Diseases of the rectum and anus: a list of diseases of the anus. Diseases of the urinary system. For the treatment of proctitis and paraproctitis

The rectum is easily accessible for examination. In the patient's squatting position, simulating the act of defecation, the patient can see rectal prolapse and external hemorrhoids. Finger examination carried out with the patient lying on his side with his legs brought to his stomach. To do this, wear a glove.

The index finger is generously lubricated with Vaseline and carefully inserted into the rectum. Digital examination makes it possible to determine pathological infiltration of the rectum and pararectal tissue, thrombosed internal hemorrhoids, compacted edges with rectal fissures, etc. Before conducting an instrumental examination, the patient is thoroughly cleansed with enemas of the colon and rectum. The study is carried out in the knee-elbow position. The rectal speculum is lubricated with Vaseline and carefully inserted to a depth of 8-10 cm. Inspection is carried out by carefully removing it. Much diagnostic data can be obtained from sigmoidoscopy. The sigmoidoscope is lubricated with Vaseline and inserted to a depth of 25-30 cm.
Using a balloon, air is pumped into the intestine and when the instrument is removed, the intestinal mucosa is examined. To examine the mucous membrane of not only the rectum, but also the colon, a colonofiberscope is used - a device with elastic optics that can be bent at the desired angle and allows you to examine large parts of the colon.
Atresia anus and rectum. The basis of malformations of the anus and rectum is a violation of embryogenesis. Until the end of the 1st month of embryonic development, the intestinal tube does not have an opening at the caudal (lower) end. The terminal part of the intestine opens together with the canal of the primary kidney into common cavity- cloaca. At the end of the 2nd month, the cloaca is divided into two parts by a longitudinal septum. The rectum and anus are formed from the posterior part, and the anus from the anterior part. urinary tract. When this process is disrupted, a corresponding anomaly occurs.
The following types of atresia are distinguished: (Fig. 1.41, a) atresia of the anus, atresia of the anus and rectum (Fig. 141, b). Rectal atresia may be observed (Fig. 141, c). Along with complete atresia, there are also stenoses, when there is a narrowing of the intestine. In addition to pure forms of atresia, there are also atresias complicated by fistulas, which can open in the perineal area, in urinary system and genital organs (uterus, vagina) (Fig. 141, d, e, f, g, h, i).
Clinical picture. With complete atresia in the first hours and days, newborns develop a clinical picture of low intestinal obstruction: vomiting, bloating, absence of meconium. For atresia with With fistulas, meconium is released from the fistula openings to the outside or into the organ where the fistula opens. But with these forms of atresia, emptying is insufficient.
With anal atresia, thinning of the skin and a “push symptom” are locally observed: when coughing or straining, a protrusion of the skin appears in the projection of the anus. With atresia of the anus and rectum, the distinctive features are the absence of a “push symptom” and the presence of gas only in the sigmoid colon. With rectal atresia, the finger passes through the anus and rests on the closed rectum.
To clarify the diagnosis, you can perform a puncture of the anus with the introduction contrast agent. An x-ray allows you to clarify the form of atresia.
Treatment is surgical. For anal atresia, the site of stenosis is dissected longitudinally. In the postoperative period, bougienage is required for 6-10 weeks.
For atresia of the anus and rectum, as well as for atresia of the rectum, abdominal-perianal proctoplasty or perianal proctoplasty is performed. To do this, the atretic section of the intestine is isolated through the abdominal and perineal or only perineal route and brought down through the perineum, suturing the edges of the intestine to the skin. At the same time, they try to preserve the rectal sphincter. If there is a fistula, the operation plan remains the same, but the fistula is additionally isolated and bandaged.
In weak and malnourished children, a fistula is placed on the sigmoid colon. Radical surgery produced at the age of 1 year.
Megacolon(Favali-Hirschsprung disease). Due to the predominance sympathetic tone of the rectum and distal sigmoid, their spastic narrowing is observed. Dilatation of the intestine between spastic areas occurs secondary. With megacolon, individual areas or the entire colon expand. The disease is more often observed in boys.
The expansion of the intestine intensifies over time and reaches large sizes. Due to stagnation of feces in the enlarged area of ​​the intestine, a picture of chronic inflammation occurs. Against the background of the inflamed mucous membrane, ulcers may be observed. The haustra in the enlarged area disappear, the mucous membrane smoothes out. The longitudinal and partially circular layers of muscles hypertrophy. The intestinal wall becomes dense, similar to skin.
Clinical picture. Constipation and bloating are observed. Bowel emptying is delayed for several days. An overcrowded colon pushes the diaphragm upward, displacing the heart and lungs, resulting in impaired breathing and cardiac function. During digital examination, the narrowed rectum gives the impression of a mechanical obstruction. Use your finger to probe the dense feces, sometimes viscous, like plasticine or clay. When you press on them, a hole remains (“a symptom of pit formation”). Over time, intoxication increases, attacks of intestinal obstruction are repeated, and perforation of an intestinal ulcer may occur.
Treatment. Conservative treatment is used as preparation for surgery. Hardened feces are softened by introducing oil into the rectum and then removed with an enema, and, if necessary, removed with a finger. Regular bowel movements reduce intoxication and allow the patient to be well prepared for surgery.
Anal fissures. The cause is minor injuries to the rectal mucosa in the anal area due to dense feces, foreign bodies, etc. Initially, a small linear defect of the mucous membrane is determined. Subsequently, the crack deepens, reaching the submucosal layer; its edges become denser.

