Prolapsus Ani

Prolapsus Ani is a common affection of the termination of the intestinal canal, and consists in an eversion of the lower portion of the rectum, and its protrusion through the anus. It may depend on a naturally relaxed condition of the parts, as in infancy, or may be caused by violent straining in cases of costiveness, piles, &c. Whenever it occurs the parts should be washed, and if possible replaced by careful pressure with the hand; and if they do not easily return the forefinger should be oiled and pushed up into the anus, and it will convey the protruded intestine with it, after which the patient should retain the recumbent position for some hours. If it cannot be returned by the above means surgical assistance should be at once sought. In order to remove the tendency to prolapsus the patient should regulate his bowels so as to avoid costiveness, should sponge the parts after every evacuation with cold water or soap and water, and if necessary use astringent injections, as, for example, a weak solution of sulphate of iron, 1 grain to the ounce. In young children the power of straining, and therefore the tendency to the occurrence of the protrusion, may be much diminished by preventing their feet from resting on the ground during defecation. Dr Druitt (in his Surgeon's Vade Mecum) recommends a plan first suggested by Dr M'Cormac—viz. that when the stools are passed the skin near the anus should be drawn to one side with the hand so as to tighten the orifice. If after the adoption of these means the bowel continues to descend certain surgical means must be resorted to, as destroying a portion of the relaxed mucous membrane by the application of nitrate of silver or nitric acid, or removing a part of the loose skin surrounding the orifice, with or without portions of the mucous membrane as well.