Rectum. Topography of the rectum. Walls, relation to the peritoneum of the rectum. Structure and functions of the rectum, length in men and women Rectum anatomy and diseases

And also to get information about its structure and its functioning, then read this article.

She'll let you get general idea about the purpose of the final part digestive tract person.

general information

It is the final section of the digestive tract, responsible for the processes of final evacuation of feces from the human body.

The size of the rectum in men and women does not differ much from each other and can range from thirteen to twenty-three centimeters.

Its length, rather, depends not on the gender of an adult, but on his build and constitution.

In large (not to be confused with “plump”) people, the length of this intestine will be greater, and in slender men and women it will be shorter.

The length of the intestine in children is smaller sizes, but gradually increases as they grow older.

The diameter of the area in question can also vary depending on the structure of the person and various pathological factors.

The normal diameter of the human rectum ranges from two and a half to seven and a half centimeters.

Its walls are elastic, so it can stretch and contract within the stated limits.

It is a mistake to think that the rectum has a straight structure. In fact, this area of ​​the digestive tract has two bends.

The first bend is called “sacral” due to the fact that its direction “points” towards the sacral bones of the coccyx.

The second bend of the rectum is called “perineal” because its bend is directed towards the perineum.

The rectum of both an adult and a child from the first days of his life has three sections. Each of them has its own specific dimensions.

The lower part of this area is the narrowest and leads directly to the anus, which is why it is called the “perineal” or “anal” canal. The length of the section does not exceed four centimeters.

The middle section of the area under consideration is a canal called “ampullary”.

Its length is from ten to twelve centimeters, it has the widest structure compared to the other two sections.

The length of the third section, called “supraampullary”, does not exceed six centimeters.

If during diagnostics aimed at studying the state of the human intestinal system, it turns out that the area in question is larger or smaller in size, different from the norm, then this fact may indicate the presence of some pathological process flowing through his body.

Typical diseases that can modify the mucous membranes of the area under consideration and provoke its increase in size are hemorrhoids and various tumor processes, both benign and malignant.

Functions of the rectum

As mentioned above, the human rectum has the most important function, which is the timely evacuation of feces from the human body.

The muscle tissue that covers the walls of this intestine makes certain contracting movements that push feces towards the sphincter.

If there are any problems, for example, hemorrhoids, cysts or tumors, feces cannot always leave the human body in a timely manner.

Stuck in the rectum, feces begin to decompose and rot, poisoning the body with a large number of toxins that negatively affect human health.

Therefore, problems arising in the rectal area cannot be ignored. If you experience the first difficulty with the urge to defecate, you should not treat it at home, but immediately consult a doctor.

Proctologists (in some cases, gastroenterologists) are involved in solving problems localized in the area under consideration.

These doctors are accepted in any municipal or private clinics.

Making an appointment with them is the best thing you can do to solve the problem as quickly as possible, or at least significantly mitigate its acute symptoms, which make adjustments to your usual way of life.

Despite the fact that the rectum ends with a through hole intended by nature for diversion food waste body, this intestine is not a through channel.

The muscle tissue that is located under the mucous membrane of this intestine allows a person to retain processed food lumps within the body for some time.

This process is realized thanks to the statistical role of the rectum. The second role of this intestine is called “dynamic” - it allows the evacuation of feces.

Organism healthy person easily performs the functions of containing and evacuating feces.

If there are any malfunctions in the functioning of the intestinal system, for example, incontinence of processed food lumps or, conversely, false urges to defecation when the tank is empty, then we can talk about complete or partial dysfunction of this zone.

Improper functioning of the intestinal system and anal sphincter is a reason to immediately consult a doctor.

The cause of such dysfunctions may be various diseases in men and women who need to be blocked or treated at the very beginning of their appearance.

It is important to understand that disruptions in the functioning of the rectum can lead to changes in the functioning of other body systems.

If specific diseases in this area are not treated, then serious inflammation of the entire intestinal system can be provoked, which will develop into sepsis.

Diseases that cause rectal dysfunction

As mentioned above, there are a number of specific diseases that can produce dysfunction in the rectal area and disrupt its normal functioning.