Clinical picture. Severe, sharp pain during defecation, sometimes a small amount of blood or serous-bloody fluid appears. The fissure is often accompanied by constipation.
Treatment. For fresh cracks, carry out conservative treatment. First of all, it is necessary to eliminate constipation. To do this, you need to adjust your diet. The patient takes castor or paraffin oil, a decoction of Alexandria leaf and buckthorn. 50-100 ml of warm water is injected into the rectum. olive oil, use candles with belladonna, warm sitz baths with potassium permanganate or baking soda.
For chronic cracks that cannot be treated conservative therapy, under local anesthesia produce overstretching of the rectal sphincter. In this case, the crack ruptures even more, but against this background it heals quickly. In particularly stubborn cases, the crack is excised and sutures are applied.
Paraproctitis. This disease is understood as purulent inflammation of the peri-rectal tissue. The disease is often caused by a mixed infection (staphylococcus, streptococcus, enterococcus, coli and etc.). Path of penetration: cracks, abrasions, maceration.
There are the following forms of paraproctitis: 1) subcutaneous; 2) submucosal, 3) ischiorectal, 4) pelvic-rectal, 5) rectal (Fig. 142).
The clinical picture depends on the form of paraproctitis. In the subcutaneous form, hyperemia of the skin area and pain are observed in the area of ​​inflammation, which intensifies during the act of defecation. Upon palpation, a dense infiltrate is determined in this area. A small general body reaction to inflammation may develop.
With the submucosal form, there is pain during defecation. A rectal examination reveals an area of ​​infiltration of the rectal mucosa.
In the ischiorectal form, the inflammatory process involves the pelvic tissue around the rectum. The clinic of this form is characterized by throbbing pain, high fever, chills; determined by rectal examination pronounced infiltration around the rectum

With the pelvic-rectal form, the process extends higher pelvic floor and is characterized by a severe septic condition without external signs of inflammation in the anus.
In the retrorectal form, the process begins with lymphadenitis localized behind the rectum, followed by
purulent melting of the surrounding tissue. The disease is characterized by severe pain in the perineum, high fever, chills, leukocytosis, etc.
For all forms of paraproctitis, a thorough digital examination of the rectum is recommended.
Treatment. At the beginning of the disease, when there is no purulent melting of tissues, general antibiotic therapy and warm sitz baths with potassium permanganate are recommended. In case of failure of conservative treatment for all forms of paraproctitis, an opening of the abscess with good drainage is required purulent cavity. When opening an abscess, in order to prevent damage to the sphincter, it is necessary to make a semilunar incision around the anus. After the operation, for 3-4 days the patient receives opium tincture and a slag-free diet to delay the act of defecation. General antibacterial and detoxification therapy is carried out. Wound treatment is carried out according to general principles treatment of purulent wounds.
Haemorrhoids. Hemorrhoids mean varicose veins venous plexuses of the rectum with a certain clinical picture (bleeding, pain, etc.).
Based on localization, they distinguish between internal and external hemorrhoids. Internal hemorrhoids is not visible to the eye and is determined by digital or rectoscopic examination. External hemorrhoids are visible near the anus (Fig. 143). In some cases, inflammation of these nodes is observed with the formation of blood clots in them - thrombophlebitis of hemorrhoids. Hemorrhoids can be caused by constipation, pregnancy, congestion in the pelvis due to prolonged sitting, etc.
Clinical picture. A simple enlargement of hemorrhoids may not cause pain and does not bother the patient. But in some cases, with large internal hemorrhoids and insufficient closing function of the sphincter, they fall out, which further reduces the function of the sphincter. This condition leads to the release of its contents from the rectum, and this in turn causes itching in the anal area, maceration of the skin and pain. In some cases, slight bleeding is observed during defecation. Frequent bleeding can lead to anemia - blood hemoglobin can decrease significantly.
With thrombophlebitis of hemorrhoids, severe pain appears in the anus, which significantly intensifies during the act of defecation. Hemorrhoidal nodes are cyanotic, tense, covered with fibrinous plaque, and in places the mucous membrane is ulcerated.
Treatment. For uncomplicated hemorrhoids, adjust the diet to avoid constipation. For constipation, castor or paraffin oil is prescribed. When macerating the skin, do sitz baths with potassium permanganate. For minor bleeding, hemostatic agents are used - vikasol, calcium chloride, hemophobin, etc. For thrombosis of hemorrhoids, warm sitz baths with potassium permanganate are indicated. Good effect presacral novocaine blockades are given.
If hemorrhoids tend to bleed and become inflamed, surgical treatment is resorted to. IN acute period inflammation, surgery is contraindicated. The hemorrhoids are ligated. After a few days, the hemorrhoids are rejected. IN postoperative period hold stool for several days. To do this, the patient takes food with a small amount of fiber and 8-10 drops of opium tincture 3 times a day. After defecation, the patient takes a sitz bath with potassium permanganate (pink solution) or soda solution (30-40 g per bath).
Prolapse of the rectum and anal mucosa. When the mucous membrane prolapses from the anus, they speak of prolapse of the anal mucosa; when all the walls of the rectum prolapse, they speak of rectal prolapse. Loss occurs in both children and adults. The development of prolapse is promoted by muscle weakness and underdevelopment of the muscles of the pelvic floor and rectum, low position peritoneum. Constipation, diarrhea, hemorrhoids, etc. are of some importance.
The clinical picture is very characteristic. When the patient strains, both during defecation and during physical activity, a pink rosette or a significant cylinder appears in the anus area, covered with the mucous membrane of the rectum. For differential diagnosis between the prolapse of the mucous membrane of the anus and the rectum are used simple trick. A finger is drawn around the fallen area. If the mucous membrane passes directly onto the skin and the size of the prolapsed area is small, then prolapse of the mucous membrane of the anus occurs (Fig. 144); if a finger passes between the mucosa and the sphincter, there is prolapse of the rectum (Fig. 145). However, a combination also occurs: prolapse of the anus and rectum. In this case, there is a significant prolapse of a large section of the intestine and a direct transition of the mucous membrane to the skin (Fig. 146).

