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Query: UMLS:C0033377 (prolapse)
 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Rectal bleeding is a frequent presenting symptom of a number of benign anorectal disorders. However, it may also be a warning sign of more significant gastrointestinal pathology. For this reason, full colonic evaluation has been recommended in patients with intermittent bright red rectal bleeding. The purpose of this study is to evaluate the utility of colonoscopy in this setting. Data were prospectively collected on 125 colonoscopies performed on the surgical service at the Cleveland Wade Park Veterans Administration Medical Center during a two year period. During this period 33 patients underwent colonoscopy for the evaluation of intermittent bright red rectal bleeding. Fourteen patients had abnormal rectal exams, including hemorrhoids in 9, mass lesions in 3, prolapse in 1, and fistula in ano in 1. Colonoscopy was normal in only 7 (21%) of the 33 patients examined. Findings in the remaining 26 included 31 polyps in 14 patients, cancer in 3, AVM in 1, diverticula in 9, hemorrhoids in 4, and other benign lesions in 5. Positive findings on rectal examination had no relationship to findings at endoscopy, with abnormal findings in 52% of patients with normal rectal exams and in 27% of patients with abnormal rectal exams (P = 0.187, NS). Findings at colonoscopy resulted in a change in management in 16 (48%) of patients examined. In patients with intermittent rectal bleeding, the entire colon should be evaluated regardless of findings on rectal examination, as a significant number of patients will have concomitant findings. Colonoscopy is an excellent method for colonic evaluation in this setting.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Colonoscopy for intermittent rectal bleeding: impact on patient management. 847 71

Haemorrhoids or piles are varicosities in the anal canal caused by local pressure. Sometimes they prolapse. Symptoms may include itching, discomfort, pain and bleeding. Haemorrhoids are common in pregnancy. Constipation aggravates piles, so a healthy diet with plenty of water and fibre is advisable. Some sufferers need an appropriate laxative as well. Cleanliness of the anal area is important. Proprietary moist toilet tissues are sold for this purpose and can be soothing and helpful. Relief of symptoms is by haemorrhoid creams, ointments and suppositories. Active ingredients typically include antiseptics, anti-inflammatories, anti-pruritics and local anaesthetics. Many are available from pharmacies without a prescription. If in doubt, always refer the patient to a doctor. For example, rectal bleeding may be due to some more serious condition, or pruritus to anal thrush. In the case of children the advice of a doctor should be sought.
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PMID:Remedies for common family ailments: 9. Haemorrhoids. 868 Feb 38

Correct definition of haemorrhoidal disease allows the estimation of the incidence and the therapeutic choices. The term "haemorrhoidal disease" should be used specifically for symptoms secondary to abnormalities of the intern haemorrhoidal plexus. The classification of severity is useful but difficult to apply to individual cases. The aetiopathogenesis remains unclear. Many arguments are in favour of a progressive degeneration of the fibromuscular structure of the internal haemorrhoidal plexus responsible for his prolapse in the anal canal. Most patients suffering from haemorrhoids are relieved by simple dietary advice. Moderate prolapsing haemorrhoids are significantly improved by rubber band ligation. Surgical haemorrhoidectomy remains the procedure of choice in patients with advanced prolapsing haemorrhoids.
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PMID:[Hemorrhoids. Review]. 877 2

