Rectal abscess paraproctitis symptoms. Symptoms and methods of treatment of acute purulent paraproctitis. Paraproctitis in adults

Purulent diseases are not only unpleasant, but also dangerous. Therefore, if their first symptoms make themselves felt, you should not hesitate to visit a doctor. In this article we will talk about paraproctitis, which can cause a lot of discomfort. It will be useful for patients facing this problem to know the features of its development, symptoms and possible methods of influencing the disease at home.

A little about the disease itself

Before considering the treatment of chronic paraproctitis without surgery, it makes sense to touch upon the general characteristics of the disease in question.

Paraproctitis is the name given to the fatty tissue that is located around. This disease can have both a chronic and acute form. The causes of this disease include exposure to infection that enters through the mouths of the anal glands from the rectum into nearby tissues.

If you look at medical statistics, you will find out that about 40% of all visitors come to proctologists with this problem. That is why the treatment of chronic paraproctitis in adults is a more than relevant topic.

Why does the disease appear?

The key reason for the development of a disease such as paraproctitis is the pathological flora, which enters from the rectum into the surrounding deep layers of cellular tissue.

Enterococci, Escherichia coli, anaerobic microbes and staphylococci can be identified as the main pathogens. The most common routes of entry for bacteria are through the Morgani crypts and anal sinuses. It is worth noting that various damage to the intestinal mucosa significantly contributes to the infection process.

Alternative routes of penetration may include the inflamed prostate gland, as well as ulcers and wounds on the skin. At the same time, there is always a possibility that the body will become self-infected. We are talking about the transfer of pathogenic bacteria from extraintestinal foci to the site of inflammation through the bloodstream.

In this case, various cellular spaces that surround the intestine can become the target of pathogen damage:

Subcutaneous fat layer;

Submucosal layer of the rectum;

Pelvic-rectal region;

Ileorectal zone, etc.

Severe cases have been recorded in which the inflammatory process covered several of these zones.

What contributes to the formation of the disease

It is worth knowing that there are factors whose presence significantly increases the risk of paraproctitis:

Haemorrhoids;

Frequent constipation;

Diabetes;

Anal intercourse;

Damage to blood vessels by atherosclerosis;

Cracks in the area of ​​the anus;

Weakened immunity, both local and general.

As you can see, problems with the intestines or even a poor state of the immune system can lead to a problem such as paraproctitis. Treatment without surgery is, of course, possible, but the choice should be made only after consultation with a qualified specialist.

Types of inflammation

Initially, it should be noted that paraproctitis can have two forms: acute and chronic.

By acute we mean inflammation that makes itself felt for the first time (it had not manifested itself before) and leads to the formation of suppuration in the fatty tissue. When it can go beyond the boundaries of the lesion, as a result a channel is formed between the abscess itself and the skin or adjacent hollow organs.

As for chronic paraproctitis, in most cases it does not cause pain. But it is still possible to manifest it through purulent fistulas, the outlets of which can be located on the buttocks and near the anus. It is from them that pus flows, perhaps even mixed with feces. If the mouth of the canal closes, pus begins to accumulate and new abscesses develop, which is not good, because they come out, forming new fistulas or penetrate into the intestines.

Treatment of chronic paraproctitis at home - This is real and acceptable if it is not possible to use the services of a qualified doctor. Indeed, in an advanced state, such a disease leads to the fact that the so-called purulent ducts form clusters of foci that have a branched structure and contribute to the appearance of numerous holes. There is no need to say that such a condition can be called extremely complex.

Acute symptoms

This paraproctitis is characterized by standard signs of the inflammatory process:

Disorders of defecation and urination;

Heat;

Feeling of pain in the area of ​​inflammation (pelvis, lower abdomen);

Signs of intoxication such as lack of appetite, headaches, chills and weakness.

But in some cases, the picture of the manifestation of paraproctitis can be quite specific, and this depends to a large extent on the location of its localization.

An example is the most common subcutaneous paraproctitis. It manifests itself through the formation of an abscess in the subcutaneous tissue with fairly clear symptoms. More specifically, a noticeable tumor appears on the patient’s body in close proximity to the anus. The skin over the abscess becomes red, swells and thickens.

Moreover, the entire area subject to the inflammatory process becomes a source of pain, which intensifies during squatting and palpation. After some time, the pain may become throbbing. The troubles do not end there: the patient becomes nervous, sleep and bowel movements are disturbed.

Chronic paraproctitis

This form of the disease causes virtually no pain. Therefore, treatment of chronic paraproctitis with folk remedies can be carried out without any haste, in contrast to the situation with acute pain syndrome.

But purulent fistulas with this form still form. They are most often located on the buttocks and near the anus.

It is important to realize the fact that the chronic form of this disease cannot go away on its own, without influencing it. If you ignore this fact, you will inevitably have to face relapses, during which the scale of the pathological process will only grow. As a result, the human body will be subjected to extremely destructive effects.

Speaking about complications of the chronic form, it is worth mentioning such negative consequences of the disease as the degeneration of paraproctitis into necrosis.

Survey

For a problem such as paraproctitis, treatment without surgery - with folk remedies - still implies a diagnosis that will allow you to accurately identify the type of problem and the condition of a particular patient.

To undergo a quality examination, you need to contact surgical and proctological doctors. As for the preliminary diagnosis, it is made according to the clinical picture and complaints of the patient himself. At the same time, you should not set yourself up for instrumental and manual examination, since due to its pain it is not carried out in most cases.