Most of these diseases have chronic course and does not always respond successfully to medical or surgical treatment.

If you have any disease that interferes with the functioning of the area in question, then do not give up on your well-being, but contact your doctors and get them to prescribe adequate treatment for the problem.

Even if it cannot completely solve the main problem causing rectal dysfunction, it will significantly soften the symptoms and allow you to return to your normal pace of life.

The most common disease that occurs in the rectal area is hemorrhoids.

This pathology is characterized by inflammatory processes localized in the hemorrhoidal veins, which create nodes in the rectum and anus.

In advanced cases, the intestine, compressed by these veins, may partially exit the anus.

Another pathology that is characteristic of this area, but is diagnosed much less frequently than hemorrhoids, is the appearance of neoplasms of various etiologies.

These growths may be polyps, which can be removed through endoscopic surgery, or rectal cancer.

The last pathology - rectal cancer - requires mandatory and long-term treatment, during which a person is prescribed courses of chemotherapy and surgery aimed at removing the cancerous tumor.

Rectal cancer, which is in the first stage of its development, is considered a curable disease.

Cancer in the later stages of its existence can be cured in far from one hundred percent of cases.

How do you know when it's time to see a doctor? There are a number of specific and nonspecific symptoms that may indicate various pathological processes occurring in the rectal area. The presence of at least two or three of them is a reason for an immediate visit to the clinic.

Symptoms inherent in rectal pathologies:

• severe discomfort in the declared area, which has a recurrent course;
• pain that accompanies the act of defecation or occurs on its own, without reference to any specific processes;
• burning and itching in the sphincter area;
• anal bleeding;
• stool containing mucus or containing blood;
• prolonged constipation;
• signs of general intoxication of the body, provoked by prolonged stagnation of decomposing and rotting food lumps within the body;
• psycho-emotional instability caused by constant discomfort and persistent pain that bothers the person suffering from the problem.

After reading this article, you were able to learn about the structure of the human rectum, as well as what functions it performs in the body.

If you feel any of the symptoms mentioned in this paragraph of the article, then do not try to self-medicate and under no circumstances use various folk remedies without consulting a doctor.

Most of the decoctions and poultices that supposedly help with the pathologies of the stated area demonstrate their inconsistency.

Treatment of problems arising in this area must be professional and adequate.

The rectum is located in the human pelvic area. It is attached to its back wall. On average, its length ranges from fourteen to eighteen centimeters. Let's take a closer look at the sections of the rectum, its features, structure and much more.

If we consider the rectum from an anatomical point of view, it includes the following sections:

1. The anus is the final region of the anatomical structure of the rectum. At the same time, it serves as an external conductor for the exit of feces. The act of defecation occurs through it.

The anus can be quite deep. It can also be flat and slightly convex (more typical for females).

Thickening of the anus in women can be explained by the fact that this occurs after childbirth (loss of contractile function of the intestine).

The skin that surrounds the anus is highly pigmented and wrinkled. The latter is justified by the function of the anal muscle, which wrinkles the skin in this area.

The total diameter of the anus can be from three to six cm. When the outer layer of the canal walls ends, the mucous membrane of the intestine itself lies next.

1. The anal canal lies after the anus. Its length on average is 30-40 mm. This part of the intestine is connected to nearby organs.
2. The internal sphincter is one of the layers of the wall of the intestinal canal, which externally appears as a slight thickening of the muscle layer in the rectum. It seems to continue its cavity.
   The sphincter ends with a round edge measuring 5-6mm. Its thickness can be from 0.5 to 0.9 cm.
3. The external sphincter is located outside, enclosing the internal sphincter. It consists of striated muscle mass and is located slightly below the internal sphincter.

The general position of the first and second sphincters is a bit like the tubes of a telescope.

1. The tailbone is located behind the rectum. In men, the vas deferens and bladder.

Women have a different physiology: they have a vagina and uterus in this place.

1. Protective layers. Like any part of the digestive tract, the rectum is protected by several mucous layers or the so-called membrane. Thanks to this, food can move more easily without damaging the intestinal walls.

