manifestations and individual characteristics of the body.

A properly selected operation allows not only to eliminate the provoking factor, but also to restore the functioning of the large intestine. Clinical manifestations of the pathology disappear. The patient feels better. The tone of the anal sphincter is restored. The functioning of the gastrointestinal tract returns to normal. Over the course of a year, it is determined how effective the intervention was. During this period, it is recommended to adhere to a special diet and avoid constipation.

Education: Diploma in General Medicine, First Moscow State Medical University named after I.M. Sechenov, Faculty of Military Training, Faculty of Medicine (2011) Internship in the specialty…