But the diagnosis cannot be ignored, because the symptoms may indicate not only paraproctitis. It is possible to develop other diseases with similar symptoms, for example, intestinal or wen tumors.

How to influence the disease

Initially, you should understand that with a problem such as paraproctitis, treatment without surgery is not the best option. The surgical route to neutralize the disease in this situation can be considered the most effective. But if for some reason such measures are not available or acceptable, you can influence the patient’s condition with the help of folk remedies.

As an example of such treatment, it makes sense to give several recipes for oral medications:

You need to squeeze the juice out of ripe red rowan and take it in the amount of 40 ml three times a day before meals. But you can use dry and frozen berries; to do this, pour 0.5 liters of boiling water in the amount of two tablespoons and use the resulting product with honey instead of tea.

If paraproctitis has developed, treatment without surgery may include the use of (3 g) filled with three liters of cold boiled water. All this should be left for two days, then the liquid should be drained and taken as a medicine several times a day. You can start by using 200 ml of the product after meals, and if the body reacts positively, then before meals.

Unrefined sunflower oil and vodka are also relevant for treatment. These components in an amount of 20 ml are mixed in a glass container and shaken thoroughly until the vodka is completely dissolved in the oil. The resulting mixture is then quickly drunk. After this procedure, you must refrain from eating for three hours.

Folk methods for overcoming paraproctitis do not end there

Application of compresses

Treatment of paraproctitis without surgery has conflicting reviews, since different people have different conditions and complications. In some cases, traditional methods, due to the relatively mild form of the disease, provide a noticeable effect, but there are people who have found a solution only through surgical intervention.

However, if you move away from the hospital and return to treatment at home, you should inevitably pay attention to the following types of compresses:

You can start with pre-grated raw potatoes. It needs to be wrapped in a clean cloth and applied to the place where the source of the disease is located for one hour.

Heat the red sand-lime brick thoroughly in the oven, place it in an enamel bucket and cover with chopped 3-4 cloves of garlic. You will have to wrap the rim of the bucket with thick cloth to avoid burns and sit on it. You need to remain in this position until the brick gives off heat. To obtain a noticeable effect, this procedure can be repeated daily.

St. John's wort can also help if it is in the amount of 3 tbsp. l. pour into boiling water (300-350 ml) and keep on fire for 15 minutes. Next, you should strain it and immediately place it on polyethylene film. It is on this that the patient will have to sit and wait until the St. John's wort cools down. Finally, you need to wash yourself with the broth that remains after filtering.

Baths with a healing effect

If paraproctitis has made itself known, treatment without surgery should also include baths. One example of such a technique could be the following recipe: 40 g of sea salt are placed in 3 liters of water. Take this bath for half an hour twice a day. If an abscess breaks through, the techniques can be reduced to once.

For those who are focused on the treatment of chronic paraproctitis, the specifics of using baths will be reduced to the use of decoctions of medicinal herbs. For these purposes, yarrow, St. John's wort, oak bark, oregano, string, bergenia, calendula, calamus and other herbs that can give an astringent, disinfectant and anti-inflammatory effect are perfect.

The principle of preparing the decoction is as follows: 60 g of any plant is poured into 0.5 liters of boiling water and boiled for 15 minutes. Then the broth is cooled for 40 minutes, filtered and poured into a basin where there is already prepared warm water. Such procedures should last 15 minutes, and the cycle itself is designed for a period of 2 to 3 weeks.

It is also worth noting the fact that treatment of chronic paraproctitis with homeopathy can have quite tangible results. But the maximum effect will be obtained only if data is available after a professional examination.

How to treat children

If you have a problem like paraproctitis in your beloved child, you need to act competently and without delay. As stated above, the key to successfully overcoming the disease is examination by a qualified specialist. And only after the diagnostic results and consultation with a doctor should you think about how to neutralize paraproctitis in a child. Treatment without surgery in this case will be one of the most relevant options.

As a method worthy of attention within the framework of such treatment, they can be identified. They are excellent for influencing the child’s body. But adding propolis is no longer advisable, since such suppositories can cause an allergic reaction in a child. Such treatment of paraproctitis without surgery has positive reviews, since it has a healing and restorative effect.

Results

Paraproctitis, as you can see, is a complex disease that can become a source of extremely unpleasant and even dangerous complications.

Therefore, you should not place all your hopes on treatment at home. Therapy under the supervision of an experienced specialist is always the best option to combat the disease.

It is an inflammation of the tissues surrounding the rectum. To understand what paraproctitis is, you need to turn to our anatomy. The cellular spaces surrounding the rectum are quite numerous - and inflammation can occur in each of them, and in especially severe cases, even in several.

The mucous membrane also has its own characteristics, rich in crypts (depressions), at the bottom of which the anal glands are located. Most often, inflammation begins with cryptitis, and later, thanks to the anal glands, the infection spreads to nearby tissues.

Classification of acute and chronic paraproctitis

1. Ordinary, anaerobic, traumatic, and specific(according to etiology).
2. Submucosal, retrorectal, subcutaneous, pelviorectal, ochiorectal(depending on where the ulcers are located).

Chronic paraproctitis(or, as it is also called, rectal fistula) It happens:

1. Full, external, incomplete And internal(according to anatomical principles).
2. Front, side, rear(according to the location of the internal opening of the fistula).
3. Simple, complex(according to severity).

Of course, paraproctitis has its own characteristics, thanks to which it can be diagnosed. Often, each type of this disease has its own symptoms. We'll look at them below.