In the anus of the rectum there are special layers consisting of connective fibers and fats. They also play a protective role.

In addition, this part of the gastrointestinal tract also has a middle layer. It is reliably protected by muscle tissue.

1. Folds of the rectum. In the case when the intestine is empty (there is no processed food in it), it forms folds. They can be very different in their location and also have a different number of small folds.

Since the rectum is the final part of the digestive tract, it is where feces accumulate and are subsequently removed from the body.

Main parts of the intestine

The following sections of the rectum are distinguished:

1. Inferior ampullary section of the rectum.
2. Ampullary section of the rectum.
3. Upper ampullary section of the rectum.
4. Rectosigmoid section.
5. Medium ampullary section.
6. Perineal department.

Despite its name, the rectum has curves. They can lie in different planes and correspond to the shape of the sacrum.

Signs of the development of pathologies in different parts of the rectum

Most often, rectal diseases manifest themselves with the following symptoms:

1. Pain that is localized in the anus. Its character can be bursting, sharp, pulsating or aching. Sometimes spasmodic and constant pain is observed.

Important! Some diseases, such as colorectal cancer, can be quite long time do not cause pain, so you should pay attention to other symptoms of such dangerous diseases.

1. The appearance of mucous discharge after defecation is characteristic of rectal fistulas. At the same time, if treatment is not carried out, then over time, along with mucus, pus will come out of the intestine, which threatens an even greater deterioration of the person’s condition.
2. Bleeding or stool mixed with blood is one of the most characteristic symptoms of rectal diseases. Usually it indicates a fissure or hemorrhoids.

You should be aware that at first a person will only experience a slight discharge of scarlet blood, but if left untreated, the bleeding may become more profuse, leading to anemia.

1. Appearance blood clots in stool may indicate bleeding in different departments Gastrointestinal tract. In this case, it is better to carry out diagnosis not only in the rectum, but also in other parts of the gastrointestinal tract.
2. Weakness and loss of appetite.
3. High temperature can be observed during acute or chronic inflammatory process in the rectum.
4. Anemia develops with chronic blood loss. In this case, the person experiences pallor, fever, dizziness and headache.
5. Constipation is also frequent companion diseases of the rectum. In this case, the absence of a bowel movement can last from several days to several weeks, which is even more dangerous.

In addition, constipation can be classified as a separate disease or as one of the symptoms of any proctological disease.

1. Colon obstruction occurs when there is a violation motor function this part of the gastrointestinal tract. In this case, the person will suffer from stool retention, difficulty passing gases and cramping pain.
2. Nausea and vomiting.
3. Bloating is often associated with flatulence or enzyme deficiency. In addition, sometimes it can be caused by dysbiosis. These conditions require immediate medical treatment, as they quickly lead to dehydration.
4. Fast weight loss.
5. Sleep disturbance and irritability can occur with frequent pain.
6. The appearance of loose stools is characteristic of various infectious bowel diseases, irritable bowel syndrome and bacterial lesions of the intestine.
7. The appearance of tenesmus. With this condition, a person experiences frequent false desires to “go to the toilet” without further excretion of feces. In this case, tenesmus itself occurs due to irritation of the colon and the presence of inflammation in the gastrointestinal tract.
8. Incontinence of feces and gases can occur when the rectum is damaged or its reflex function is impaired. This can happen for both psychological and physiological reasons.

Diseases of the rectum

The most common diseases of the rectum are:

1. Proctalgia
2. Haemorrhoids

Proctalgia is a disease in which a person suffers from constant (chronic pain) in the anus. In this case, apart from the pain symptom, no disturbances are observed in the body. The reasons for this condition are also not always known. Typically, proctalgia is caused by gastrointestinal diseases.

In most cases, proctalgia is diagnosed in middle-aged men who lead a sedentary lifestyle. At the same time, they are bothered by pain in the form of spasms that last from three to twenty minutes.

Important! If any symptoms or pain in the rectum appear, you should consult a proctologist. It is this specialist who diagnoses and treats diseases of the rectum.

