Procidentia Case Study

COMPLETE RECTAL PROLAPSE
Also called as Procidentia, is less common than partial prolapse [11]. It is common in females due to weakened levator ani and supporting pelvic tissues. The descent is always more than 3.75 cm, contains all layers of the rectum. Often descends down up to 10-15 cm. It is often associated with the uterine prolapse. It is also thought to be as intussusception of the rectum. Patulous anal sphincter is typical with mucus discharge and fecal incontinence. Mucosa of the chronic rectal prolapse is thickened, ulcerated, bleeds, and often incarcerated below the level of anal verge.
Aetiology
Bowel habit, Laxity of the anal sphincters, Sliding hernia, Lack of rectal fixation, Rectal intussusception, Disordered function of the

Sepsis, discharge, fever, anemia are other features.
P/R examination shows lax sphincter. Anteriorly, peritoneal sac comes down as pouch which may contain small bowel [11].
Treatment
Fixation Operations [10]
Well’s operation (ivalon sponge warp operation)
Rectopexy (Lockhartmummery) operation
Rectal sling operation
Perineal approach (Delorme’s operation)
Lahaut’s operation.
Resection Operations [10]
Anterior resection of the rectum.
Perineal rectosigmoidectomy.
Operations on pelvic floor and perineum.
Differential diagnosis
Rectosigmoid intussusception
Third degree piles
Large rectal polyp.
Complications [11]
Ulceration, bleeding, anemia, Proctitis, sepsis. Irreducibility, gangrene. Rupture with evisceration.
Investigations [11]
Defecography, Sigmoidoscopy, Anal manometry
Pudendal nerve latency study.
Electromyography.
DISCUSSION
If we go through the detail pathophysiology and etiology of Gudabhransha in different ayurvedic classical text, we find that Atisara and Pravahana are the prime cause in pathophysiology of gudabhransha [1], [6]. Atisara, due to loss of essential fluids, Vata aggravates [6]. Guda itself is one of the sthana

It is circumferential descent of bowel through the anal canal. It is a common discomfort that is getting worse by prolonging immediate treatment. As in case of every disease prevention is the best common treatment, Recta prolapse can also be reduced by changes in life style, diet habit, and intake of appropriate dose of respective botanicals, which can also intervene in the pathogenesis to decrease vascular integrity.