For small prolapses, after the straining stops, the prolapsed area is reduced on its own; in case of large prolapses, reduction is performed by hand. With frequent prolapses, ulcers are formed on the mucous membrane, covered with fibrinous plaque.
Treatment. Children in the initial stages of the disease benefit from conservative treatment. First of all, it is necessary to normalize the stool. After defecation and repositioning of the intestines, the buttocks are glued together with an adhesive plaster. Of the surgical interventions, the simplest and most effective is the Kümel operation: lower laparotomy and fixation of the rectum to the promontorium of the sacrum in an upward tension position. This operation is often combined with subcutaneous tissue strip the fascia lata around the anus and stitch its ends together. Stitching is done in such a way that the tip of the finger passes through the anus (Bogoslavsky's operation).

Rectal polyps. These are benign tumors. They can be single or multiple, ranging in size from a millet grain to walnut. Low-lying polyps with a thin stalk can prolapse through the anus.
Clinical picture. Tenesmus and sometimes bleeding may be observed. The diagnosis is made on the basis of digital examination, rectoscopy and sigmoidoscopy (Fig. 147). For highly localized polyps, the diagnosis is made by colonoscopy. X-ray examination also helps in diagnosis.
Treatment. For single polyps with low localization, electrocoagulation is performed. At multiple polyps and single high-lying polyps, resection of the corresponding section of the intestine is performed.
Rectal cancer. It occurs quite often and ranks fifth among other cancer localizations. The ratio of men to women among patients is 3:2. Anal cancer is less common, but is especially malignant. Cancer ampoule and proximal part rectum has the character of adenocarcinoma or scirrhus, sometimes causing circular narrowing of the rectum. Metastasis can occur both by lymphogenic and hematogenous routes.
The clinical picture depends on the stage of the disease. Initially, the disease may be asymptomatic. Subsequently, constipation appears, alternating with diarrhea, tenesmus, and discharge of mucus, blood and pus from the rectum. As the tumor grows, blockage of the rectal lumen may occur, which leads to low intestinal obstruction.
Big diagnostic value have digital examination, rectoscopy and sigmoidoscopy (Fig. 148). With these types of examinations, it is possible to detect a tumor, determine its size, extent, localization, ulceration, etc., and take a piece of tissue for histological examination.
When the tumor grows into the peri-rectal tissue, severe pain appears in the perineal area, in bladder- urination is impaired.
Treatment. In the initial stages of the disease, radical treatment is used surgical treatment- removal of the rectum along with the tumor within healthy tissue. The remaining part of the intestine is brought down through the perineum or brought out to abdominal wall. In advanced cases, when radical surgical treatment cannot be carried out, an unnatural anus is created (anus preternaturalis) by bringing the segment out sigmoid colon in the left iliac region.
X-ray therapy gives a more satisfactory result for anal cancer. X-ray therapy does not lead to a radical cure, but only slightly slows down the growth of a cancerous tumor. The life expectancy of a patient with palliative treatment is 2-3 years. Without palliative surgery, patients die from low intestinal obstruction.

Diseases of the rectum have unpleasant symptoms, which usually appear on late stages. Having discovered them, you must urgently go to the hospital, since timely treatment will help get rid of most ailments. If you do nothing and wait for everything to go away on its own, complications will arise that not only worsen the quality of life, but also lead to death. By the way, it is women who more often experience diseases of the rectum, since in men this organ is located differently, more favorably.

Of course, each anal disease has its own symptoms, but there are several common ones that indicate the presence of a problem. Any of the following signs may indicate a serious illness.