Treatment of proctalgia should be medicinal. It is also important that the patient stops being nervous and normalizes his psycho-emotional state. To do this, he may be prescribed sedatives.

Hemorrhoids are a disease in which veins expand and form nodes in the intestine. Subsequently, such nodes begin to bleed and fall out of the anus.

Hemorrhoids are very dangerous because they can cause excessive bleeding or infection. It requires immediate medical and surgical treatment.

Most often, hemorrhoids develop with frequent consumption of alcoholic beverages, pregnancy, eating spicy foods or lifting weights. Also, its appearance can be caused by insufficient intake of fiber and dietary fiber.

Unfortunately, people usually go to the doctor quite late for hemorrhoids, when the disease has already become chronic. At the same time, the disease itself can occur in waves (either subside or worsen again).
The main symptom of hemorrhoids is bleeding with scarlet blood. Sometimes there is itching and discomfort.

A serious complication of hemorrhoids (if left untreated) is prolapse of the nodes. Over time, it will be difficult to set them back again, which will lead to even more bleeding.

Today, there are quite effective methods for combating hemorrhoids, in which the patient does not even have to go to the hospital.

One of these methods is to put compressive rubber pads on the hemorrhoidal nodes, due to which the blood circulation in the node is blocked and it literally dries out.

This leads to its death, so it disappears on its own after a few days. Using this technique you can do without surgery.

Laser therapy is also practiced, in which the nodes are cauterized.
Anti-inflammatory ointments can be used as an auxiliary treatment.
In addition, diet plays an important role in the proper treatment of hemorrhoids and other proctological diseases. Thus, during therapy you should avoid consuming the following products:

• spicy dishes;
• sauces;
• fat;
• sausages;
• mushrooms;
• alcohol;
• fast food;
• salo;
• flour;
• vermicelli;
• smoked meats;
• salt;
• sweets.

The basis of the menu should be steamed or boiled dishes. It is best to eat more fruits and vegetables during this period, as well as use vegetable oils.

1. An anal fissure can occur due to constipation or a sedentary lifestyle. Symptoms of this condition include severe pain and bloody discharge during defecation.

If there is a crack in the rectum, you should immediately consult a doctor before the disease becomes chronic. In its initial form, this condition can be treated quite successfully and quickly with suppositories and ointments.

1. Proctitis is a disease in which the mucous membrane of the rectum becomes severely inflamed. A person in this state will complain of diarrhea, painful sensations in the anus and the appearance of blood after defecation.

Most often, proctitis is caused by pathogenic microorganisms (germs and bacteria). For this reason, proctitis is best eliminated by long-term use of antibacterial drugs (antibiotics wide range actions).

1. Paraproctitis is a disease that is characterized by inflammation of the subcutaneous layer of tissue located next to the rectum. It develops due to the entry of pathogenic microorganisms from the intestine into this area.

The acute form of paraproctitis develops quite quickly: a person experiences pain, weakness, loss of appetite, nausea and fatigue. Digestion may also be affected.

1. Constipation is a violation of the timely function of bowel movements. It can be either acute or chronic.

Moreover, constipation includes not only general stool retention, but also daily bowel movements, but in a very small volume.

Constipation is very discomfort and pain in humans. It also disrupts the process of moving feces through the intestines.

The causes of constipation are:

• unhealthy diet (unbalanced menu, eating on the run, overeating, etc.);
• psychological reasons (stress often causes disruption of the normal act of bowel movement and constipation);
• insufficient physical activity often contributes to constipation in older people;
• various intestinal diseases;
• work in hazardous conditions;
• taking certain strong medications (antidepressants, diuretics);
• various endocrine diseases (diabetes mellitus);
• hormonal imbalances.

1. Rectal cancer or polyps. Unfortunately, apart from general malaise, these diseases rarely manifest themselves. They are diagnosed in an already quite advanced state.

Despite this, sometimes when such diseases develop, a person will suffer from spotting after bowel movements, constipation and sudden weight loss.

If detected early, the patient has every chance of recovery. Treatment is selected according to individually for each patient, depending on the complexity and severity of the disease.

