In medical practice, bowel diseases are frequent clinical cases. In a child, rectal prolapse can also be called a common problem. Pathology is a displacement of the walls of the distal section with their subsequent prolapse through the anus.
Why does prolapse occur in children?
As a rule, the disease is diagnosed in early childhood. At the same time, boys under 5 years of age are much more likely to be affected.
Before considering in detail the prolapse of the rectum in a child and its pathogenesis, it is worth paying attention to the fact that this problem cannot be considered an independent disease. Most often, it appears as a result of various pathological conditions. In an adult, as well as in a child, rectal prolapse is mainly caused by an increase in intra-abdominal pressure.
In turn, factors favorable to this process are considered to be the root causes of the onset and formation of the disease. Themdivided into two groups.
Predisposition to pathology
The first includes predisposing factors that provoke the disease. This is:
- Innate tendency. It is due to the fact that in children under the age of 6 years in the area of \u200b\u200bthe bones of the lumbosacral region, the natural concavity is rather weakly expressed. Due to the lack of lordosis and insufficient pelvic tilt, the rectum is located straight. With increased intra-abdominal pressure, the entire load is transferred precisely to the anus.
- Douglas space depth. The larger this value (which is typical for young children), the lower the vesico-intestinal depressions in the peritoneum. With high pressure on the anterior wall, invagination occurs, which is a good reason for the development of pathology in a child. Rectal prolapse can also occur in the presence of other anatomical features in childhood: a long mesentery, a loose type of intra-intestinal arteries, etc.
- Other gastrointestinal diseases caused by malnutrition or poor feeding. In this case, the pathology develops due to dystrophic abnormal changes in the muscles of the pelvic floor and pararectal tissue.
Acquired factors causing bowel prolapse
The second group of causative factors includes acquired disorders in the functioning of the digestive system and the digestive tract, which served as the starting point for the appearance of the problem. The child has rectal prolapse (what should parents do in this case, the specialist will tell, thereforeit is strongly not recommended to take measures to treat the baby on your own) often occurs due to stool disorders. Difficulties during the act of defecation in the form of regular constipation are the main mechanism for triggering the development of the disease. Frequent straining and a long stay on the potty negatively affect the condition of the anal sphincter.
Meanwhile, quite often other factors can cause an increase in pressure in the intra-abdominal cavity, which provokes prolapse of the rectum in children. The causes of this pathological phenomenon often lie in a hysterical cough with bronchitis or difficulty urinating (for example, with phimosis in boys).
In addition, for the manifestation of this serious pathology, as a rule, a combination of factors plays a decisive role. In most cases, with one or more of the above problems, the child's rectal prolapse occurs gradually.
Features of the symptoms of the disease in children
The danger of this pathology is that its first symptoms for a long time can remain completely invisible. The reason for this is the prolapse of the rectal mucosa. In children, this occurs most often unilaterally and in stages. During the acts of defecation, part of the intestine falls out, and after the process is completed, it hides behind the sphincter again.
During this period, the baby's parents may notice redness in the anus, resembling a rosette. In fact, this manifestation should be alarmingly regardedparents. Bloody staining of the anus is also a clear sign of prolapse.
Progressive disease is characterized by more pronounced symptoms. Characteristic can be called a slit-like or star-shaped hole in the middle of a slightly cyanotic hue.
Signs of a progressive disease
Besides this, the tone of the anal sphincter remains for a long time, it is difficult to set the prolapsed area of the intestine, so any attempts are accompanied by painful sensations in the child. Prolapse of the rectum further manifests itself as hypotension of the muscles of the pelvic floor, as a result of which it is already possible to put the prolapsed part back into the anal canal without difficulty, but its subsequent falling out immediately occurs.
When the pathology is running, the protruding part often acquires significant dimensions, sometimes making up the length of the entire organ. Each prolapse of the rectum in children (it is impossible to imagine a photo for ethical reasons) occurs uncontrollably, for example, when sneezing or coughing, with little physical exertion. Most often, it is fashionable to set this element only manually. Weakness of the external sphincter contributes to the aggravation of the pathological condition of the child, where fecal incontinence is a huge problem.
At the same time, maintaining the contractility of the sphincter muscles can negatively affect the development of the disease and lead to such complications asmucosal infringement. In this case, the child will need emergency surgery.
