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In the memory of 70-year-old Wang Dabo (pseudonym).
This "unspeakable secret" has been since childhood
It started before the age of 10
After each bowel movement
There are as if there is a meat ball
It comes out of the anus
Medical conditions were limited at the time
I thought it was "hemorrhoids"
There is no attention and no treatment
//
In the past 60 years, Wang Dabo has been repeatedly troubled by this incident, and at the same time, he has symptoms of difficulty in stool, distension, and itching. Later, the mass came out slowly and increased, and sometimes there was bleeding, mucus, etc., and Uncle Wang was miserable.
Uncle Wang's children have been busy with work, and this time when they returned home, they finally found the "unspeakable secret" that had plagued his father for most of his life.
So the children took Wang Dabo to find Deputy Chief Physician Of the Department of Anorectal Surgery at Run Run Shaw Hospital affiliated to Zhejiang University. When Dr. Lao examined it, it turned out to be "rectal prolapse".
What is rectal prolapse?
Rectal prolapse is a pelvic floor disease, which, as the name suggests, is the rectum protruding outside the anus.
Rectal prolapse tend to occur in the elderly. Because of the immature development of the pelvic floor in children and the relative weakness of pelvic floor support, rectal prolapse also occurs from time to time in children, and if detected early, early intervention may be exempted from surgical treatment.
What causes rectal prolapse?
In addition to congenital factors, the causes of rectal prolapse are associated with the following common factors:
chronic constipation or diarrhea constipation, including defecation disorders;
Delivery, vaginal delivery, multiple deliveries;
History of pelvic surgery;
Neurological diseases (eg spinal cord injury, dementia, stroke);
Pelvic floor dysfunction (eg, abnormal contraction of the rectal pubic muscle, flaccid pubic rectal muscle, decreased perineum);
Pelvic floor anatomical defects (eg, rectal bulging, uterine bladder bulge, deepening of rectal uterine pitting).
Since Wang Dabo's symptoms were already very obvious and seriously affected the quality of life, Dr. Lao immediately arranged for him to be hospitalized.
After being hospitalized, the anorectal surgery team and pelvic floor comprehensive treatment team of Run Run Shaw Hospital immediately conducted a scientific and rigorous assessment of Wang Dabo, including colonoscopy, anorectal manometry, pelvic floor electromyography, and defecation angiography.
Because the treatment of rectal prolapse is not only to solve the "target" of rectal prolapse out of the anus, but also to find out the cause of rectal prolapse. To achieve the goal of curing the symptoms and curing the root causes, a comprehensive and scientific assessment is indispensable. As one of the first units in the country to carry out comprehensive pelvic floor treatment, the comprehensive assessment of pelvic floor is also the advantage of Shaw Hospital.
After a rapid and rigorous preoperative evaluation, considering Wang Dabo's advanced age and poor lung function, Dr. Lao's team chose the "Delorme" surgery with minimal trauma and clear effect for Wang Dabo. Only half-body anesthesia is required and can be completed within an hour.
After 3 days after the operation, Uncle Wang resumed eating, the stool was much smoother, and there was no more annoying meat ball coming out of the anus. Uncle Wang also had a long-lost smile on his face. He was discharged from the hospital in 5 days.
Half a month after surgery, the surgical sutures fell off and the wound healed. There is no meat ball at the entrance when defecating, but perennial prolapse has led to damage to pelvic floor muscle function and coordination, and Wang Dabo will occasionally have poor stool control, and currently continue to carry out rehabilitation treatment in the Pelvic Floor Treatment Center of the Rehabilitation Medicine Department of Shaw Run Run Run Hospital, and it is expected that after a variety of methods of combined rehabilitation treatment, Wang Dabo's bowel control ability can be restored to normal levels.
The onset of rectal prolapse is not uncommon, and studies have shown that the prevalence in adults is about 40 in 10,000, while the prevalence in individuals over 65 years of age increases to 100 in 10,000.
However, this disease has not received enough attention from everyone and is often treated as "hemorrhoids" and delayed treatment.
The following symptoms occur
It is necessary to be vigilant against the possibility of rectal prolapse
Incomplete defecation, discharge of mucus and/or feces, especially when defecation occurs, there is a lump out of the anus, typically showing a concentric circle appearance, some will retract themselves after standing up after defecation, some need to use their hands to stuff it back, the most serious case, the rectal mass of the entrance will not be able to be stuffed into the anus, causing great pain.
How is rectal prolapse treated?
Rectal prolapse cannot heal on its own, and it is found that it should be timely to seek medical advice to a specialist for scientific evaluation and treatment. Otherwise, the symptoms will continue to worsen, accompanied by other pelvic floor diseases such as urinary and urinary incontinence, bladder bulge, and vaginal vault bulge.
Treatment of rectal prolapse includes conservative treatment and surgical treatment.
Conservative treatment includes
Ensure adequate fluid and fiber intake to regulate bowel movements, and patients with severe constipation who have difficulty emptying the colon may need enemas and suppositories;
Pelvic floor muscle Kegel training improves pelvic floor muscle endurance, thereby improving symptoms;
Pelvic-abdominal coordination contraction training;
Core muscle group training;
Pelvic floor muscle low-frequency electrical stimulation and biofeedback therapy, etc.
Surgical treatment
Surgical treatment is the most common treatment for rectal prolapse.
Surgical modalities include transperitoneal surgery (e.g., laparoscopic rectal suspension fixation with biological mesh) and transperineal surgery (mainly Altemeier and Delorme).
Each choice of surgical procedure is based on the patient's general physical tolerance, rectal prolapse etiology, and severity of rectal prolapse. The Delorme surgery for Uncle Wang was a choice made by considering the above factors.
Introduction to the Pelvic Floor Center team
The Pelvic Floor Center of Run Run Shaw Hospital is composed of more than ten departments such as anorectal surgery, rehabilitation medicine, obstetrics and gynecology, urology, gastroenterology, pain, mental health, imaging, ultrasound, etc. Since its inception, it has been committed to the research and diagnosis and treatment of complex pelvic floor dysfunction diseases, including pelvic floor muscle disorder rehabilitation, and has accumulated rich clinical experience.
Every year, the Pelvic Floor Center relieves a large number of patients from pelvic floor organ prolapse, constipation, urinary leakage and pelvic floor pain caused by pelvic floor muscle disorders. Unlike the traditional pelvic floor muscle rehabilitation team, we have pelvic floor surface emography assessment, pelvic floor muscle ultrasound (elastography) assessment, urodynamic assessment, pressure measurement, balloon discharge assessment, pelvic floor muscle fascial manipulation assessment, trunk muscle fascial manual evaluation, etc., based on accurate evaluation to develop a detailed treatment plan. The treatment methods are not only surgical treatment, pelvic floor emery stimulation, biofeedback stimulation or nerve block treatment, but also acupuncture treatment, pelvic floor magnetic stimulation, transcranial magnetic stimulation treatment, pelvic floor muscle manual training, pelvic correction training, abdominal core muscle group training, pubic joint separation and rectus abdominomyal muscle separation correction training according to the patient's situation, etc., to provide a one-stop rehabilitation experience for patients with pelvic floor disorders.
Source: Department of Anorectal Surgery, Run Run Shaw Hospital
Original works, reprinted please indicate the source and source
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