Main symptoms:

  • Pain. This is what first of all indicates that it is time to see a doctor, since there is. The pain can be either mild or intense. It usually appears during or after defecation. In some cases, it may occur when moving or in a sitting position.
  • Purulent and bleeding. Most often they indicate the presence of polyps, hemorrhoids, fissures or a tumor. These symptoms are considered bad sign, therefore treatment must be prescribed immediately.
  • Diarrhea or constipation. This may indicate both an ailment of the anus and problems with the stomach and other digestive organs in men or women.
  • Flatulence and false urges to defecation. These signs should also not be ignored, especially if they are repeated frequently.

If you discover similar symptoms in yourself, you should not engage in self-diagnosis and try to determine the disease, for example, from a photo.

Only a doctor who can prescribe effective treatment can give an accurate answer.

Hemorrhoids and proctitis

Hemorrhoids are a disease in which hemorrhoids fall out and become inflamed. It has symptoms such as pain during bowel movements, bleeding, swelling of the anus, and constipation. It is advisable to start treatment in the early stages, when you can still get by only with medications and folk remedies. It occurs more often in women, as it can appear during pregnancy and after difficult childbirth. However, it also happens to men, especially if they lead sedentary image life and malnutrition.

Proctitis is another disease that relates to ailments of the anus. It can occur due to infection, hemorrhoids, injury and other factors. The following symptoms are noted: itching, pain, diarrhea, inflammation of the perineum. By the way, there is also paraproctitis, which has the same symptoms, but a fistula is added to them, from which pus and blood emanate. In this case it is required surgical intervention, aimed at reducing the fistula. You can't get by with medications alone.

Ulcer and cancer

Rectal diseases are often caused by constipation, as is the case with ulcers. Because of it, defects appear on the mucous membrane, from which there may be bleeding. Quite often men have the feeling incomplete emptying. Of course, there must be treatment. In some cases, medication can be used, but in more severe cases, surgery is required. It is also necessary to adhere to a diet or at least eat right to avoid complications of the anus.

Rectal cancer is one of those diseases that leads to death. Its difficulty lies in the fact that it is not always possible to notice symptoms at stages 1-2, and at stages 3-4, when they are visible, treatment is already useless. That is why it is recommended to undergo regular screening, especially if close relatives have had anal cancer. Prevention also doesn't hurt - active image life, proper nutrition and relief from constipation. Noticing pus, painful sensations, flatulence or intestinal obstruction, you should consult a doctor. This can be both signs of cancer and symptoms of other diseases.

Cracks and cyst

Anal fissures are extremely unpleasant, since a person who has them regularly experiences sharp pain. It occurs during bowel movements, while sitting and while walking. Even when a person is just lying down, he feels a burning sensation and discomfort in the anus. To get rid of a crack, you have to take painkillers, use special suppositories, make baths, and apply ointment.

Many patients, having eliminated the pain and got rid of the burning sensation, forget about the problem until the next time. This approach leads to complications or progression of the disease to chronic form. To permanently eliminate the signs of the disease, sometimes properly selected medications are enough. In advanced forms, surgical treatment may be required.

Cracks occur due to constipation, injuries, anal sex and improper surgical intervention. Therefore, if possible, it is necessary to prevent the causes of the disease.

An anal cyst can be diagnosed in men, women, and children. It is usually discovered during an examination by a proctologist, since due to the absence of clear symptoms, people may not notice the presence of a problem. Signs of this disease include difficult bowel movements or ribbon-shaped stool. Pain is most often absent, but may appear if the cyst becomes infected. In this case, treatment is definitely necessary, as complications are possible.

Polyps and hernia

As you can already understand, diseases of the rectum are very different. Some of them are dangerous, others are quite livable. For example, polyps do not cause harm to the body, so they are often left as is. Small growths inside the intestine have the unpleasant property of growing under favorable conditions.

Still, treatment of polyps is much simpler and guarantees positive result. But this cannot be said about cancer, since there is a chance of healing from it only in the early stages. And on the third one, at best, you will be able to live for about 5 years. On the fourth, life expectancy is at most 9 months. That is why you need to be attentive to your health so that you can prevent the occurrence of many ailments and get rid of existing ones.

However, it is better to remove these benign formations to prevent the occurrence of anal cancer.

An anal hernia is called an anal hernia, which is accompanied by pain, problems with emptying and constipation. It appears due to problems with stool, various injuries and surgical intervention. Treatment should be surgical, and it should not be delayed. If you ignore the problem, it will take on an advanced form. Then the rectum will fall out even when walking, which will cause extreme discomfort. It is recommended to go for examination at the first symptoms so that the doctor can diagnose accurate diagnosis and determine the degree of the disease. This is necessary so that the correct therapy can be prescribed, which will actually have the desired effect.

About the anatomy of the rectum and various diseases that develop in it, watch the video:

The knowledge gained will help you promptly recognize the slightest changes in the rectal area and consult a doctor for help.

Conclusion

Every person can encounter them, since they arise both due to an incorrect lifestyle and diet, and due to an accidental injury or a surgeon’s error. The main thing is to start treating the problem in time in order to regain your normal condition as fast as possible. You should not wait until surgery is no longer possible. In most cases, you can be cured only with the help of pills and traditional medicine. And don’t forget about prevention, which will help ensure that the disease does not return.

