Mucosal prolapse: - The mucous membrane and submucosa of the rectum protrude outside the anus for approximately 1–4 cm. When the prolapsed mucosa is palpated between the finger and the thumb, it is evident that it is composed of no more than a double layer of mucous membrane. This distinguishes mucosal prolapse from full-thickness prolapse where the entire rectal wall exits from the anal canal.
IN INFANTS: - The direct downward course of the rectum, due to the as-yet undeveloped sacral curve, predisposes infants to this condition.
IN CHILDREN: - Mucosal prolapse often commences after an attack of diarrhea, or from loss of weight and consequent loss of fat inthe is chiorectal fossa. It may also be associated with cystic fibrosis, neurological disorder, Hirschsprung’s disease, rectalpolyps and maldevelopment of the pelvis.
IN ADULTS: - The condition in adults is often associated with third-degree haemorrhoids, when it is referred to as mucohaemorrhoidal prolapse. In the female, a torn perineum, and in the male straining from urethral obstruction, predispose to mucosal prolapse. In old age, both mucosal and full-thickness prolapse are associated with weakness of the sphincter mechanism. Partial prolapse may follow an operation for fistula-in-ano where a large portion of muscle has been divided. Here, the prolapse is usually localised to the damaged quadrant and is seldom progressive.
FULL-THICKNESS PROLAPSE: - Complete rectal prolapse (synonym: procidentia) is less common than the mucosal variety. The protrusion consists of all layers of the rectal wall and is usually associated with a weak pelvic floor and/or chronic straining. The prolapse is thought to commence as an intussusception of the rectum, which descends to protrude outside the anus. The process starts with the anterior wall of the rectum, where the supporting tissues are weakest, especially in women. It is more than 4 cm andcommonly as much as 10–15 cm in length. On palpation between the finger and thumb, the prolapse feels much thicker than mucosal prolapse, and consists of a double thickness of the entire wall of the rectum. Any prolapse over 5 cm in length will contain anteriorly, between its layers, a pouch of peritoneum. When large, the peritoneal pouch may contain small intestine or bladder. The anal sphincter is characteristically patulous and gapes widely on straining to allow the rectum to prolapse. Complete prolapse is uncommon in children but may occur as a result of malnutrition. In adults, it can occur at any age, but it is more common in the elderly and sometimes in patients with anorexia nervosa. Women are affected six times more often than men, and it is commonly associated with other pelvic organ prolapse. In approximately 50% of adults, faecal incontinence is also a feature.
Complicationsof rectal prolapse :- include rectal ulceration and bleeding, incontinence and even incarceration with strangulation of the rectum.
HOMOEOPATHIC MANAGEMENT OF RECTAL PROLAPSE: -
Homoeopathic system of medicine can work wonders in curing prolapsed rectum since it is natural and non toxic compared to other modes of treatments.
Podophyllum:- The rectum may get Prolapsed either before or during passing stools. There may be a sore pain in the anus. Podophyllum may be prescribed in children in children with complaints of Prolapse of rectum. There is a history of chronic constipation.
Ignatia:- Ignatia may be prescribed when the parts protrude with soft stools and remain intact with hard stools. The pain may be sharp and shooting in nature. The pain subsides considerably when the patient is in sitting posture.
Ruta graveolens:- For prolapse that occurs after straining or after delivery. Prescribed in cases which occurs due to complications after childbirth. The stools may be Constipated and can be passed only with great straining and difficulty. The pain sensation is as if the rectum and anus are being pricked with sticks.
Aesculus:- When Prolapse is due to Chronic Piles. It may be prescribed in persons suffering from chronic piles leading to a prolapsed rectum. The sensation of pain is that of the rectum being filled with sticks. There may be intense burning pain in the anus which radiates up to the back.
Hydrastis:- Effective in cases of prolapsed rectum in children. The child may be Constipated and cries while passing stools on account of pain. There may be much swelling in anus and rectum with congestion. The complaints may be associated with fissures in the anus.