Anorectal disorders are commonly encountered in the practice of emergency medicine. Most can be diagnosed and treated in the emergency department setting. Almost all anorectal disorders once diagnosed and treated in the emergency department need appropriate follow-up to ensure adequacy of treatment, for further possible diagnostic procedures (e.g., endoscopy, biopsy), or for definitive treatment. Hemorrhoids are the most prevalent anorectal disorder and are the most common cause of hematochezia. Treatment is dependent on the degree of hemorrhoid prolapse and symptoms. Most cases can be treated by conservative medical treatment (e.g., dietary changes, sitz baths) or nonsurgical procedures (e.g., rubber band liagation, infrared coagulation). Surgical excision of symptomatic thrombosed external hemorrhoids is indicated if within 48 to 72 hours of pain onset. Anal fissures are one of the most common causes of anorectal pain. They are most frequently idiopathic, and most are located in the posterior midline of the anal canal. Most anal fissures are adequately treated by a medical approach using sitz baths, stool softeners, and analgesics. If the anal fissure becomes chronic and is not responsive to medical therapy, a lateral sphincterotomy of the internal anal sphincter is the surgical procedure of choice. Pharmacologic treatment (botulinum toxin or nitroglycerin ointment) to decrease internal anal sphincter tone has shown promise in the treatment of anal fissure. Anorectal abscesses are categorized into four types: perianal, ischiorectal, intersphincteric, and supralevator. Most are idiopathic and contain mixed aerobic-anaerobic pathogens. Fistula formation varies from 25% to 50% and is much more common with gut-derived organisms (e.g., E. coli, B. fragilis). Definitive treatment for an anorectal abscess is timely surgical incision and drainage to prevent more serious complications (e.g., serious infection, extension of the abscess). Anal carcinomas are infrequent, the majority of them being squamous cell or epidermoid carcinomas. The emergency physician must maintain a high index of suspicion and obtain a biopsy of suspicious lesions in order not to miss the diagnosis of a cancer. The most common presenting complaint of anal tumors is rectal bleeding. Combination chemotherapy and radiotherapy have shown promising results in the treatment of anal canal tumors. Bacterial, viral, and protozoal infections can be transmitted to the anorectum via anoreceptive intercourse. Such infections must be considered when a patient presents with rectal pain or discharge, tenesmus, or rectal or perineal ulcers. Proctosigmoidoscopy and rectal cultures may be necessary to determine the cause. Potential rectal complications of HIV infection include infectious diarrhea, acyclovir-resistant strains of HSV2, Kaposi's sarcoma, lymphoma, and squamous cell carcinoma. Rectal injuries may result from penetrating or blunt trauma, iatrogenic injuries, or foreign bodies. Rectal injury should be suspected when a patient presents with low abdominal, pelvic, or perineal pain or blood per rectum after sustaining trauma or undergoing an endoscopic or surgical procedure. Tetanus prophylaxis, intravenous antibiotics, and surgical intervention are indicated in all but superficial rectal tears.
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PMID:Anorectal disorders. 892 68

Age related, about 10% of the general population suffer from faecal incontinence. In a surgical, proctological office diagnosis is possible with carefully taken history, physical examination, digital examination of the anorectum, rigid rectosigmoidoscopy, and anoscopy. Together with special examinations (endoanal ultrasound, electromyography, pudendal nerve terminal motor latency [PNTML], anorectal manometry, defaecography, transit time of the colon) the plan for medical and surgical treatment can be made. The basic medical conservative therapy consists of regulating the form of stool (high fibre diet and/or loperamid), training of the sphincter and pelvic muscles electrical stimulation or biofeedback training. Outpatient surgery is possible for small prolapsing tumors of the lower rectum or anal canal, hemorrhoids grade 2 or segmental anal prolapse. Inpatient surgery is needed for any form of reconstruction of the sphincter or the sensitive area of the anal canal, post- and preanal repair, anal and rectal prolapse, (dynamic) gracilis sphincteroplasty, or for a terminal stoma in those patients, whose uncontrolled incontinence cannot be managed otherwise. After surgery it is needed to continue the medical therapy (regulating the bowel movements, biofeedback training, electrical stimulation of the sphincter).
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PMID:[Diagnostic and therapeutic procedures in fecal incontinence in general practice of the surgically educated proctologist]. 896 12

Due to the fact that the intensity of haemorrhoidal complaints may rapidly change, also numerous therapeutic approaches of minor effectiveness are considered a helpful remedy. However, the advantage of the Barron-ligature is not seriously doubted. By placing it correctly at the insensitive distal rectum, haemorrhoidal operations are only necessary in very advanced stages. Can the Barron ligature be optimized even more? Three patient groups consisting of 120 patients with 2nd degree haemorrhoids who were simultaneously treated by anal dilation using an appropriate lubricant for the anal dilator, were compared with each other in a randomized, open, placebo-controlled study conducted in two centres. In these groups treatment consisted of: rubber-band ligature alone rubber-band ligature and anal dilator and Kamillosan ointment rubber-band ligature and anal dilator and vaseline The observation period comprised six weeks. Every two weeks a check was made. Assessment criteria were: light-red haemorrhage, itching, oozing, sensation of incomplete evacuation, nodal prolapse and slight staining after defecation The pressure ratios of the closing apparatus were investigated at the beginning and end of the study. The group who had been treated with rubber-band ligature, anal dilator and Kamillosan ointment showed the best results. By simultaneously applying the rubber-band ligature, anal dilator and Kamillosan ointment as a lubricant, significantly better results could be obtained. The findings are based on a former retrospective study carried out in 500 patients with 2nd degree haemorrhoids. In this study by applying the anal dilator and Kamillosan ointment, the number of treatments could significantly be reduced from 5.95 to 4.2 and the number of necessary ligatures from 3.8 to 2.76 which, also from the economic point of view, was favourable.
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PMID:[Optimization of the Barron ligature treatment of 2nd and 3rd-degree hemorrhoids using a therapeutic troika]. 898 70

