🌿 Folk Prescriptions

· Thoracic-knee hanging sclerotherapy for rectal mucosal prolapse
Indications: Rectal mucosal prolapse, various hemorrhoids
· Transrectal thoracic-knee sacrorectal adhesion release surgery
Indications: Sacrorectal flexure, rectal folding separation
· Transrectal rectal valve electrosection
Indications: Excessively wide rectal valves, rectal pouch formation
· Transrectal rectal valve thread ligation therapy
Indications: Excessively wide rectal valves
· Closed-end partial mucosal suture and internal hemorrhoid suture procedure
Indications: Moderate to severe rectal mucosal prolapse, large internal hemorrhoids
· Manual anal dilation
· Transabdominal sigmoidectomy
· Transabdominal left hemicolectomy
· Transabdominal subtotal colectomy
Single-item description
Sigmoid colon redundancy
Commonly seen, due to the free-floating nature of the sigmoid colon with a long mesentery, while the descending colon and rectum are relatively fixed. If congenital sigmoid colon is excessively long, drooping, and forms an acute angle with the rectum, progressive excessive peristalsis may occur over time, leading to fatigue-induced injury. When the haustral folds disappear, it can be preliminarily determined that motility function is lost. Surgical specimens confirm that in elongated sigmoid colon with absent haustra, interstitial nerve ganglia are often deficient or sparse, and intestinal muscle shows degeneration. Patients may frequently perform thoracic-knee exercises to strengthen mesenteric tension, reduce angulation, and facilitate defecation; severe cases may require partial resection.
Sigmoid colon looping
Confirmed by X-ray defecography and barium enema. Some sigmoid colons loop once or twice; we have observed up to four loops. Bowel looping increases evacuation resistance. During straining, abdominal pressure acts vertically downward, but looping segments form multiple angles, making defecation more difficult.
Descending colon looping
We have observed descending colon looping of one or two turns in clinical practice.
Left-sided colonic duplication anomaly
After descending colon prolapse, it reverses upward, forming a large fold at the splenic flexure before continuing downward. Symptoms are not apparent when function is preserved, but if haustral folds disappear, persistent constipation occurs.
Sacrorectal separation
Refers to separation between the sacrum and rectum. Normally, the rectum should parallel the sacrococcygeal curve. If the sigmoid colon is redundant, the upper rectum becomes intussuscepted, the upper rectal valves are overly wide or form annular valves, increasing evacuation resistance. During excessive straining, loose tissue between the rectum and sacrum may tear, disrupting the parallel alignment and resulting in sacral separation.
Transverse colon redundancy
Previously known as splenic flexure syndrome. Due to excessive length of the transverse colon, some descend into the pelvic cavity. The hepatic and splenic flexures are relatively fixed, forming acute angles at these points, increasing evacuation resistance. Prolonged fecal retention leads to constipation. In long-standing cases, the transverse colon gradually loses function.
Colonic reversal with looping
In barium enema X-rays, we documented one case of refractory constipation with colonic reversal accompanied by looping. The colon is tortuous and twisted with multiple angles, causing difficulty in defecation, usually beginning from childhood.
Complete or partial colonic functional loss
Acquired partial or complete colonic dysfunction. Distal to the site of absent haustra, there are typically loops, kinks, or narrowed segments. Due to high evacuation resistance, colonic fatigue injury results in imaging showing shallow or absent haustra, resembling a "sausage-like" appearance. Commonly seen in sigmoid colon redundancy, descending colon, transverse colon descent, and left transverse colon. In severe cases, even the cecum and ascending colon become dilated with absent haustra. Colonic transit time is significantly prolonged. We once observed a patient who retained markers in the cecum for six days after ingestion.
Right-sided colonic duplication anomaly
The segment below the hepatic flexure descends and then ascends near the hepatic flexure, subsequently changing to a horizontal colon extending to the splenic flexure.
