2. Prolapse is the main symptom of this syndrome. In light cases, rectal mucosa prolapse occurs during defecation, and it can reflux automatically after defecation; Over time, it gradually develops into full-thickness rectal prolapse. Except for defecation, even coughing, walking and squatting, it must be pushed back by hand or rested in bed before recovery. If the prolapse does not return immediately, the rectal mucosa is congested and edematous, bleeding or erosion. It may be accompanied by itchy skin around the anus, swelling and pain in the waist and sacrum. Prolapse time is a little longer,' not timely reduction can cause incarceration, the mucosa changes from pink to dark purple, and even erosion and necrosis, swelling and pain, rising body temperature, dysuria, internal urgency and heavy anus.
3. The disease is often divided into I, II and III degrees.
I degree: rectal mucosa prolapse, reddish, 2 ~ 5 cm long. Soft, not easy to bleed, and can recover naturally after defecation.
Second degree: the rectum is completely prolapsed, with a length of 5-9 cm, which is conical and reddish. The surface is annular and layered mucosal folds, thick and elastic, which need to be recovered by hand after defecation, often accompanied by anal relaxation.
ⅲ degree: prolapse of rectum and part of sigmoid colon, more than 10 cm long, cylindrical, with shallow annular folds, and weakness of sphincter.
4. This disease should be differentiated from internal hemorrhoids. Although internal hemorrhoids can also appear in the middle and late stage, the hemorrhoid nucleus is obviously prominent, and the surface is mostly dark red or blue-purple, which is easy to bleed.
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Rectal symptoms
The disease is due to the deficiency of qi and blood in children, hypoplasia, or the decline of qi and blood in the elderly, or the deficiency of both qi and blood due to childbirth, or chronic diarrhea, dysentery and cough, which leads to the deficiency of middle qi, stagnation of qi, inability to absorb and lift, anal relaxation and rectal displacement. If the anus is damaged by operation or trauma, and the anus loses its fixation, it will also lead to this disease.
The disease is located in the large intestine, and the etiology is complex, but the fundamental reason is the lack of middle qi. Deficiency syndrome is more common in clinical rectal prolapse. Deficiency of middle qi, subsidence of qi deficiency, inability to lift up the internal organs, weakness of strengthening anus due to qi deficiency, prolapse of anus or increased abdominal pressure during defecation. If you don't take it back in time after prolapse, local qi and blood stagnate, dampness accumulates, and heat is generated, then the swelling and pain of prolapse will be combined into one, and the internal urgency will be severe. At this time, the essence is insufficient. The basic principle of treatment is to tonify the middle energizer, strengthen the body resistance and improve the foundation.
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Treatment of rectal prolapse
Deficiency of middle qi type
Symptoms are rectal mucosal prolapse or full-thickness prolapse, varying in severity, some prolapse during defecation, some prolapse when abdominal pressure increases, mucous membrane is reddish, mucus is not much, abdominal distension pain is not obvious, accompanied by poor eating. The tongue is pale, the coating is thin and white, and the pulse is heavy and thin.
Treatment can tonify the middle energizer and strengthen the body.
Herbs on the prescription
1. The main prescription Buzhong Yiqi Decoction (Gao Li's Ten Books of Dongyuan) is modified.
Prescription: Radix Codonopsis 30g, Radix Astragali 30g, Rhizoma Cimicifugae 9g, Radix Bupleuri 6g, Radix Angelicae Sinensis 9g, Atractylodis Rhizoma12g, Radix Glycyrrhizae Preparata 3g, Fructus Jujubae 9g, Fructus Rosae Laevigatae12g, Radix Dipsaci 9g and Galla Chinensis12g. Decoct with water, daily 1 dose.
For patients with deficiency-cold syndrome, 3 grams of Cinnamomum cassia, 9 grams of cooked ginger and 9 grams of cooked aconite root are added. For patients with fever, 6 grams of Coptidis Rhizoma, 9 grams of Scutellariae Radix and 9 grams of Sophora japonica Flos are added. For patients with chronic diarrhea and dysentery, terminalia chebula 12g and 9g of shredded paper are added.
