Differential diagnosis method of rectal prolapse

Many people do not understand the problem of rectal prolapse. If you want to effectively treat and solve the harm caused by rectal prolapse, you must correctly understand these diseases. Rectal prolapse can manifest as complete prolapse, partial prolapse and other symptoms.

1. Complete prolapse

It is a full-thickness prolapse of the rectum. In severe cases, the rectum and anal canal can be turned out of the anus. The prolapsed length often exceeds 10 cm, or even 20 cm, and is pagoda-shaped, with the mucosal folds arranged in a ring shape. The prolapsed part is composed of two layers of folded intestinal wall, which are thicker to the touch, and there is a peritoneal space between the two layers of intestinal wall.

2. Partial prolapse (incomplete prolapse)

The prolapsed part is only the mucosa at the lower end of the rectum, so it is also called mucosal prolapse. The prolapsed length is 2 to 3 cm, generally not exceeding 7 cm. The mucosal folds are radial, and the prolapsed part is composed of two layers of mucosa. There is no groove between the prolapsed mucosa and the anus.

The disease develops slowly. In the early stage, the lump will only protrude from the anus during defecation and will retract on its own after defecation. As the disease progresses, the levator ani muscles and anal sphincter lack contraction force and need to be restored by hand. In severe cases, the gland may fall out during coughing, sneezing, exerting force or walking, and is difficult to restore. If not repositioned in time, the prolapsed intestinal segment may become edematous, strangulated, and even risk necrosis. In addition, there is often incomplete defecation, a feeling of prolapse and soreness in the anus, and some may experience lower abdominal pain, frequent urination, etc. The pain is severe when incarcerated.

3. Diagnosis and differentiation of rectal prolapse

It is not difficult to diagnose external rectal prolapse. When the patient squats down and does the defecation movement, the abdominal muscles exert force and prolapse will occur. Partial prolapse may be seen as a round, red, smooth-surfaced mass with a "radially" wrinkled mucosa that is soft and retracts spontaneously after defecation. If it is complete, the prolapse is longer, and the prolapse is pagoda-like or spherical, with circular rectal mucosal folds visible on the surface. Rectal examination revealed that the sphincter was relaxed and weak. If there is small intestine in the prolapse, bowel sounds can sometimes be heard.

Rectal mucosal prolapse needs to be differentiated from annular internal hemorrhoids. In addition to the different medical histories, when annular internal hemorrhoids prolapse, congested and enlarged hemorrhoids can be seen, which are plum blossom-shaped, easy to bleed, and normal mucosa appears concave between the hemorrhoids. During rectal examination, the sphincter is strongly contracted, while in cases of rectal mucosal prolapse, it is relaxed, which is an important distinguishing point.

Internal rectal prolapse is difficult to diagnose and requires defecography to assist in the diagnosis, but this disease should be suspected when the patient complains of obstruction in the ampulla of the rectum and a feeling of incomplete defecation.