Symptoms of paraproctitis

During the examination, the patient experiences hyperemia (redness), swelling of the affected tissue and deformation of the anal canal. During palpation (palpation), the patient experiences sharp pain, sometimes fluctuation is detected (a symptom indicating the presence of fluid in a closed cavity).

Submucosal paraproctitis. Occurs in a small percentage. Painful sensations, which, however, increase during bowel movements, are quite moderate at other times. Body temperature remains subfebral (that is, it can rise for a long time to 37-37.5 degrees). Palpation also determines bulging of the abscess and pain. If the abscess breaks into the lumen of the rectum on its own, recovery occurs.

Retrorectal paraproctitis It is considered the form of the disease that is least common among sick people. It is characterized by severe painful sensations in the rectum, radiating to the perineum, thighs, sacrum and even to the rectum. The pain becomes stronger during defecation, sitting, palpation of the tailbone or pressing it. The posterior wall of the intestine bulges sharply, which is noticeable during examination.

Ischio-rectal paraproctitis, which occurs in 35-40% of patients, reports itself, first of all, with signs of inflammation of a purulent nature - the patient is bothered by sleep disturbances, accompanied by weakness and chills.

Subsequently, the disease manifests itself in a more localized manner - in particular, pain of a dull nature begins in the perineum and rectum, becoming sharp and throbbing over time. The pain intensifies not only during physical activity and during the act of defecation, but also during an ordinary cough.

In front of the rectum, when an abscess appears, dysuria is noted. After 5-7 days, moderate redness and swelling is observed in the perineum, where the abscess is located. The semilunar fold is smoothed, and the gluteal lobes are asymmetrical. On palpation, patients complain of pain (though moderate) inside the sciatic nerve.

Palviorectal paraproctitis(or, as it is also called, pelvicorectal) is considered the most severe form of the disease. Diagnosed in 2-7% of patients with acute paraproctitis. The main clinical picture is general weakness, malaise, slight increase in body temperature (up to 37.5), headaches, loss of appetite and even aches in the joints.

Pain is also noted in the lower abdomen. When, after a week or three, an abscess of the infiltrate of the palviorectal tissue occurs, the body temperature begins to sharply “jump” by several degrees. Symptoms of purulent intoxication become more pronounced - the pain intensifies, constipation is observed (but at the same time, patients complain of a false painful urge to defecate, which is called tenesmus in medicine), and impaired urine outflow. At this stage, there is no pain on palpation in the perineum; they appear later, with a longer course of the disease.

Diagnosis is difficult until the inflammatory process spreads to the ischiorectum and subcutaneous tissue. In this case, the symptoms are quite recognizable - hyperemia and swelling of the perineal tissue, pain on palpation. Also, during examination, the doctor may detect infiltration (accumulation of blood and lymph in the tissue) of the wall of the rectum, bulging of the abscess into the intestinal lumen (it is not possible to feel the upper edge of the bulge).

Classification by pathogens

Tuberculous paraproctitis occurs due to infection from the rectum or metastasis. The formation of a dense infiltrate is noted, which softens and opens over time, releasing a large amount of colorless pus.

Actinomycosis paraproctitis(caused by a fungus) is very rare in medical practice. It is characterized by the formation of a dense infiltrate, which then opens, releasing a small amount of thick pus. Whitish grains are visible in it - these are the fungi that caused paraproctitis.

Complications of paraproctitis

Complications of acute paraproctitis

1. Breakthrough of the abscess. If the abscess breaks out on its own, this is a plus, but the fact that when it breaks out, pus from it can get into the nearest intercellular spaces is a minus, because pus getting into the rectum or vagina will cause infection.
2. The inflammatory phenomenon can spread to neighboring organs (uterus, prostate gland, rectum, vagina or even urethra), which will lead to irreversible deformation of them, possibly leading to disability, because sometimes the only method of treatment is their removal. The infection can also enter the abdominal cavity, causing peritonitis.

Consequences of chronic paraproctitis

1. The growth of the fistula tract into many branches, which complicates treatment.
2. Deformation of the rectum, up to the inability to retain feces due to poor functioning of the sphincter.
3. If periodically exacerbating paraproctitis occurs for more than five years, this can lead to the development of cancer.

Possible complications after surgery

1. Relapse (reappearance of the fistula).
2. Insufficiency of the anal sphincter (partial or complete incontinence).

Causes of paraproctitis

There have been cases when paraproctitis occurred due to heavy lifting, poor diet (as well as excessive alcohol consumption), hypothermia, and even previous rhinitis. In other cases, it is impossible to find out the cause of paraproctitis. It has been established that in women it often occurs against the background of underwear constantly cutting into the skin of the anus.

A little about paraproctitis in children

However, in children (including infants), it is necessary to differentiate true paraproctitis from perineal abscesses, which, it should be noted, occur much more often. In general, some doctors are sure that childhood and paraproctitis are incompatible. Also, the purulent process that occurs with septicopyemia cannot be called true paraproctitis.

Diagnosis and treatment of paraproctitis

*Often, paraproctitis is diagnosed quickly enough using finger scanning with the addition of a rectal speculum, if the patient’s condition allows this.
*This disease is quite common, given that the percentage of patients with paraproctitis is 20-40% of all proctological diseases, ranking 4th among them in frequency.
*It is noteworthy that men suffer from this disease more often than women. The age of patients ranges from 30 to 50 years.
*Paraproctitis affects not only people, but also animals - it more often affects dogs than cats.