2. Chinese patent medicine
(1) Buzhong Yiqi Pill, 9g each time, twice a day, with warm boiled water.
(2) Ginseng Yang Rong Pill, 9g each time, twice a day, with warm boiled water.
3. One-sided prescription
(1) Ginseng Reed (Gu Bohua Clinical Manual of Traditional Chinese Medicine Surgery)
Prescription: ginseng reed 1 (ground). 1 tablet a day, taken with warm water.
(2) the tortoise's head (Zhu Renkang's traditional Chinese medicine surgery)
Prescription: 3 grams of glans penis (dried and ground), taken orally, 3 times a day. Suitable for children with proctoptosis.
(3) Prescription for rectal prolapse (Ke Zechun's prescription)
Prescription: Mash a certain amount of gentleman's meat and add a proper amount of maltose to make pills. 3 grams per capsule, each time 1 capsule. Stew 100- 150g lean pork and take broth. Take pills and broth 1 time every 3 days, 3 times for 1 course of treatment. Suitable for children with I and II degree proctoptosis.
(4) Smilax China Jinying Decoction (Cao Huiqing Syndrome)
Prescription: Smilax China 90 ~ 120g, Rosa laevigata (root) 60.90g Decoct in water for 3 time; Children should be reduced.
(5) Shengxian Ileum Decoction (proved by Wang Jianye, etc. )
Prescription: 30g of Codonopsis pilosula, 9g of Cimicifuga rhizome and 6g of Glycyrrhiza uralensis Fisch. Add 400 ml of water and decoct to 200 ml, filter to get juice, add 300 ml of water and decoct to 150 ml. Mix the liquid medicine twice, and take it once in the morning and once in the evening. External washing: use 30g of mirabilite and 9g of licorice, add 2500-3000ml of water, and boil for 5min; Sit bath in the morning and evening 1 time.
Damp-heat type lower coke
Symptoms are rectal mucosal prolapse or full-thickness prolapse, burning pain and swelling, bloody mucus, internal urgency, excessive urination, anal dilatation and severe pain. Red tongue, yellow and greasy fur, and rapid pulse.
Treat damp-heat, detoxify and reduce swelling.
Herbs on the prescription
1. Modified Huanglian Jiedu Decoction (Wang Dao's Secret Recipe of Outer Taiwan) and Sanguisorba Powder (Wang Huaiyin's Taiping Shenghui Formula).
Prescription: 6 grams of Rhizoma Coptidis, 9 grams of Scutellariae Radix, 9 grams of Fructus Gardeniae, 9 grams of Cortex Phellodendri, 9 grams of Sanguisorba officinalis 12, 9 grams of Radix Paeoniae Rubra, 3 grams of Radix Glycyrrhizae, 9 grams of Rhizoma Atractylodis, 9 grams of Alismatis Rhizoma, 9 grams of Flos Sophorae Immaturus, and 0/5 grams of Herba Pteris/kloc-0. Decoct with water, daily 1 dose.
After damp-heat detumescence and pain relief, the treatment principle is still to replenish qi and lift, and the treatment method is to treat the deficiency of middle qi.
2. Chinese patent medicine
(1) Huanglian Jiedu Pill, each time 10g, twice a day, taken with warm water.
(2) Sanguisorba Sophora japonica Pill, 9g each time, twice a day, taken with warm boiled water.
3. Unilateral refers to the unilateral syndrome of deficiency of middle qi (1) ~ (4).
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External treatment of rectal prolapse
1. Fumigation and washing can be selected from Sophora Flavescentis Decoction, Pomegranate Peel, Alum and Galla Chinensis Decoction; Or decocting Fructus Cnidii, Alumen, Mume Fructus, Flos Sophorae Immaturus, Radix Sangusorbae, Radix Saposhnikoviae and onion leaves in soup, smoking first and then washing, twice a day.
2. The medicine can be made by burning puffball and equisetum, grinding into fine powder and mixing well. Apply the powder to the affected area to make it recover.
