A prolapse of all the coats of the rectum, amounting in some instances to complete invagination, is of such rare form, occurring mostly during infancy, that it might be considered practically out of the list of rectal ailments.
Prolapse of the mucous coat of the bowel is not an uncommon affection, and is a frequent complication of internal hemorrhoids. When the hemorrhoids are cured the prolapsus usually disappears.
It is natural for the mucous membrane at the lower end of the rectum, by its loose attachment to the muscular coat through the cellular layer, to roll down and become somewhat everted during the act of defecation. It is only when this condition becomes excessive and the protrusion so great that it does not return of its own accord, that it is called prolapsus of the first degree and treatment required.
Should it occur independently or persist after the removal of piles, a cure may be easily effected by the injection of from eight to ten minims of a ten per cent. solution of carbolic acid, beneath the mucous membrane in the cellular structure, at points where it is desirable to take up a fold. The needle may be introduced in a line with the axis of the rectum, varying from one-fourth, one-half of an inch or more from the muco-cutaneous junction, and even as high up as the upper margin of the internal sphincter.
This can be done while the membrane is prolapsed, or through the slot of a speculum. The latter is preferable on account of the sides of the slot limiting the distribution of the medicine. Anything that will excite an adhesive inflammation or a change in the cellular coat will have a similar effect.
The following preparation is effective:
| ℞ | Acidi Salicyl. | ||
| Sod. Bibor. | ā ā | ʒ i | |
| Glycerinæ | ℥ i | ||
| M. | |||
Take six drachms of this preparation and add carbolic acid 40 minims.
If it be desirable to remove a thickened fold or bunch-like appearance of the mucous membrane, inject the same as you would piles, using the hemorrhoidal compound. It will slough off neatly and heal readily. It is peculiar of the injection of internal piles or of the same strength of medicine into or beneath the mucous membrane, that it tightens and takes up a slack of the membrane permanently, without apparent lessening of the calibre of the gut. It is also peculiar of the treatment and cure of internal hemorrhoids by injection, that no cicatrix, cicatricial tissue or contraction results, unless the operation has been extensive, involving both sides, and an active inflammation has been excited by extraneous causes.