Pathologies in the anal area are provoked various factors and are accompanied specific symptoms. On later, anal diseases in men cause complications, many of which require surgical intervention.

Common pathologies of the anus

Diseases affecting the terminal section digestive system, enough. The development of most pathologies is associated with an incorrect lifestyle: low physical activity, harmful working conditions. Much less often, anal diseases occur due to congenital anomalies.

The most common diseases in men are:

  • Haemorrhoids. It is a form of varicose veins in which the hemorrhoidal vein is affected. In the early stages, it is accompanied by severe discomfort in the anal area, which intensifies while sitting or visiting the toilet. Subsequently, the patient develops small hemorrhages in the rectum. In the later stages, the anus becomes inflamed, hemorrhoids may prolapse, which is accompanied by intense pain.
  • Malignant neoplasms. Adenocarcinoma is a cancerous lesion of the rectum. On early stage development, the pathology does not cause significant clinical picture. Most often, symptoms appear when the tumor is practically untreatable. Provoking factors for the development of adenocarcinoma are considered to be poor nutrition, prolonged constipation, long-term use drugs, stress.
  • Polyps. They are benign neoplasms, but they pose a danger to the body, as they affect the functions of the digestive system. Polyps are considered a pre-cancer pathology; the presence of such formations in a patient is not reliable evidence that he will develop cancer. The main cause is considered to be systematic damage to the intestines by infections or chronic dysbacteriosis accompanied by inflammatory processes.
  • Rectal prolapse. With this pathology, the lower parts of the rectum exit the anus. In this case, the blood vessels are compressed, resulting in atrophy, and in the absence of therapy, tissue necrosis. The pathology is accompanied by pain, discomfort during bowel movements, stool disorders, and general malaise.
  • Proctitis. Disease infectious origin, in which the rectum becomes inflamed. The mucous membrane of the wall is damaged lower section intestines. At an early stage it occurs without pronounced symptomatic manifestations. Subsequently, the patient experiences pain and minor bleeding.
  • Anal fissure. It is a damage to the mucous membrane, the size of which reaches from 3-5 mm to 2 cm. Often the development of a crack occurs due to prolonged constipation, intense physical activity, or, on the contrary, reduced activity. At acute course accompanied by severe pain, discomfort when going to the toilet, and bleeding.
  • Paraproctitis. Purulent, developing in tissues located close to the anus, in particular in its anal glands. At an early stage it is accompanied by pain. Subsequently, compactions are formed, and in the absence of timely treatment- large purulent formation. The disease usually develops against the background of an infectious lesion and can be transmitted to nearby organs.

Thus there are various diseases anus in men requiring medical intervention.

Therapeutic measures

The method of therapy is prescribed by the proctologist depending on the nature of the pathology. Treatment is aimed at eliminating the cause of the disease, which may include infectious lesion tissues, long-term systematic disorders, injuries, unhealthy lifestyle. Also carried out symptomatic therapy aimed at eliminating the negative manifestations of the disease.

Treatment methods:

  • Lifestyle correction. The patient is prescribed moderate physical exercise, helping to normalize blood circulation in affected tissues. Changes are made to the daily diet: food is easy to digest and does not burden the intestines. The patient is advised to refuse bad habits, exclude reception.
  • Taking medications. Medicines are prescribed according to the nature of the pathology. In proctology, anti-inflammatory drugs, antibiotics, and antiseptics for external use are actively used. Painkillers, antipyretics, and laxatives are also used. Often medicines used locally in the form of rectal suppositories.
  • Physiotherapy methods. Used to improve blood flow to inflamed tissues, elimination pain manifestations. Also prescribed in the postoperative period, during the patient’s rehabilitation. For diseases of the anus it is used drug electrophoresis, magnetic therapy, infrared heating. Massage procedures are performed less frequently.
  • Surgery. The degree of complexity of operations differs depending on the severity of the pathological process. For example, with paraproctitis, surgical intervention consists of opening purulent formation and pumping out the exudate with further antiseptic treatment of the cavity. In case of hemorrhoids, the patient has damaged vessels removed, since in most cases they are not restored. Also surgical method used for benign and malignant formations of the rectum.

  • Unconventional therapy. Conduct self-treatment using folk remedies should only be done after consultation with a specialist. Therapy for anal disease is carried out using enemas containing natural composition. In addition, compresses, lotions, and preparations for internal use are used.

To treat anal diseases in men, a variety of methods are used, the choice of which is made taking into account the clinical picture.

Diseases of the anus in men are a group of pathologies that affect the rectum. Diseases can have different origins, symptoms, complications, and require special treatment.

Version: MedElement Disease Directory

Ulcer of the anus and rectum (K62.6)

Gastroenterology

general information

Short description


Ulcer of the anus and rectum - benign disease, characterized by the presence of a deep inflamed defect of the mucous membrane and (in contrast to erosion Erosion is a superficial defect of the mucous membrane or epidermis
) basement membrane of the rectum and/or anal canal. An ulcer, unlike a wound, is characterized by tissue loss (“minus tissue”).