Rectal mucosal prolapse
One of the most common types of outlet obstruction constipation. Age is not the sole factor; our youngest patient was 4 years old with obvious mucosal prolapse. It is associated with any cause of rectal narrowing, especially rectal variations. Due to relatively narrow rectal diameter, evacuation resistance increases, and friction on the rectal mucosa intensifies. Under excessive straining, the mucosa separates from the muscular layer, forming folds or accumulations at the rectum and anal canal neck. Stool accumulates above, resulting in a "toothpaste-like" expulsion pattern, sometimes leading to fecal impaction.
Excessively wide rectal valves, closely spaced, increased number
Congenital condition characterized by excessively wide, densely packed, and numerous rectal valves. The physiological role of rectal valves is to prevent rapid stool descent in upright posture, evolving through gradual thickening of the circular muscle layer. Typically crescent-shaped, with about three valves. However, in our clinical observations, some valves occupy half the intestinal lumen or appear as ring-shaped valves, with up to seven or eight valves observed. Valve variation causes relative narrowing of the rectal lumen, increasing evacuation resistance. Stool frequently becomes impacted above the valves. The widest valve we observed measured 2.5 cm, occupying nearly half the lumen. After electrosection, normal defecation resumed.
Rectal folding
Rare, occurring in the middle rectum. Separation between the rectum and sacrum results from overly wide rectal valves. Stool cannot form axial flow within the rectum but only eccentric flow. Due to mechanical forces, the rectum detaches from the sacrum, forming a fold. After cutting the valves (ligation) and performing transrectal sacrorectal adhesion surgery, the fold disappears.
Rectal pouch formation
Caused by excessively wide rectal valves. Stool cannot form axial flow, forming pouches on the lateral walls above the valves. Stool circles around in the pouch before returning to the rectum. The deepest pouch we observed reached 3 cm. Patients eventually develop complete rectal prolapse. Mild cases resolve after valve incision; severe cases require partial resection and anastomosis below the pouch.
Proximal rectal intussusception
Often caused by narrowing formed by circumferential rectal valves. A circumferential intussusception forms in the upper rectum, commonly associated with sigmoid colon redundancy. Mild cases may use hanging sclerotherapy, especially injecting sclerosing agents above the valves to create a funnel shape, facilitating stool passage. Severe cases with sigmoid colon redundancy may require partial colectomy.
Anal stenosis and internal sphincter dyssynergia
Can be managed via manual anal dilation or internal sphincter division surgery.
Puborectalis syndrome
Over ten years of diagnosis, we identified over 40 cases of puborectalis syndrome via X-ray. Clinical diagnosis confirmed only one case due to infection-induced rigidity and dyssynergia. All others were relieved by rectal mucosal injection and valve incision. Thus, puborectalis syndrome as a cause of constipation remains uncertain.
Rectal anterior prolapse
Most scholars believe female rectal anterior wall weakness is the cause. However, we consider rectal anterior wall weakness a normal anatomical feature in females. Constipation arises due to relative narrowing of the lower rectum—such as overly wide rectal valves, rectal mucosal prolapse, internal sphincter dyssynergia, anal stenosis—and other factors causing outlet obstruction. Since the posterior rectal wall has bony or ligamentous support from the sacrococcygeal region, stool impacts the anterior weak area. Male rectal anterior walls are denser, but the rectovaginal septum in women is weaker, leading to rectal anterior prolapse. Therefore, we believe rectal anterior prolapse is a characteristic radiological sign of female outlet obstruction. Treatment focuses on relieving the outlet obstruction—resolving rectal mucosal prolapse, overly wide valves, internal sphincter dyssynergia, and anal stenosis—leading to reduced or resolved anterior prolapse and improved constipation.
Isolated ulcer syndrome
Severe rectal mucosal prolapse may lead to ischemia and hypoxia due to compression by hard stools, causing superficial ulcers. Treatment primarily targets rectal mucosal prolapse. Generally, first treat with medicated enemas until ulcers disappear, then proceed to surgery.
<Treatment of Constipation>