Prolapse of the rectum
- Reasons of the Prolapse of the rectum
- Symptoms of the Prolapse of the rectum
- Treatment of the Prolapse of the rectum
Prolapse of the rectum — rectum shift from top to bottom with a vykhozhdeniye its (reversing) through an anus. Frequency of a prolapse of the rectum makes 9 — 10% of all diseases of a large intestine. Depending on expressiveness the prolapse of the rectum is subdivided on:
1) loss of a mucous membrane;
2) loss of an anus;
3) internal invagination of a rectum;
4) prolapse of the rectum;
5) loss of the invaginated large intestine.
Reasons of the Prolapse of the rectum:
The disease develops owing to increase in intra belly pressure (at childbirth, locks, a weight raising) and weakening of the supporting device of a basin and a rectum (a long mesentery of a sigmoid colon, small concavity of a sacrum, exhaustion, disturbance of an innervation). At children at early age loss of a mucous membrane of the anal channel results from long ponos or, on the contrary, persistent locks, the most frequent cause of illness - hemorrhoids.
Loss of all layers of a rectum arises when weakening muscles of a pelvic bottom and prelum abdominale, at weakness of internal and outside sphincters of an anus, at severe general exhaustion, as a result of anatomic features of a structure of a mesentery of a lower part of a sigmoid colon. In the presence of at least one of these factors sometimes there is enough raising of an excessive load or strong natuzhivaniye during defecation that there was a loss. According to scientists, at 37% of patients with an incitement to development of a prolapse of the rectum hard physical activity, at 40% — obstipations, at 13% — an injury, at 7% of women — childbirth was, clinical signs of a disease are found in 3% of patients after ponos and a considerable degrowth of a body.
Symptoms of the Prolapse of the rectum:
The prolapse of the rectum occurs at defecation, cough, sneezing. Usually disturb also pains in the bottom of a stomach and in the field of an anus. At an ulceration of a mucous membrane of a gut bleedings develop. The diagnosis is established during the proctologic research. For identification of the dropping-out gut of the patient it is necessary to ask to be extinguished in situation on cards. Much more rare there is an internal loss directly guts, i.e. invagination of overlying departments of a rectum in underlying. In these cases diagnosis is quite difficult. If invagination is not defined at a manual research of a rectum, then make an irrigoskopiya and a proktografiya with a natuzhivaniye. On roentgenograms of a rectum at rest and at a natuzhivaniye find the changes characteristic of the hidden loss of a gut. Fungoid deformation of a rectum and/or a rectocele — spherical hypodermic loss of a front wall of a rectum through defect of muscles of a crotch concern to them. Conduct also functional researches — a stsintidefekografiya, electrophysiologic researches of motor function of a large intestine. At 71% of patients with an internal prolapse of the rectum reveal a solitary ulcer of a rectum in an invagination zone.
Treatment of the Prolapse of the rectum:
The prolapse of the rectum demands immediate reposition. If it and to make, the dropped-out gut swells. To set it then it is extremely difficult. At the child reposition of a rectum is made as follows: raise legs, part them in the parties, plentifully grease the dropped-out gut with vaseline and a hand carefully set it in a pelvic cavity, rolling the central part in a gut gleam. The part of a gut located closer to anal to an opening is set at the same time, as a rule, independently. At adults reposition of a rectum is made in genucubital situation or on the left side. At children at early age this disease can be liquidated without operation. If to take the appropriate measures, loss can not repeat any more. It is impossible to allow tension during defecation, it is not necessary to put some time of the child on a pot, to allow it to shout, it is necessary to stop that hour a diarrhea by means of the fixing means, at a lock to give enemas. At loss of a mucous membrane of the anal channel rather simple surgical method — excision of the dropped-out site is applied. As a rule, this operation is combined with bandaging and excision of internal hemorrhoidal nodes. Loss of all layers of a rectum demands also operational treatment, in this case it is much more difficult. There is a number of techniques depending on the nature of interventions; narrowing of an opening of an anus by means of a silver wire, fixing of a rectum from a crotch, intra belly fixing, different types of a sphincteroplasty, implantation of the magnetic locking device. At impossibility of operational treatment recommend use of bandages and pilots. The leading role is played by prevention and treatment of disturbances of a chair, in particular locks.