Note 1

From this subsection excluded:
- fissure and fistula of the anus and rectum (K60.-);
- ulcerative colitis (K51.-);
- intestinal ulcers in Behcet's disease (M35.2);
- ulcers colon, including those caused by colitis of other etiologies (K52.-);
- ulcers rectum and anus of a specific origin (syphilis, tuberculosis, etc.).

Note 2
Many authors attribute the so-called “colitis cystica profunda” (CCP, deep cystic colitis or hamartomatous inverted polyp) to the solitary rectal ulcer syndrome, although the identity of both terms is not clear.
Solitary (single) ulcer is an imprecise term. The disease can manifest itself as multiple ulcers.

Classification


There is no generally accepted classification of ulcers of the anus and rectum. Most doctors use an endoscopic description of ulcers, which typically includes the number, location, diameter, type, presence or absence of complications (bleeding or malignancy Malignization is the acquisition by cells of normal or pathologically altered tissue (for example, a benign tumor) of the properties of malignant tumor cells.
) and other signs.


Etiology and pathogenesis


Etiology Ulcers of the rectum and anus are unknown. The disease is associated with other pathologies:
- with rectal prolapse (some authors regard it as a variant of intussusception Invagination - invagination of a layer of cells during any formative process
rectum);
- with cracks;
- with inadequate (or paradoxical) contraction of the puborectal muscle and with constipation.

Main trigger mechanisms:
- high blood pressure in the rectum during bowel movements (ischemia);
- pressure of compacted feces on the wall of the rectum (direct traumatic effect);
- manual release feces with coprostasis Coprostasis - stagnation of feces in the colon
(direct traumatic impact);
- use of suppositories with ergotamine (ischemia);
- irradiation (trauma and ischemia).

Pathogenesis
In general, the pathogenesis of ulcers is reduced to ischemia of the intestinal wall due to various reasons and/or mechanical injury mucous membrane. Thus, there are several possible components in the pathogenesis:
- pressure on the vessels of the submucosal layer;
- narrowing or obliteration of blood vessels due to proliferation Proliferation - an increase in the number of cells of any tissue due to their reproduction
fibroblasts;
- compression of the prolapsed area of ​​the mucous membrane by the anal sphincter;
- difficulty in emptying caused by prolapse Prolapse is a downward displacement of any organ or tissue from its normal position; The cause of such displacement is usually weakening of the tissues surrounding and supporting it.
mucous membrane, resulting in an even greater increase in pressure in the rectum;
- venous stasis and ulcer formation.

Solitary ulcers have an irregular shape and vary in size from 2-3 mm to several centimeters in diameter. These ulcers are superficial and can penetrate only a short distance relative to the level of the mucous membrane. The base of the ulcer is covered with a white or grayish-white coating. Since the plaque is thin, the base of the ulcer often remains uncovered and accessible to view.
The outline of the ulcer is usually irregular shape. The edges rise above the level of the mucosa, sometimes they are polypoid.
From time to time there are single ulcers of the “punch” type.

Over the course of many years, the external appearance of the ulcer undergoes only minor changes. Early manifestations become noticeable even before the ulcer itself appears. They consist of replacing the normal lamina propria with fibroblasts. Sometimes bundles of smooth muscle coming from the muscular plate of the mucosa pass between the glands next to the fibroblasts. Structural deformation and reactive hyperemia of the tubular glands are observed, which sometimes even acquire a villous configuration. There is a tendency for the goblet cell population to decrease.
A unique feature is obliteration Obliteration is the fusion of a cavity internal organ, canal, blood or lymphatic vessel.
lamina propria by fibroblasts and muscle fibers. During the process of ulceration, fibrinous and polymorphic exudate is released on the surface of the mucous membrane.
The ulcer is usually superficial and never penetrates deeper than the submucosal layer. The base of the ulcer consists of dense collagen covered with a thin layer of pus and granulation tissue.


Epidemiology

Age: mostly young

Sign of prevalence: Extremely rare

Sex ratio(m/f): 1


Ulcers of the anus and rectum are extremely rare. Most authors describe the incidence as 1-3: 100,000.

The disease mainly affects young people, but cases have also been described in children. Most patients with rectal ulcers are 50 years of age or younger, with 25% of patients over 60 years of age.

No differences by gender were found, although some authors indicate a slight predominance of women.

Risk factors and groups


Risk factors are considered:
- the presence in patients of various psychiatric disorders, manifested, among other things, by defecation disorders (obsessive-compulsive disorder and treatment with antipsychotics are most often mentioned in this regard);
- anal sex;
- constipation.


Clinical picture

Clinical diagnostic criteria

Constipation; feeling of incomplete passage of stool; pain or feeling of fullness in the pelvic area; discharge of mucus from the rectum; fecal incontinence; rectal pain or anal sphincter spasms; hematochezia, straining during bowel movements

Symptoms, course


The clinical picture of ulcers of the anus and rectum is extremely diverse. This is partly why (along with the rarity of the disease) only about a third of patients have correct diagnosis after the first examination.