In order to distinguish paraproctitis, additional examination methods are needed, which is especially necessary when the abscess is too high. Such instrumental diagnostics include anoscopy, rectromanoscopy, and fistulography. In some cases, ultrasonography is used.

Treatment of paraproctitis

Conservative treatment.

Conservative treatment of paraproctitis is, of course, possible, but in most cases it turns out to be ineffective due to relapses, and therefore is used only in the initial stages of the disease. In particular, conservative treatment consists of the doctor prescribing bed rest, antiseptics, sitz baths and warm enemas with a medicinal effect.

A diet is also prescribed. It consists in the need to adhere to the regime (eat at least 4 times a day at the same time), eat hot liquid meals at least once a day, limit yourself to food in the evenings and avoid unhealthy foods - fried, fatty, salty. It is important to drink a lot of water. It is recommended to avoid products that contain tannin, as well as foods with a viscous consistency (rice porridge, semolina) and ground foods.

Along with diet, there have been cases of successful treatment of paraproctitis with the help of regular compresses (using Vishnevsky ointment), baths with potassium permanganate, and suppositories with antibiotics. Suppositories such as Relief, Anestezol, Ultraproct, Anuzol, suppositories with methyluracil and propolis have proven themselves well in the treatment of paraproctitis.

If conservative treatment is ineffective, surgery is indicated.

Surgery It is often prescribed immediately after diagnosis, because it is considered urgent. However, sometimes it can be postponed - in this case, the doctor advises the patient to take antibiotics and prescribe physiotherapeutic procedures. However, surgical treatment is mandatory because inflammation may occur in case of recurrence.

The main purpose of the operation is to open and drain the inflammatory focus. The patient is given epidural and sacral anesthesia, in other, more rare cases, general anesthesia. When opening paralectal processes, local anesthesia is usually not given.

During the operation, the surgeon finds and opens the abscess and pumps out the pus. Then he finds the inflamed crypt, which is the source of infection, and excises it along with the purulent tract. If the source of inflammation remains in the body, a relapse may occur in the future. Therefore, the source in the body is removed. After this, the chances of a full recovery are high.

The most difficult operation is opening the abscess, which is located in the pelvic area. If chronic paraproctitis occurs, the fistula must be excised. But during an exacerbation, this cannot be done - you must first open and drain the existing abscesses, after which the fistula itself is removed.

If there are areas of infiltration, antibacterial therapy along with anti-inflammatory therapy is prescribed as preoperative preparation. The fistula tract must be removed as soon as possible in order to avoid relapse, which can occur quite quickly. In some cases, surgery becomes impossible. In this case, the patient's condition should be improved with conservative therapy and only then surgery should be performed.

Folk remedies for treating paraproctitis

Treatment of fistula (chronic) with calendula. Brew fresh calendula flowers in boiling water and leave for two hours. Microenemas are made with this infusion, combining the use (if there are no contraindications) with stone oil. One course is usually enough for patients.

Milk with onions. Boil two liters of boiling water, then throw in 2 medium onions and 4 cloves of garlic. After boiling for a few minutes, cool it down a bit. With a blanket wrapped around you, sit on the pan. The procedure should be done while it is hot, when the milk cools down, the treatment for today can be completed. To save money, you can boil the same milk every day.

Hot baths. Baths should be taken at night, when the patient feels that the pain will soon arise again. To do this, it is recommended to lie in hot water and wait until the body gets used to this temperature. After this, add more hot water. And so on until the patient can no longer bear it. You should spend at least half an hour in the bathroom.

Prevention of paraproctitis

1. Drink plenty of fluids (from 1.5 liters per day).
2. Eat more cereals, fruits and vegetables, which improve peristalsis.
3. Do not get carried away with laxatives (they cause constipation) and enemas.
4. Avoid increasing your own weight.
5. Move a lot.

is an inflammation of the tissue (fatty tissue) surrounding the rectum.

Paraproctitis is one of those diseases that cannot be treated at home. You can relieve the severity of the symptoms of paraproctitis, but the problems will remain (in the form of chronic paraproctitis or its complications). Treatment of paraproctitis, like other proctological diseases, is sometimes postponed due to embarrassment to see a doctor. This should not be done. Timely medical assistance will allow you to regain your lost quality of life.

Causes of paraproctitis

In most cases, inflammation is caused by opportunistic bacteria and fungi that are normally present in the human intestine; however, if they manage to overcome the mucous membrane and enter the tissue surrounding the rectum, in the absence of oxygen they begin to rapidly multiply and cause an acute inflammatory process. As a rule, paraproctitis is caused immediately by a complex of pathogens, which may include streptococci, staphylococci, and E. coli.

The trigger for the development of paraproctitis can be any damage to the rectal mucosa. Therefore, risk factors for paraproctitis include:

• (inflammation of the rectal mucosa);
• (dense feces can injure the mucous membrane);
• (prolonged stool disorder leads to damage to the mucous membrane);
• (bursted hemorrhoids form open wounds).

Often the infection enters through the anal glands. These glands are designed to secrete enzymes that help digest food and mucus that facilitates the passage of feces. The anal glands enter the rectum in crypts - tissue pockets open to the movement of feces. If the process of emptying the rectum is disrupted or if the crypt is injured (even minor), the crypt may become blocked. As a result, an inflammatory process develops in the gland, and the infection enters the cellular spaces through its duct.

