Archoptosis
Rectal prolapse is the prolapse through the anus all the layers of the rectum. Precipitating length portion may be different: from 2 to 20 centimeters, and sometimes more.
Among stationary surgical patients, patients with rectal prolapse make up 1 %. Hair loss often begins in childhood. Truth, not all parents bring such children to the doctor. Иногда они годами ждут, что заболевание само пройдет, или применяют какие-то домашние средства. И только уже во взрослом состоянии, когда выпадение становится большим, больные обращаются за медицинской помощью.
По данным многих проктологов, первые признаки выпадения прямой кишки у большинства больных (83,6%) были замечены в возрасте до 3 years. This is because, что в раннем детском возрасте часто возникают самые различные болезни желудочно-кишечного тракта, которые способствуют выпадению прямой кишки.
Среди больных, coming for treatment to proctologists, 70-75% refers to the most working age - from 20 to 50 years. Rectal prolapse is more common in men, than in women (70% and 30%), причем такое различие наблюдается в любых возрастных группах населения. Это объясняется многими факторами, в том числе тяжелой физической работой, которую чаще выполняют мужчины, и наличием у женщин органов малого таза (uterus, ее придатки). Последние при повышении внутрибрюшного давления берут на себя основную часть нагрузки и защищают переднюю стенку прямой кишки, where, usually, и начинается процесс ее выпадения.
Causes of rectal prolapse
Различают две группы причин, способствующих выпадению прямой кишки: предрасполагающие и производящие. К предрасполагающим факторам относятся врожденные аномалии развития организма, в том числе и те, которые отражаются на анатомическом строении костей таза, shape and length of the rectum and sigmoid colon. Pathological changes in the pelvic muscles can also play a negative role..
The structure of the sacrum and coccyx is of particular importance, which under normal conditions form a bend, concave forward. The rectum lies on such a concavity. If the curvature is weakly expressed or absent altogether, as often happens with children, then the rectum seems to slide downwards without delay along the bones, which leads to her, loss.
Важным фактором является большая против нормы длина сигмовидной кишки и ее брыжейки. Established, что у больных с выпадением прямой кишки длина сигмы почти на 15 сантиметров а высота ее брыжейки на 6 more centimeters, than in patients without prolapse. One of the causes of rectal prolapse is considered to be weakness of the pelvic floor muscles and the obturator anus..
Among the producing factors, directly causing rectal prolapse, heavy physical activity comes first, especially in young people. Loss occurs equally often as a result of a single excessive sudden physical effort (most often lifting weights), and with constant hard work, when intra-abdominal pressure increases.
In some cases, rectal prolapse may occur immediately after injury, for example, falling from a height onto the buttocks, during a parachute landing, a strong blow to the sacrococcygeal region.
Diseases of other organs and systems, especially the gastrointestinal tract, accompanied by abdominal wall tension, and respiratory system, uncontrollable cough, can be provoking moments, especially in children. Such diseases, like pneumonia, bronchitis, pertussis, infectious diseases, ponosy, quite often lead to rectal prolapse in children. In this case, loss can occur during the period of illness, and soon after he was cured.
Polyps and other rectal tumors, some diseases of the genitourinary system, in particular bladder stones, prostate adenoma, phimosis and others, making it difficult to urinate normally, may contribute to rectal prolapse.
Diagnosis and first aid for rectal prolapse
The clinical picture of rectal prolapse is quite characteristic and allows most patients to make a correct diagnosis when they first visit a doctor.. Usually the very fact of rectal prolapse in children is noticed by parents, and the reason for the examination is the child’s complaints of pain in the abdomen or in the anus during bowel movements.
In adults, rectal prolapse also occurs more often during bowel movements or during heavy physical work.. But in about every fifth patient, the intestine prolapses during minor exertion: during long and especially fast walking, and also for coughing, cixanii, laughter. It depends on the degree of violation of the rectal holding apparatus.
Initially, a small section of intestine usually falls out, and it straightens itself after the tension stops. Subsequently, the intestine prolapses even with light loads and does not reset on its own.. The patient must adjust it himself, after which it is held in place.