How is bowel prolapse treated?
Parents, having timely contacted specialists with this problem in their baby, may not worry. Most often, the prognosis for recovery is very favorable. In addition, the tactics of therapy are more conservative in comparison with the treatment of adult patients. At the same time, it is impossible to overcome prolapse of the rectum in children with folk remedies. Treatment should only take place under the supervision of specialists who coordinate the use of certain drugs and procedures.
In an individual order, depending on the clinical picture of the manifestation of the disease, the baby's well-being and the duration of the course of the pathology, the doctor prescribes one of three options for differentiated therapy:
- conservative treatment plan;
- sclerosing method;
- surgical intervention.
Conservative treatment
The first treatment option for rectal prolapse in a child under 5 years of age is the most common and in demand. With mucosal prolapse, this type of treatment is indicated in most cases for older children. The main objectives of the specified complex of restoration measures are:
- stabilization of character and elimination of any violations of the stool, defecation;
- promptly establish normal bowel habits;
- selection of the most suitable diet duringnutritional adjustments.
All this can only be achieved through diet therapy. It is possible to eliminate the root cause of the disease - high intra-abdominal pressure - by choosing the optimally suitable nutrition scheme with the necessary corresponding effect of relaxation or consolidation. In the absence of positive dynamics, the doctor may prescribe the use of special medications.
Potless Therapy
Once the correct bowel habits have been established, it is extremely important to relieve the child of the frequent urge to empty. To restore the pelvic muscles and their functional connections, the violation of which causes rectal prolapse in children, Komarovsky recommends minimizing possible tension and straining. As a rule, during treatment, the child is not allowed to use a potty or toilet, he should defecate only in a lying or standing position. The absence of load on the anus is one of the fundamental conditions for the treatment of this pathology, and this moment requires a lot of patience and care on the part of parents.
Often, for a complete recovery, such a regimen is established by a doctor for a period of about 3-4 months. The success of such treatment guarantees almost one hundred percent result. The advantages of this method of treatment are obvious: there is no outside intervention in the child's body, self-healing occurs due to muscle recovery and shortening of their fibers.
However, recovery does not mean that the result is finally achieved andThe child is not in danger of relapse. Over the next year, it is extremely important to monitor his condition and, in case of repeated prolapse, set the intestine into the anal canal as quickly as possible.
How to set a prolapsed gut on your own?
Particular attention deserves familiarization with the nuances of the reduction technique. Regardless of age, rectal prolapse in a child (2 years or 6 years) requires urgent simple manipulation. The main thing is that the baby is calm, as relaxed as possible. The child should lie on his back. The fallen fragment of the rectum must be lubricated with a lubricant, after which, after putting on gloves, grabbing it with the fingers of both hands and without assertive efforts, gently and gently set it inside. You should start from the central part, because with a correctly performed technique, the edges of the prolapsed intestine will spontaneously fit into the anal canal. As soon as the reduced fragment is inside, it is important to slowly turn the child on the stomach and bring the buttocks together.
How sclerotherapy works
In more complex, advanced cases, treatment is carried out in a hospital and, as a rule, resort to the help of a surgeon. Sclerotherapy, which is often used today, is also a method of surgical intervention. The procedure is the introduction of special substances, the action of which is aimed at swelling of the perirectal tissue.
Then, the expected cell necrosis occurs, which is replaced by sclerosis and scarring of the tissues surrounding the rectumgut. This allows them to tightly fix their epithelium and the surface of the intestine.
Probable complications of hardening
Meanwhile, most specialists in the field of pediatric surgery are very reserved about this method of treatment. The reason for this is the frequent administration of drugs, as well as the high risk of developing necrotic complications of the internal walls of the intestine. Sclerosing therapy should only be considered when conservative treatment has failed completely or there is a significant likelihood of incarceration.
The second method of surgical intervention involves rectopexy - removal of the prolapsed area according to the Zerenin-Kummel method.
In any case, every disease, including intestinal prolapse in children, is much easier to prevent than to cure. To prevent the development of pathology, any potentially dangerous factors should be prevented. In particular, do not force the baby to sit for a long time on the potty and take urgent measures at the slightest violation of the stool.