Sometimes the infection can enter the peri-rectal tissues through the bloodstream. In this case, the source of infection may be inflammatory processes in other organs.

Types of paraproctitis

In the rectal area, several cellular spaces are distinguished. Inflammation of the tissue, as a rule, develops isolated in any one space; depending on this, the following types of paraproctitis are distinguished:

• subcutaneous (pararectal abscess);
• ischiorectal (ischiorectal abscess);
• pelvic-rectal (pelviorectal);
• submucosal.

Subcutaneous paraproctitis is most easily diagnosed and relatively easy to treat. The most dangerous form is pelviorectal paraproctitis (the disease is rare) - its symptoms are nonspecific, and the source of inflammation is located deep in the pelvic area.

Depending on the nature of the disease, paraproctitis can be acute or chronic.

Symptoms of paraproctitis

The onset of the inflammatory process can be marked by a slight increase in temperature (up to 37°C). When inflammation moves into the cellular space, i.e. In the development of acute paraproctitis itself, a complex of symptoms simultaneously appears. First of all, this is:

• up to 38°C (and higher);
• chills;
• pain in the rectal area not associated with bowel movements.

Subcutaneous paraproctitis has its own pronounced symptoms: the area of ​​inflammation located next to the anus is distinguished by redness, swelling and thickening of the tissue. When palpated, a sharp pain is experienced.

With other types of paraproctitis, stool retention and false urge to defecate may be observed.

Inflammation leads to the melting of cellular tissue and the accumulation of pus. In the absence of timely treatment, the resulting abscess breaks through and a fistula opening is formed - either outward (in the perineum, on the anterior abdominal wall or thigh), or into the intestinal lumen. In women, the abscess can open, forming a fistula in the vagina. The most dangerous option is the opening of a fistula into the abdominal cavity.

After the formation of a fistula, the bulk of the pus comes out, and the severity of the symptoms decreases. However, purulent processes continue, the disease becomes chronic.

Symptoms of chronic paraproctitis

With chronic paraproctitis, pain and discomfort are felt only if the exit of pus through the fistula is difficult for any reason. Usually pain is observed only with an internal fistula. The pain intensifies during bowel movements, and then subsides, since stretching of the intestines during the passage of stool promotes the release of pus. Pus or ichor is constantly secreted. With a rectal fistula, which has an external opening in the perineal area, the discharge irritates the skin, causing itching.

Chronic paraproctitis is characterized by a wave-like course of the disease. From time to time, the fistula canal becomes blocked by granulations and becomes clogged with dead tissue, as a result, pus again begins to accumulate in the area of ​​inflammation and the symptoms of acute paraproctitis return. Then the abscess breaks out again and the severity of the symptoms disappears.

Treatment methods for paraproctitis

The only treatment for paraproctitis is surgery.

Along with hemorrhoids and rectal fissures, this disease is one of the most common reasons for visiting a specialist. A proctologist treats paraproctitis. An infection in the human body, be it influenza or a sore throat, penetrates the fatty tissue of the rectum through microscopic damage to its mucous membrane and causes its inflammation.

Men get sick more often than women. This ratio ranges from 1.5:1 to 4.7:1. Paraproctitis is a disease of adults: descriptions of rectal fistulas in children are rare.

Reasons for the development of the disease

The root cause of the disease is infection (Escherichia coli, staphylococci, streptococci) that enter the cellular space from the rectum. Any wounds, household injuries and microtraumas, surgery on the mucous membrane are the entrance gates for such infections.

Staphylococci and streptococci penetrate into the cellular space not only through cracks in the rectal mucosa. There is an internal path: caries, or any other source of sluggish (chronic) infection. With the flow of blood and lymph, pathogens from the epicenter of inflammation are transferred to other organs and tissues.

Another way pathogens penetrate the cellular space is by blocking the anal gland duct.

The appearance of the disease is favored by poor nutrition, a sedentary lifestyle and the presence of low-grade inflammatory processes. Additional aspects that increase the risk of the disease:

• weakened immune system;
• diabetes;
• anal intercourse;
• fissures in the anus.

In particularly severe manifestations of the disease, inflammation can affect several areas located near the intestines.

Classification

Forms of pathology:

• according to the depth of the pathology - superficial, deep;
• along the course - acute (first formed) and chronic (formed fistulas);
• in relation to the fistula to the anal sphincter - intra-, extra- and transsphincteral;
• according to the complexity of the structure of the fistula tracts - simple and complex (the presence of several tracts, leaks and purulent pockets);
• according to the presence of a fistula exit - incomplete (there is only an entrance through the anal crypt) and complete (the abscess has found its way out through the skin, into the abdominal space or into the lumen of the rectum);
• according to the localization of purulent foci - subcutaneous, submucosal, intrasphincteral (located between the fibers of the external and internal sphincter), ischiorectal (the abscess is located in the perineum, outside the anal sphincter), pelviorectal (high location, high threat of total purulent process).

Symptoms of paraproctitis

Since paraproctitis is a purulent inflammatory process, it will be characterized by classic symptoms:

• increase in body temperature to critical levels;
• pain syndrome in the area of ​​paraproctitis formation - patients complain of the inability to sit and walk;
• the tissues around the anus become red and blue in color;
• The patient himself, when palpating the site of development of the inflammatory process, determines the swelling of the tissues.

The acute form of paraproctitis is also characterized by general signs of intoxication of the body - nausea and dizziness, vomiting and slight tremor of the upper extremities, severe weakness. Suppuration is sure to appear.

