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Ptosis (下垂/脱垂) refers to drooping of any body part. In Traditional Chinese Medicine, there is reference to ptosis of the stomach, the eyelid, the uterus and of course the anus.

Now, how is this ptosis of the anal rectal region related to anorectal diseases which modern day medicine has subcategorized anatomically and histologically?

We have the following ‘growths’ that may end up drooping down and popping out of the anus for all to see.

• Internal hemorrhoids (内痔): happening above the linea dentata (齿状线). The ‘growths’ here refer to the rectal varices (直肠静脉曲张).
• Rectal polyp (息肉痔): they can be seen together with colon polyps in inflammatory bowel disese, or may just appear in the rectal area as age catches on. They are benign tumors but may develop into malignant ones.

We also have non-growths that collect just start drooping down. We call it:

• Rectal prolapse (肛脱): This drooping happens less because of the heaviness of a growth, but age and deteriorating nerve impulses to this region get the rap.

Differential Diagnosis: Rectal Prolapse

Let’s first talk about rectal prolapse, which we mentioned above to be related to ageing. It is also related to subclinical conditions like constipation or diarrhea over a long period of time which puts a strain on the anus. It is also related to pregnancy and childbirth, which causes rectocele.

What we may see is either:

• Mucosal prolapse: Just the rectal mucosa drooping down
• Full thickness prolapse: the entire four layers drooping down.

Now that we have scope technology, we can note whether or not the ptosis has exit the anus.

If it has exited, it will present as concentric circles of light color – less likely to bleed.

Differential Diagnosis: Internal Hemorrhoids vs Rectal Prolapse

Unlike rectal prolapse which present as lightly colored concemtric circles, internal hemorrhoids will present as rounded knot(s). They will be dark in color (blood in the rectal varices), and they tend to bleed easily.

Differential Diagnosis: Internal Hemorrhoids vs Polyps

Both internal hemorrhoids and polyps will present as rounded knot(s). But the polyp will often be hanging by a thin neck (蒂部).

Internal hemorrhiods often happen in adults, and not kids. If a kid has a rectal growth it is juvenile polyp (幼年息肉) – often simple polyps (单发性息肉). Young adults may also get polyps, but it will often be multiple polyps (多发性息肉). So age is not the best diagnostic tool, although it can help.

Histologically, internal hemorrhoids are different than polyps. We know that internal hemorrhoids are rectal varices while polyps are often adenomas.

Some sites to refer to regarding:

1. Colorectal polyp: http://en.wikipedia.org/wiki/Colorectal_polyp
2. Rectal polyp: http://medical-dictionary.thefreedictionary.com/Rectal+Polyps
3. Rectal prolapse: http://www.emedicinehealth.com/rectal_prolapse/article_em.htm

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