Symptoms may include (in various variations):

Bleeding from the rectum (89-92% of patients);
- rectal prolapse (history in about 94% of cases);

Feeling of incomplete bowel movement (about 23% of patients);
- rectal pain or spasms of the anal sphincter (42-54%);
- tenesmus Tenesmus - false painful urge to defecate, for example with proctitis, dysentery
(84%);

Diarrhea (about 20%);

Fecal incontinence (rare);

Constipation (64%);
- straining during bowel movements (28-85%);

Mucus in the stool (more than 45% of patients).

Inspection

A digital rectal examination may reveal rectal tenderness and bleeding. In addition, local tissue elasticity or hardness (compaction) is sometimes detected. There may be traces of blood on the glove. If the ulcer is located high, digital examination yields nothing.
A digital examination can exclude a number of diseases of the rectum that can also be a source of bleeding (for example, hemorrhoids).

Notes
1. Patients with rectal ulcers usually report rectal bleeding as their chief complaint.
2. The patient may report anal symptoms obstruction Obstruction - obstruction, blockage
.
3. Pain is often localized in the area around the anus (perineum) or in the lower back ( sacral region). Typically the pain is described as dull, continuous and constant, not changing after or during bowel movements. In some patients, the nature and intensity of pain may change during or after defecation.
4. About a quarter of all people with rectal ulcers report no symptoms.

Diagnostics


The clinical diagnosis of anal and rectal ulcers is difficult due to the rarity of the disease, variability and nonspecificity of symptoms.

1. The “gold standard” of diagnosis is considered fibrorectosigmoscopy. It is recommended not to limit yourself to examining only the rectum, since the ulcerative process can also affect the rectosigmoid junction. The procedure is also necessary for differential diagnosis.
As a rule, the method is combined with a biopsy and/or stopping rectal bleeding. The histological manifestations of a solitary ulcer are the only one of its kind, so diagnosis is possible solely on the basis of rectal biopsy data (for pathomorphology, see the section “Etiology and Pathogenesis”).
Open ulcers are found in 57% of cases; ulcers are located on the anterior wall of the rectum, most often at a distance of 7-12 cm from the dentate line.
Non-ulcerative lesions (inverted hamartomatous polyps), which, according to some authors, also belong to the syndrome of solitary rectal ulcers, are detected in 25% of cases.
Signs of local inflammation (mucosal hyperemia) are observed in 18% of cases.
Attempts to compare the clinical picture and detected endoscopic changes have not yet led to clear results.


2. Ultrasound(transrectal sonography). A thickened mucous layer and hypertrophy of the internal anal sphincter may be detected.

3. Rectography And video defecography used for suspected sphincter pathology. Defecography often reveals prolapse of the rectal mucosa or insufficient relaxation of the puborectalis muscle.

4. Physiological studies(anal manometry and others) can also be performed according to indications.

Laboratory diagnostics


There are no specific laboratory tests to diagnose rectal ulcers, but a comprehensive study is necessary for the purpose of differential diagnosis.
The most common changes are the detection of blood and mucus in the stool without significant admixture of neutrophils and lymphocytes.

Differential diagnosis


Differential diagnosis carried out with diseases that are characterized by rectal bleeding and pain in the rectum. Rectosigmoidoscopy plays a decisive role.

In the human body important function performed by the rectum, diseases, symptoms, treatment of which are topics of interest to those who have been diagnosed with pathology of this organ. Treatment is prescribed taking into account the results of the examination. In the human body, the rectum serves to eliminate digestive tract remnants of digested food, toxins and other products that are incompatible with the vital functions of the body. When performing its functions, it is injured, which increases the risk of developing various diseases.

1 Medical indications

Rectal diseases have similar symptoms:

  • painful sensations;
  • the appearance of mucous discharge resembling pus from the anus and perianal area;
  • feces contain blood;
  • frequent constipation and diarrhea;
  • uncontrolled passage of gases and feces.
  • taking tests;
  • examination of the rectal mucosa using an endoscope (it is inserted into the anus 30 cm).

It is first necessary to empty the intestines and carry out a hygienic procedure for the entire perineal area (drink a laxative solution, give an enema). To determine an accurate diagnosis, the doctor performs a biopsy. Examination of the affected tissue excludes the possibility of developing a tumor or rectal polyps. If changes are visible in the intestinal lumen, then such a diagnosis is mandatory.

2 Proctalgia

Proctalgia is a disease in which periodic pain appears in the rectum, but organic damage she's not there. The pain syndrome disappears after 10-15 minutes. The diagnosis is made when all other pathologies of the rectum are excluded. Doctors highlight following reasons development of rectal disease in women and men:

  • previous surgery on the pelvic organs;
  • inflammation genitourinary area, when neoplasms appeared in neighboring areas.

If the examination did not reveal any special deviations from the norm in the intestines, the patient may be prescribed sedatives, warm baths and physiotherapy. Hemorrhoids are the most common disease in proctology. Primary symptoms of rectal disease:

  • burning;
  • pain during bowel movements.

As the disease of the anus progresses, bleeding appears and necrosis of the veins of the anal zone develops. The reason for the development of the disease is the weakening vascular walls, feeding colon. The disease can be congenital or acquired.