Chronic paraproctitis has all the symptoms inherent in the acute form of the disease, but in a less pronounced form. The chronic inflammatory process in question has one peculiarity - it always leads to the formation of a fistula. Purulent fluid leaks regularly through the opening of the fistula - constant irritation of the perineum leads to severe itching. Such paraproctitis is not capable of self-healing. With each relapse, the scale of the pathological process only increases, increasingly destroying the patient’s body. Gradually, severe complications arise in the form of necrosis, malignant degeneration of paraproctitis.

Since the symptoms of acute paraproctitis are quite specific, if they are detected, it is important to consult a proctologist as soon as possible in order to avoid life-threatening consequences and to prevent the disease from becoming chronic.

Diagnostics

For diagnosis, as a rule, it is sufficient to collect complaints, anamnesis of the disease and an external examination. In rare cases, especially with a deep location of the abscess, there may be difficulties in differentiating the diagnosis. Then instrumental research methods may be required, for example, computed tomography or ultrasound with a rectal sensor.

In the presence of fistulas, fistulography is performed - staining of the fistula tract to determine its depth, length and direction of the tract.

Laboratory research methods determine the presence of inflammation.

Treatment of acute paraproctitis

In case of acute paraproctitis, surgery is indicated. It must be performed as early as possible (surgical intervention for acute paraproctitis is classified as emergency). Otherwise, complications may develop and acute paraproctitis may become chronic.

The operation for paraproctitis takes place according to the following scheme:

• The surgeon clarifies the location of the abscess by examining the rectum on a rectal speculum.
• Then the abscess is opened and cleaned of pus. The surgeon must carefully examine the cavity, open all pockets, and destroy existing partitions.
• The abscess cavity is washed with an antiseptic solution.
• A drainage is left in the wound (a drain through which pus and ichor flow out).
• A special tube may be inserted into the rectum to drain gases.
• Subsequently, dressings are performed daily, and the patient is prescribed antibiotics.

Beforehand, the surgeon and anesthesiologist inform the patient about the features of the operation and anesthesia, and talk about possible complications and risks. The patient must sign written consent for surgery and anesthesia.

Local anesthesia cannot be used during surgery for acute paraproctitis, since it most often is not able to completely eliminate pain. Inserting a needle can spread the pus. General anesthesia is used: mask or intravenous.

Three main tasks that the doctor must solve during the operation:

• open and clean the abscess;
• excise the affected crypt - since it is a source of purulent infection;
• dissect and clean the purulent tract that connects the crypt and the abscess.

The deeper the abscess is, the more complicated and difficult the operation. If the operation is performed in a timely manner, the prognosis is favorable. If the patient does not consult a doctor on time, then acute paraproctitis becomes chronic and complications develop.

Treatment of chronic paraproctitis

If the patient is diagnosed with chronic paraproctitis, then the formed fistula will need to be excised. But during active purulent inflammation of the paraproctitis fistula, surgical intervention is contraindicated, so doctors first open the abscesses, clean them of contents and drain them - after which they can proceed with the operation.

If there are infiltrated areas in the fistula canal, then doctors first carry out antibacterial therapy using physiotherapeutic methods. But the operation to remove the fistula must be carried out as quickly as possible after preliminary treatment - relapse with purulent inflammation is inevitable.

Important: old age, severe somatic diseases and closure of fistula tracts are contraindications for surgical treatment of chronic paraproctitis. Doctors must first stabilize the patient’s condition and only then refer him for surgical treatment.

Complications

Chronic paraproctitis is characterized by a high risk of complications:

1. Spontaneous opening of an abscess.
2. Purulent melting and necrotization of the walls of the vagina and urethra.
3. Proliferation of scar tissue and decreased elasticity of the walls of the anal canal.
4. Cancerous degeneration in the presence of a fistula for more than 5 years.
5. The release of feces into the peri-rectal tissue through the necrotic wall of the rectum, the lightning-fast spread of the purulent process.
6. Breakthrough of the abscess into the abdominal space and the development of peritonitis, which can be fatal.
7. Insufficiency of the anal sphincter due to severe damage to its fibers, leakage of feces.

When the first signs of paraproctitis appear, emergency surgical care is required. The prognosis of the disease depends on the timing of its provision.

Prevention

Prevention of paraproctitis is simple:

• avoiding hypothermia;
• strengthening immunity;
• compliance with the rules of intimate hygiene;
• timely treatment of diseases of the rectum (hemorrhoids, anal fissure, etc.);
• treatment of diseases accompanied by itching and irritation of the skin around the anus (worm infestation, diabetes, colitis);
• normalization of digestion in order to prevent constipation and diarrhea.

The disease paraproctitis is not known to everyone, but among proctological problems it occupies a leading position, second only to hemorrhoids and colitis. Statistics say that paraproctitis occurs more often in men than in women. Middle-aged people are most susceptible to the disease, but this disease affects even infants. Let's consider what this pathology is. Let us clarify what the symptoms and treatment of paraproctitis are. Let's find out whether it is possible to get rid of the disease without surgery and what the risks of self-medication are.

Causes of paraproctitis

Let's start with the definition of the disease itself. So, paraproctitis, what is it and what causes the disease? The term “paraproctitis” is used by doctors to refer to inflammation of the rectal tissues, complicated by an abscess. Now a little about what causes suppuration. The causes of mixed pathogenic microflora: staphylococci of various types, streptococci, E. coli, enterococci. Pathogenic bacteria enter the rectum from the outside, through the anus. Analysis of the contents of the abscess usually shows the presence of various types of microorganisms.