A new solo operated haemorrhoid ligator rectoscope is described by the author. This new ligator consists of a double barreled cone, one fitting precisely inside the other. The device functions as a rectoscope to visualize the wall of the ano-rectum and at the same time the distal end of the interior barrel carries the rubber band and functions as the ligator. After the operator grasps the pile and pulls it into the barrel with a tenaculum, he discharges the band by retracting the internal barrel with a simple flick of the thumb. The tool is greatly simplified and more efficient than prior art. It is easy to operate and clean. The view through the rectoscope is clear and unobstructed. The author also reports on a retrospective analysis of his experience with 200 consecutive bandings of symptomatic internal haemorrhoids. The tool proved to be an effective way of rubberbanding haemorrhoids and similar clinical results as with other rubber band devices were attained, with the added bonus that whenever indicated the device allows for a larger amount of tissue to be banded, which may be desirable when treating mucosal prolapse.
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PMID:Solo operated haemorrhoid ligator rectoscope. A report on 200 consecutive bandings. 911 50

Rectal prolapse is the transposition of the entire rectal wall into the rectal lumen, the anal canal or through the anal canal out side. It differs from anal prolapse in thickness, circular plication of the mucosa and, if large, its extent. The cause is not clearly established, but disorders in bowel movement seem to be of importance. Symptoms reach from the feeling of incomplete evacuation to defecation block and irreducible prolapse. The diagnosis of outer prolapse is easy. The inner prolapse [intussusception] can be suspected by anamnesis and in the presence of solitary rectal ulcer. Defecography gives the conclusive examination. Conservative therapy is analogous to hemorrhoids: Fibres and sufficient liquid intake. Operative procedures can be divided in transabdominal and perineal procedures. From the latter Delorme's procedure gives good results with low stress for the patient. Of the transabdominal procedures we favor rectopexy with Ivalon-sponge, preservation of the lateral bands and sigmoid resection. This procedure can easily be done by laparoscopy. Postoperative constipation is observed above all if the lateral bands are dissected and no sigmoid resection is done. Preexistent constipation Improves in about 50% of the cases. Same does incontinence.
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PMID:[Rectal prolapse]. 922 42

A technique used for the treatment of 34 patients with partial rectal prolapse [20 children (mean age 4.2 +/- 1.4 years), 10 women, and 4 men (mean age 44.6 years)] is presented. The prolapsed mucosa protruded outside the anus in 26 patients and was inside the rectal neck in 8. Mucosal plication was performed; the prolapsed mucosa was reefed by multiple vertical pursestring sutures. Associated hemorrhoids and anal fissures were also corrected. The patients were followed up for a mean of 31.6 months. No straining at stool or recurrence of the mucosal prolapse occurred. The technique is simple, cost-effective, had no complications, and was performed on an outpatient basis.
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PMID:Mucosal plication in the treatment of partial rectal prolapse. 924 6

Early diagnosed functional disorders of the ano-rectum or pelvic floor can be treated in the office by conservative treatment or out-patient surgery. The normal anatomy of the anal canal must be restituted by reducing enlarged haemorrhoids, removing a prolapse of the anterior rectal wall with rubber-band ligation, excision of chronic fissures and prolapsing tumours. The basic therapy then consists of normalisation of bowel habits and stool consistency. An anal stenosis must be dilated. Training of the sphincter, gymnastics of the pelvic floor, electrostimulation and biofeedback are the therapy for the sphincter and pelvic floor insufficiency.
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PMID:[Functional disorders of the rectum and pelvic floor. Ambulatory/conservative therapy]. 957 99


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