With increasing weakness of the obturator apparatus after reduction, the intestine is not retained and is constantly in a prolapsed state. This is accompanied by pain in the anus, lower back, at the bottom of the abdomen. Quite often in such patients – there is bleeding from the rectum as in the condition that gave it away, as well as when managed.
Among the complications of rectal prolapse, the most dangerous is its strangulation.. It is accompanied by acute sharp pain in the anus or lower abdomen. In this case, the previously self-reduced, and with the help of a doctor, the intestine cannot be reduced, stays outside.
In the initial stages, the prolapsed intestine is reset on its own after the cessation of physical stress. Sometimes patients are able to achieve periodic contractions of the anal muscles and active retraction of the intestinal tract through a sufficient volitional effort.. Occasionally, such a reduction can only be done in the knee-elbow position with a deep breath.. Some patients have their intestines adjusted, squeezing the buttocks with both hands. Положение на животе с приподнятым тазом также способствует устранению выпадения. Все эти приемы при повторных выпадениях кишки больной может делать сам.
В острых случаях при первичном выпадении и когда не удается вправить вторично выпавшую кишку без особых усилий, It is necessary to consult a physician.
Under no circumstances should you even try to reset a strangulated prolapsed intestine yourself.. All patients, who manage to set their intestines, should be under the supervision of a physician. Inconveniences, associated with frequent reduction, changes, occurring over time in the intestine, eventually become mandatory indications for surgery. These indications are determined by the doctor.
Treatment of rectal prolapse
Known a lot, more 200, various methods of surgical interventions, which can be divided into several groups: performed only from the perineum, exclusively from the abdominal cavity and combined operations.
Therapeutic tactics for rectal prolapse in children have some features. Conservative therapy is carried out more persistently, and quite often it turns out to be effective. The attending physician usually sets himself the task, and his parents should help him with this, First of all, cure the child from diseases, способствующих выпадению прямой кишки (pertussis, bronchitis, pneumonia, constipation, diarrhea, inflammatory diseases and colon polyps).
Simultaneously with the specified, The baby is not allowed to defecate on the potty. It is with this method of emptying the rectum that prolapse occurs. Several positions are recommended, in which the child should be during the act of defecation. The main one is: being in the mother's arms with the child's hips brought to the stomach as much as possible. This position was recommended by Hippocrates. Besides, it is possible to allow defecation while standing or lying in bed with your hips straight or drawn towards the stomach, and adults at this moment should squeeze the child’s hips and buttocks.
All this is complemented by toileting the anus and therapeutic microenemas from a furatsilin solution, enteroseptol, chamomile infusion, sage, which are injected into the rectum in an amount of 30-50 milliliters. During treatment, the doctor prescribes B vitamins to the patient..
If the child is suffering, constipation and he does not have a bowel movement for several days, It is necessary to give cleansing enemas with water at room temperature daily.
A large number of different dressings have been proposed, bandages, the purpose of which is to prevent rectal prolapse. They can be used in addition to the above treatment. You can use cotton gauze rolls, greased with zinc paste, which are placed between the buttocks and reinforced with a bandage or adhesive plaster. Sometimes simply tightening the buttock areas with adhesive tape without pads helps. All these procedures, as well as additional drug treatment, must be carried out as prescribed and under the supervision of a physician.
How long can this treatment be used for children?? Some surgeons recommend treatment until recovery and another 3-6 months after the last rectal prolapse. Others think, that it takes 2-3 months to treat, and if during this time there is no improvement, should move on to other treatment methods, in particular to injection or surgical.
With the injection method of treatment, various substances are injected into the tissue around the rectum, which you cause sclerosis, tissue scarring, and, thereby keeping the intestine in its normal position.
Failure of conservative treatment, as well as relapses after the injection method are indications for surgical treatment. Last thing; performed in children, usually aged 13-14 years. At a younger age, operations are performed only in those cases, where, except for falling out; have other diseases, requiring surgical intervention.
Of the wide variety of operations, doctors usually use the simplest ones, in particular aimed at narrowing the anus. It should be remembered, that rectal prolapse is a treatable disease, if you consult a doctor early and start treatment in a timely manner.
