PROLAPSUS OF THE RECTUM.
This disease is often confounded with piles; and as patients are generally diffident in submitting to an examination, any extraordinary protrusion of piles they denominate a falling of the gut. Prolapsus Ani is distinguished from piles by the muscular coats of the intestine descending with the mucous membrane, and forming a bag, like a pendulum, to the length of many inches; the rectum, in fact, becomes everted, as we see the finger part of gloves when turned inside out; and the inner membrane being highly vascular, and the vessels in a congested state, it assumes a blood-red appearance. The case is here well portrayed. Of course the disease occasions much inconvenience and if not abated by appropriate treatment, serious consequences ensue. Piles are most commonly the cause of prolapsus, when, from the frequent and hard straining, the gut at last descends, bringing the piles with it, which will be seen winding around the upper part. When that is the case, the best treatment is first to apply a ligature round the hœmorrhoids, and then return them and the rectum together. Where the gut protrudes from relaxation of the sphincter, the treatment depends upon local support, for which there are many contrivances.[16] Astringent injections should also be used to give tone to the parts, and medicines given to render the alvine evacuations less hurtful. Children are very liable to prolapsus, but with them a return of the fallen gut, and a brisk purgative is all that is needed to prevent a repetition, provided proper attention be paid to the bowels afterward—a disturbance of the latter being, in most instances, the cause. Where a rectum has been for a long time the seat of disease, excrescences are apt to arise, resembling warts: they may be removed without much pain, and with perfect safety.