3. After rectal prolapse is recovered, it must be recovered immediately; If the prolapse lasts for a long time and the local congestion and swelling, it will be difficult to recover. During the operation, the lateral position was taken, the mucosa was coated with lubricant, and the prolapsed part was slowly pushed in; Then put the index finger into the anus to check whether it is pushed above the sphincter. Due to pain; If it is difficult to recover, it can be done under local anesthesia. The patient should stay in bed for 2 ~ 3 days after operation, so that he won't get out of bed again.
4. Inject drugs into rectal submucosa by injection to make mucosa adhere to muscularis; Inject into the space around the rectum to make the rectal wall adhere and fix with the surrounding tissues. This method has a good effect on children, and it can also be cured for adults who have undergone anus reduction surgery. If the dose is too large and the concentration is too high, it may cause necrosis of rectal mucosa or tissues around rectum, and even infection and abscess formation.
(1) Submucous injection: ① indications: rectal mucosal prolapse in children. Contraindications: acute rectal inflammation, diarrhea and persistent abdominal pressure increase. 3 medicine: proctoptosis. ④ Operation method: Take the lateral position or lithotomy position, and expose the anorectal mucosa after local disinfection. The prolapsed mucosa was fixed with rat dental forceps, and the submucosa was punctured above floss 1 cm with a fine needle for punctate or columnar injection. Inject 0. 1-0.3 ml into each point with a distance of 0.5- 1 cm, with a total dose of about 12 ml each time. Sterile gauze should be placed inside and outside anus immediately after injection and disinfection. Take intestinal anti-inflammatory drugs as appropriate after operation.
(2) Double-layer injection method: ① Indications: second and third degree rectal prolapse in adults. Contraindications: dysentery, diarrhea, acute anorectal inflammation. 3 medicine: proctoptosis. ④ Operation method: routine skin preparation and clean enema. Take lateral position or lithotomy position, Shu Yao anesthesia, routine anal disinfection, and spread towels. Ask the patient to defecate and try to get the rectum out of the anus. After the rectal mucosa was disinfected with 0. 1% bromogeramine, the top layer of prolapsed mucosa was fixed with rat dental forceps 2-3, and the submucosa was injected upward with a fine muscle needle, and then outward with a dose of about 10 ml. After the prolapsed rectum is completely injected, it is disinfected and then returned to the anus. Change the No.6 needle (8 cm long) and insert the needle at 3 o'clock and 9 o'clock, respectively, at a distance of 1.5 cm from the anal margin. First, the subcutaneous and external sphincter of the left skin are inserted into the ischiorectal space, about 4-5 cm. When the needle encounters slight resistance, it will reach levator ani, and then it will enter the pelvic and rectal space when it feels frustrated when passing through the levator ani needle. At this time, the index finger of the left hand extends into the rectum, and when the position of the touch needle is determined to be outside the rectal wall and in the pelvic and rectal space, it will go deep 2-3 cm. Generally, the depth of acupuncture is not more than 7.5 cm for men and 5.5 cm for women. Then pull out the needle and slowly inject the medicine, and inject 5- 10 ml in a fan shape. Change the needle and inject the opposite side in the same way; Finally, inject the needle into the back, and make the needle slightly arc-shaped, stabbing between the anus and coccyx, bending the needle along the sacrum, inserting the index finger into the rectum to guide the needle into the retrorectal space, and injecting 3 ~ 5 ml of medicine. The total amount of drugs injected at three points should not exceed 25ml.
operation
(1) Scar stent fixation:
Indications: ⅱ and ⅲ degree rectal prolapse in adults.
Contraindications: incarceration, edema and necrosis after rectal prolapse.
Operation method: routine skin preparation and clean enema. Shu Yao anesthesia, lithotomy position, routine disinfection, towel laying. The rectum was disinfected with 0. 1% bromogeramine, and the left and right points were taken respectively. Above the tooth line 1.5 cm, clamp the rectal mucosa vertically with rat dental forceps. Then use curved needle and 0 # catgut to ligate 1 needle under tweezers, and ligate 4 ~ 5 needles vertically intermittently, with the needle distance of 1 cm, and ligate the opposite side in the same way. After the operation, vaseline gauze was placed in the rectum and fixed with sterile dressing.