The reasons for it are sedentary lifestyle life, sedentary work, tendency to constipation. The veins in the rectum stretch, forming hemorrhoids in the anus. Every year they increase in size, the disease becomes external forms. When the disease worsens, the nodes swell (they may fall out of the anus), which contributes to the development of thrombosis.

3 Cracks in the anus area

When you feel the bumps in the anus and nodes under the skin, pain appears, which creates discomfort. Internal and external hemorrhoids should not be treated without consulting a doctor. Otherwise, the disease will progress (the rectum will fall out of the anus). Stage 1-2 disease can be treated conservatively. At severe course hemorrhoids undergo surgery.

When the first signs of hemorrhoids appear, it is recommended to seek help from a doctor. With the help of folk and medical supplies You can remove swelling and restore blood circulation in the anus. For this purpose, ointments (Relief), suspensions (Anuzol), and compresses are used.

  • eliminate constipation;
  • monitor your weight;
  • to live an active lifestyle;
  • avoid hypothermia and overheating;
  • do not lift heavy things;
  • to refuse from bad habits.

With persistent constipation and hemorrhoids, anal fissures appear. A large load on the intestinal walls causes increased pressure on the rectal mucosa, which leads to the occurrence of microcracks. The cause of the injury is dense feces or thrombosis of hemorrhoids.

4 Main symptoms

A fresh anal fissure (a 2 cm long gap) passes through the entire mucous layer to the sphincter muscle tissue. For a time damaged tissue are replaced by connective cells, forming a deep crack. The disease becomes chronic.

Signs of anal fissure:

  • acute pain during and after bowel movements;
  • traces of blood;
  • itching and burning;
  • pressure is felt in the anal canal;
  • penetration of pain into the perineum, genitourinary system, sacrum;
  • periodic spasm of the sphincter.

The patient experiences severe pain during defecation and involuntarily restrains the urge, thereby aggravating constipation and interfering with the healing of the mucous membrane. Cracks in anal passage treated with conservative methods. Analgesics are used to relieve pain.

To normalize stool, the patient must adhere to a fermented milk diet. In the first 2-3 weeks it is recommended to give an enema. To do this, use a solution of potassium permanganate or chamomile with calendula. After the enema, disinfectant baths are given. If you correctly follow all the doctor’s recommendations, then after 2-3 months the anal fissure will heal. A chronic fissure is surgically removed.

5 What is proctitis

In the rectal mucosa inflammatory processes occur due to constipation, intestinal damage, infections and intoxications. Similar symptoms are characteristic of proctitis. At acute form The disease exhibits the following symptoms:

  • pain in the lower back and perineum;
  • frequent urge to go to the toilet;
  • bowel dysfunction;
  • pus.

When the disease progresses to chronic condition pain decreases, fatigue increases, the patient quickly gets tired, and clear signs of anemia appear. Anti-inflammatory and antibacterial agents are used to treat the disease.

Untimely treatment of proctitis contributes to the development of paraproctitis. The infection penetrates deeply through cracks, capturing the entire intestinal wall and extending beyond its limits. Symptoms and intensity of pain depend on the location of the purulent focus. General signs- heaviness in the intestines, pain in the depths of the anus, lack of appetite, insomnia, weakness, swelling of the buttocks.

Paraproctitis is dangerous, since the abscess can open and the contents enter the abdominal cavity. In this case, there is a risk of developing peritonitis. When an abscess emerges on the surface of the skin, a fistula is formed. This dangerous disease is treated surgically.

6 Polyps

Polyps may appear on the colon mucosa. The reasons for their appearance include heredity, poor lifestyle, and frequent inflammation of the rectum. Polyps can grow throughout the intestines. IN upper sections They for a long time go unnoticed.

Colon polyps are immediately noticeable. Reaching a certain size, they cause severe discomfort to the patient and can provoke different types of discharge. It is recommended to check neoplasms for malignancy. They are removed using an endoscope. Polyps are prone to relapse, so the patient must be constantly monitored by a proctologist.

Condyloma acuminata is called benign neoplasm caused by the human papillomavirus. The growth has the appearance of a cauliflower. It can attack the intestines anal hole and the entire groin area. The disease is transmitted sexually. Fans of anal sex and homosexuals are most susceptible to condyloma infection. The growths are removed chemically or using laser coagulation.

7 Cancerous tumor

When rectal cancer occurs, the following symptoms appear:

  • impaired bowel movement;
  • soreness;
  • bleeding.

Tumor growth increases pain, and ribbon-like stool is possible. In this case, symptoms characteristic of cancer appear:

  • rapid weight loss;
  • low performance;
  • frequent colds;
  • decreased immunity.

When a hernia develops, part of the rectum prolapses beyond the anus. The patient experiences discomfort. Bowel prolapse is not accompanied by pain. The cause of this disease in children can be a normal cough or physical exercise. Hernia is anatomical feature small pelvis. Incorrect placement of bones weak muscles, high pressure V abdominal cavity, difficult childbirth, some neurological factors can trigger the development of the disease. A hernia can be removed surgically.

Prevention of the disease consists of managing healthy image life and proper nutrition.

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