Table of contents:
2023 Author: Alfred Shackley | [email protected]. Last modified: 2023-05-21 13:14
Parents of toddlers from one to 5 years old can often meet with a serious pathology - prolapse of the rectal mucosa. In children, at the same time, pain appears in the anus, the mucous membrane in the area acquires a purple-cyanotic color, since the vessels are compressed in the submucous layer. If this continues for a long time, tissue necrosis begins.
Both the mucous membrane and all layers of the rectum can protrude through the anus.
A bit of anatomy
The rectum - the end of the intestine - is located in the small pelvis.
Anatomically, it is divided into 3 parts:
- anal canal.
The lower part - the anal canal - is surrounded by a sphincter made of muscles. They can be classified into indoor and outdoor - they work together and are fully coordinated.
The inner part of the sphincter consists of the same tissue as the muscular part of the rectum - smooth muscles. In the outer there are 3 groups of striated muscles. In addition, the sphincter is supported by the muscles that block the anus.
The functions of the rectal mucosa are the absorption of residual fluid and the formation of stools that come out naturally.
With a decrease in the tone of any muscle group - regardless of the department - the muscles are not able to keep it in the place set by nature. An increase in intra-abdominal pressure, regardless of the cause, causes prolapse.
Reasons for rectal prolapse
If the folds of the peritoneum and muscles located in the pelvic region help to keep the rectum in a healthy state, then atony does not allow them to perform the necessary functions.
Predisposing factors include the following conditions.
- First of all, constipation, regardless of etiology, is especially chronic. When straining, the ligaments are stretched, the appearance of rectal prolapse is diagnosed. Self-defecation is difficult.
- The same condition is caused by diarrhea, in which it is difficult to maintain stool.
- Postoperative condition or surgery on the muscle tissues of the pelvic floor.
- Physical efforts with increased stress.
- Congenital weakness of the ligaments of the rectum or pelvic muscles - this is often the case in weakened children.
Inflammatory diseases, neurological pathology of a congenital or acquired nature, brain tumors affect the state of the rectal mucosa.
Parents can also provoke a disease in children. When teaching children to potty, they leave them in this position for a long time, force the child to push in order to teach them to perform an act of defecation at a certain time - for example, before leaving for kindergarten.
All this leads to the fact that you have to think about the treatment of rectal prolapse in children.
Condition symptoms and diagnosis
Children are not able to tell adults how they feel in the anus - they just cry. The disease can develop gradually and abruptly.
In the first case, first there is a feeling of a foreign body inside, non-retention of feces, and then partial loss. With the sudden formation of pathology, the intestine is displaced immediately. The feces are no longer retained. Bloody or mucous discharge may appear with increased exertion or increased physical activity.
The severity of the disease is classified as follows.
- The rectum mixes only during bowel movements and is easily repositioned.
- Fallout occurs at any voltage.
If the treatment of rectal prolapse in children is not started early, complications may occur. The mucous membrane swells, becomes inflamed, ulcers appear on it, darkens, acquires a bluish color. If the tone of the sphincter is not weakened, prolapse can lead to necrosis, since large vessels are squeezed during it.
Ulcerative defects and inflammation lead to the appearance of profuse purulent discharge from the anus. Outside of the act of defecation, there is a burning sensation, itching, soreness, and a foreign body sensation in the anus.
On the child's panties, parents can notice traces of feces, purulent discharge and scold him for lack of control. But such discharge occurs spontaneously. They appear especially often when the baby is running, laughing, even sneezing and coughing.
The condition is diagnosed quite simply. On external examination, it is clear that a bright corolla came out of the anus - this is a mucous membrane. Additionally, the site is palpated, in order to exclude the presence of pathologies, a colonoscopy or sigmoidoscopy may be required.
The displacement can be limited to the mucous membrane and submucosa, along with it the muscle ring falls out - in this case, the transitional fold between the mucous membrane and the skin opens.
The rectum constantly exits through the sphincter, and through the groove that it forms, a finger can be freely inserted into the rectum. The most serious condition is when the whole intestine falls out into the anus, along with the muscle ring. It is impossible to correct such a large area on your own.
How is rectal prolapse treated?
Therapeutic measures begin with finding out the reasons due to which the child has a pathology. If muscle atony is congenital, surgery may be required.
In most cases, the disease is treated conservatively.
- A special diet of laxative, low-fiber foods is prescribed.
- If it is not possible to eliminate constipation by changing the diet quickly, a laxative is used.
- On a potty or toilet - if the baby is old enough for this - you cannot plant a month or two. Defecation is carried out on the back or in a lateral position - while the parents tone the intestines, pressing their bent legs to the chest.
- A complex of physiotherapy exercises is connected to therapeutic measures - during the exercises, the muscles of the pelvic floor are strengthened. The treatment is supplemented with physiotherapeutic procedures: d'Arsonval currents, electrophoresis with strychnine, stimulation with impulses of different frequencies.
Together with specific measures, general strengthening effects are also carried out.
When the intestine itself does not enter into place after the act of defecation, it is adjusted manually. The baby is laid on his stomach, his legs are raised, the anus is irrigated with petroleum jelly. Then, with the fingers of both hands, they cover the fallen out area, and they begin to gently return it to its place, from the central part to the periphery, trying to control the physical impact. Once the cylinder is in place, the mucous membrane is drawn into the anus on its own.
After the procedure, the baby needs to stay in bed for 3-5 days - constantly lie on his stomach.
In weakened children, a relapse of the disease is possible. In this case, after the procedure, the buttocks are fixed with strips of plaster - in young children, tight swaddling is used.
If home treatment is ineffective, then in the hospital, 70% alcohol is injected into the tissue surrounding the rectum to a depth of 5-6 cm. In this way, an inflammatory process is provoked, as the process subsides, the fatty tissue is replaced by scar tissue. The scar provides secure fixation.
All this time you will not have to be in the hospital. To eliminate the loss, you need to do 1-2 procedures, after 3 - 3, 5 weeks, depending on the rate of scarring.
If conservative methods prove to be powerless, an operation has to be performed. The method of surgical intervention depends on the clinical picture, the age of the child and the severity of the condition. There are about 100 types of surgical procedures.
Complications after rectal prolapse in children are extremely rare. Complete cure in children under 5 years of age is achieved in 95% of cases. Neglected cases require compulsory treatment - you cannot let the disease take its course, since fecal incontinence and constant inflammatory processes may develop in the future.
In order to prevent the development of pathology in children, it is very important to conduct preventive conversations with parents, to explain to them how to properly care for children - not to force them to sit on a potty for a long time, how important proper nutrition is for the state of the intestines.
Acute and chronic diseases of the digestive tract must be treated immediately, at the first signs of appearance.