(2) Anal contraction:
Indications: Rectal prolapse with anal relaxation and incomplete incontinence.
Contraindications: acute perianal inflammation, diarrhea, dysentery and frequent defecation.
Operation method: routine skin preparation and clean enema. Shu Yao anesthesia, lithotomy position, routine disinfection, towel laying. Make a V-shaped incision 2 cm behind the anus along the left and right anal margins, and the length of the incision depends on the degree of anal relaxation. If the anus is slack, it can be inserted with more than 3 fingers, which can be contracted1/2; 3 refers to the following, tighten 1/3. Cut the skin and subcutaneous tissue, free the flap to the tooth line and pull it upward to expose the anal tail ligament, the subcutaneous part of the external sphincter and the posterior triangle of the anal canal; Suture the external sphincter with 2 stitches, close the posterior triangle of anal canal, suture the V-shaped incision of skin, and then cut the U-shaped upward free flap. After hemostasis, vaseline gauze was placed in the anus for drainage and covered with sterile gauze. The stitches are removed in 5-7 days, and anti-infective drugs can be taken after operation.
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How to treat proctoptosis?
1. Acupuncture therapy
Body acupuncture: Take points such as Changqiang, Baihui, Hegu, Zusanli, Chengshan, Yinlingquan, Sanyinjiao and Baxiu. Children take Baihui point and use moxa stick moxibustion. Every time 10 minute, every day 1 time, and 7 days is 1 course of treatment.
Ear acupuncture: take the lower part of rectum, Shenmen and subcortical, twist for 1 ~ 3 seconds, and leave the needle for 30-60 minutes.
Plum blossom needle: pierce the skin around anus, and enhance the supporting and fixing effect of sphincter and pelvic muscles on rectum.
2. Diet therapy
Steamed chicken with astragalus membranaceus: 50g of astragalus membranaceus, hen 1 chicken, a little salt. The hen removes viscera, hair and claws, stuffs Astragalus into the belly of the chicken, puts it into a vessel for steaming, adds salt to taste, and eats meat and soup in separate meals, which is suitable for the syndrome of insufficient middle qi.
Cimicifuga jujube pork intestines soup: Cimicifuga 10g, jujube 30g, pork intestines 500g, a little salt. Cimicifuga is wrapped in gauze, stewed with jujube and pork intestines until the pork intestines are cooked, and seasoned with salt. Go to Cimicifuga, eat dates, eat fat intestines and eat soup three times. Suitable for deficiency of middle qi.
Portulaca Cimicifuga porridge: Portulaca oleracea 200g, Cimicifuga 10g, japonica rice 50g, salt or sugar. Boil Portulaca oleracea and Cimicifuga foetida in water to remove residues, then put them into japonica rice to cook porridge, and season with salt or white sugar. It is suitable for damp-heat syndrome of lower energizer.
Gardenia fig paste: Gardenia 10g, fig 500g, a little sugar. Grinding Fructus Gardeniae into fine powder, mashing Fructus Fici, adding Fructus Gardeniae powder and sugar, and taking at will. It is suitable for damp-heat syndrome of lower energizer.
3. Prevention and care
Avoid activities that increase abdominal pressure for a long time and change the bad habit of squatting for too long.
Patients with internal hemorrhoids, rectal polyps and other diseases that often prolapse should be treated in time.
Prevent constipation or dysentery, diarrhea, frequent defecation and other diseases that increase intra-abdominal pressure.
For the elderly who are weak due to qi deficiency, gastroptosis and uterine prolapse, the method of reinforcing the middle energizer can not only achieve therapeutic effect, but also prevent and treat diseases.
After proctoptosis, it must be reset in time, and those with third-degree proctoptosis should be fixed with cotton pad and "T" belt to prevent incarceration.