Anaerobic bacteria cause the most severe forms of this disease: putrefactive paraproctitis, anaerobic sepsis, gas phlegmon of the pelvic floor.

The prerequisite for the disease is cracks, inflammation and other damage to the mucosal tissue. They are formed when foreign objects enter the rectum due to the presence of sharp particles in the stool. Infection from the outside is facilitated by injuries to the pelvis and anus. Inflammation can penetrate from adjacent organs: prostate gland, vagina, urethra.

Microbes penetrate the rectal tissue through cracks and postoperative sutures. But they do not necessarily enter the body from the outside; there are also internal routes. Chronic diseases become the source of infection in the body: sinusitis, tonsillitis, caries. Pathogens are carried through the bloodstream from one part of the body to another. In addition to chronic inflammatory diseases, the causes of paroproctitis are:

• weak immune system,
• high sugar content,
• hormonal disorders,
• atherosclerosis,
• nonspecific ulcerative colitis,
• exhaustion after prolonged fasting,
• alcoholism,
• chronic infections,
• fragility of blood vessels,
• constipation or diarrhea,
• inflammation of hemorrhoids,
• prostatitis,
• cystitis,
• salpingoophoritis,
• Crohn's disease.

In rare cases, paroproctitis is a manifestation of such serious illnesses as syphilis, antinomycosis, and tuberculosis.

Development of the disease

Inflammation in the intestines is caused by pathogenic bacteria. We have already found this out. Let's talk in more detail about the disease paroproctitis, what it is, how it is formed, why it develops? To understand, let's remember the anatomy. The rectum is the lower section of the intestine, ending at the anus. The wall of the rectum consists of several layers:

• mucous membrane,
• muscle tissue,
• serous membrane,
• pararectal tissue.

Around the organ there are several cellular spaces permeated with nerve fibers and blood vessels:

• ileo-rectal,
• pelvic-rectal,
• posterior rectal.

There is also a subcutaneous and submucosal cellular space. The first is localized near the anus, the second is one of the components of the rectum itself. Along the anorectal line, the rectum forms depressions called pouches. The ducts of the anal glands depart from them. The spread of infection begins precisely from the pockets, the so-called Morganian crypts, and spreads through the ducts into the anal glands, and then to the adjacent areas. Once the canal is blocked, suppuration forms. In simple terms, paraproctitis is an abscess of the rectum.

Signs

It is customary to distinguish between two forms of the disease: chronic and acute. The manifestations of the disease differ in both cases. Acute purulent paraproctitis occurs with all the symptoms inherent in this process: high fever, pain, muscle weakness. The processes of urination and excretion of feces are disrupted. Often the patient exhibits signs of general intoxication: nausea and vomiting. The symptoms of childhood paraproctitis are the same as in an adult patient. There is pain in the anus and perineum, swelling of the sphincter tissue. The most characteristic symptom is painful bowel movements.

Symptoms depend entirely on where the abscess forms. Based on the localization of suppuration, it is customary to distinguish the following types of paraproctitis:

• subcutaneous,
• submucosal,
• ischiorectal,
• pelvic-rectal (pelviorectal),
• retrorectal.

Subcutaneous paraproctitis is detected immediately upon visual examination. The skin at the site of the lesion turns red, swelling and compaction form. Pressure causes pain. This form of the disease occurs in children. With submucosal paraproctitis, an abscess forms in the anus. In this case, the patient has a low-grade fever, pain symptoms are not as pronounced as in the first case.

Pelviorectal paroproctitis is the most difficult to diagnose. In this case, symptoms similar to a common infection are observed, which confuses the patient. Often a person begins to self-treat for acute respiratory infections. The source of infection is deep, next to the pelvic floor muscles. The acute form of the disease lasts about 2 weeks. During this period, the patient's condition noticeably worsens; during bowel movements, blood and pus are observed in the stool. In women, an abscess breakthrough is observed in the perineal area. The ileo-rectal location of the lesion is characterized by swelling and redness of the tissue. But it appears only a week after the onset of inflammation. Before this, the disease may occur without external symptoms.

Paraproctitis in necrotic form is especially dangerous. It is characterized by severe intoxication, girdling pain in the perineal area.

A sharp disruption of blood circulation causes tissue death, and cyanosis of the skin is observed. The patient's heart rate and pulse increase, and blood pressure decreases. Instead of the release of pus, tissue rotting occurs, accompanied by the release of “swamp” gas. The cause of the development of this pathology is gram-negative anaerobic microorganisms (clostridia, fusobacteria).

At the first symptoms, you should contact a specialist for qualified assistance. Paroproctitis, like any purulent inflammation, is dangerous due to its complications. When an abscess ruptures, the contents can enter the peritoneum and cause peritonitis. In the absence of proper therapy, the disease becomes sluggish and causes long-term suffering.

Treatment of acute form

Most experts categorically state that paraproctitis, like any abscess, is amenable to only one type of treatment - surgical.

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At the first signs of discomfort, you urgently need to contact a proctologist. It is pointless to try to cure the source of infection located deep in the intestines on your own. Various baths, enemas, suppositories and compresses only alleviate the symptoms, but do not solve the problem. Paraproctitis is operated on immediately after diagnosis, except in cases where it is not immediately possible to detect the area of ​​infection or the fistula passages are blocked. This makes it difficult to draw up a surgical plan.

The treatment regimen looks like this:

• the abscess is opened surgically,
• the abscess cavity is cleaned out,
• possible routes of infection spread are cut off.

The operation is usually performed twice. First, suppuration is eliminated and drainage is carried out, then diseased glands and sinuses are cut off. If the location of the abscess is easily determined, and the tissue surrounding the source of inflammation is not affected, a single surgical intervention is possible. If the suppuration is deep, the sphincter is cut with a scalpel. This can lead to complications such as fecal incontinence. To prevent this situation, sealing tampons are used, which are made from animal intestines. In the postoperative period, therapy is reduced to daily dressings if the intervention was performed on a lesion located outside. Antibiotics and asepsis are used to treat the wound.

In cases where surgical intervention is unacceptable, drug therapy is used. To relieve inflammation, antibiotics of a certain spectrum are used, effective against a specific type of bacteria. In the absence of fever, non-steroidal drugs such as Ibuprofen are used. It is possible to answer the question of how exactly paraproctitis can be cured in a particular patient only after a sensitivity test. The abscess near the anus is treated with various anti-inflammatory ointments. When the fistula is located inside the intestine, suppositories (Ichthyol, Posterisan, Proctosedyl) and suspositories with propolis and methyluracil are used.

Chronic paraproctitis

If the abscess opens naturally or as a result of self-medication, the disease becomes chronic, with periodic exacerbations. Treatment of an advanced disease is much more difficult and lengthy. Periods of relapse occur without fever or severe pain. Symptoms appear only during exacerbations. The main discomfort for the patient is caused by a parapractical fistula on the butt, formed at the site of the abscess. The skin in this area is easily irritated, itching often occurs, and sometimes pus appears. If the fistula cavity is not clogged with particles of feces and secretions, pain does not bother you. When clogged, new abscesses form. The lack of proper therapy ultimately leads to the formation of multiple fistulous canals with one epicenter in the infectious focus.

Among the complications of advanced paroproctitis are such serious diseases as:

• proctitis,
• peritonitis,
• proctosigmoiditis,
• malignant tumors.

Self-medication often leads to inflammation of the entire intestine, weakening of the sphincter and, as a result, fecal incontinence. The next exacerbation of the process may result in a breakthrough of pus into the pelvic tissue, which is fraught with serious consequences, including death.

The reasons for the transition of the disease to the fistula form are the lack of competent therapy and late referral to a specialist. After a fistula forms at the site of the abscess and the contents come out of it, the patient’s condition is relieved. Sometimes the hole heals on its own, but often the fistula remains a source of inflammation. Gases and feces get inside, the formation of pus resumes from time to time.

Chronic paraproctitis is treated comprehensively, using antibiotics and physiotherapy. Excision of the fistula is performed surgically.

With this form of paraproctitis, fistulas of several types are formed:

• full,
• incomplete,
• internal,
• external.

Complete fistulas have openings in the skin and inside the rectum. A perianal fistula looks like a funnel-shaped hole. Incomplete fistulas end at one end with a kind of pouch. In internal and external fistulas, the openings extend onto the skin and inside, respectively.

Alternative medicine

Chronic illness is often treated with folk remedies, combining various techniques with taking pharmacological drugs. External agents, decoctions, ointments, baths, help reduce discomfort, reduce inflammation and pain.

Baths with sea salt help. For disinfection, soda is added to it. Salt is known for its ability to draw pus from wounds, promoting their healing. The saline treatment method was used in military hospitals during the First World War. For a sitz bath, add a spoonful of soda and salt to a volume of 5 liters. In some formulations, sodium carbonate is replaced with mummy tablets. The temperature of the liquid is no more than 38 degrees, the procedure takes half an hour.

A herbal bath that relieves inflammation is prepared from calendula, chamomile, sage, St. John's wort, string, calamus and oak bark. All components are taken approximately equally. Crushed plant material in an amount of 50 grams is poured with water (0.5 liters), the liquid is allowed to boil for a couple of minutes and after filtration, diluted to 5 liters.

Microenemas with herbal decoctions are also effective for paraproctitis. To prepare the solution, pour calamus and marshmallow roots, oak bark, and wormwood into a thermos (1 tsp each). After 4 hours, the broth is filtered. Use no more than a quarter glass for an enema. The herbal decoction is administered after preliminary cleansing of the intestines. You can add a spoonful of soda to the solution for the first enema. Treatment is continued for up to 10 days.

A popular folk remedy for the treatment of chronic paraproctitis is sea buckthorn oil. It has a wound healing effect and improves tissue trophism. Tampons pre-soaked in oil are inserted into the rectum overnight.

Homemade suppositories made from lard and propolis, in a ratio of 10:1, are used in postoperative therapy or for the chronic course of the disease. Use the product twice a day for a week.

A mixture of collargol and sea buckthorn oil helps a lot. Microenema with a suspension based on “silver water” and vegetable oil has a wide spectrum of action.

The procedure helps reduce pain and speed up healing. Collargol and sea buckthorn have an antiseptic effect.

The microclyster is preceded by a cleansing enema; a decoction of calendula and chamomile can be added to the liquid. The suspension is administered slowly, in small portions and not more than 40 milliliters.

Only a doctor should diagnose the disease and decide how to treat paraproctitis at home. The choice of technique depends on the location of the fistula, the presence of concomitant ailments and other factors. Prevention of relapse of the disease includes avoiding alcohol, a diet that prevents constipation, and maintaining good hygiene. All possible sources of infection in the body must be eliminated in a timely manner.