1. Rectal prolapse involves the literal protrusion of the intestine beyond the anus. Untreated hemorrhoids, as well as prolonged inflammation of the rectum, lead to this pathology.

There are three distinct types of bowel prolapse complications:

• slight prolapse of only the mucous membrane during defecation, after which the intestine can straighten on its own;
• average prolapse of the end part not only during the act of defecation, but also during strong sports activities (in this case, the person must reset the intestine into place);
• profuse intestinal prolapse even with little physical activity, as well as when standing in an upright position.

In the latter case, the person requires immediate surgical treatment.

Moreover, with frequent intestinal prolapses, it constantly hurts and bleeds. This can lead to infection and further complicate the treatment process.

1. Anal itching can be either a separate pathology or a symptom of a developing disease.
   Call anal itching There may be the following reasons:

• various diseases of the rectum (inflammation in the anus, hemorrhoids, etc.);
• various gynecological pathologies in women (candidiasis, vulvovaginitis, etc.);
• diseases that are transmitted through unprotected sexual intercourse (chlamydia, trichomoniasis, urethritis, prostatitis, etc.);
• skin diseases (psoriasis, dermatitis, eczema);
• skin irritation resulting from the use of low-quality soap, paper, powders and other cosmetics);
• wearing synthetic underwear, which also irritates the skin;
• diabetes;
• various chronic liver diseases;
• fungal diseases;
• itching, as a result of taking certain medications that cause such side effects;
• allergic reaction to certain foods and seasonings.

Separately, it is necessary to say about such a cause of anal itching as psychogenic factors. They can be stress, neurosis or prolonged depression. In this state, all body systems, including the immune system, will be weakened, so the person will become more vulnerable to external negative influences.

Moreover, due to anxiety, people often experience constipation and worsen stomach ulcers. Sometimes acute diseases can become chronic.

For this reason, it is very important to eliminate not only visible signs diseases of the rectum, but also to get rid of the root cause of the disease - stress or an unstable psycho-emotional state. Taking sedatives will help with this.

Treat anal itching with antipruritic ointments and anti-inflammatory gels. It is worth remembering that even such a condition requires a trip to the doctor. You should not self-prescribe medications, as self-medication can be harmful to health.

Prevention of diseases of the rectum and the guarantee of its “health”

To prevent the development of diseases in the rectum, you should follow the following advice from doctors:

1. Give up bad habits (smoking, drinking alcohol).
2. Avoid excessive exercise and heavy lifting.
3. Avoid eating spicy and fatty foods.
4. Eat a balanced diet. In this case, the basis of the diet should be vegetables, cereals, fruits and protein products.
5. When working sedentarily, take frequent breaks and simply stretch your body.
6. Avoid stress, anxiety and nervous tension, as they most often provoke constipation.
7. Don't overeat.
8. Treat even minor pathologies of the rectum and gastrointestinal tract in a timely manner.
9. When the first unpleasant symptoms appear, you should consult a doctor as soon as possible and have necessary diagnostics. Moreover, the sooner treatment is started, the sooner the person will recover.

Circulatory system in the rectum

The rectum is fed by artelial blood, which flows in the upper intestinal artery and descends through the lower rectal veins.

Venous blood flows through the rectum to the rectal vein and portal vein system.

This part of the gastrointestinal tract also has lymphatic vessels. They pass to the internal and superior rectal lymph nodes.

Nerves of the rectum

There are many nerve endings in the rectum. Together they form a kind of network in which the fibers of the nervous system are located.

All processes that are localized in the nerve endings of the rectum are transmitted to the cerebral cortex. This is a natural function.

Role of the rectum

When functioning normally, the rectum ensures the complete process and functioning of the digestive tract. It performs an elimination role in removing processed food and toxins from the body.

If unnecessary toxins, substances and waste begin to accumulate in the rectum, then they must be removed from there, otherwise the intestine will stop working normally and will poison the body. Gastroenterologist, therapist

Work experience more than 7 years.

Professional skills: diagnosis and treatment of diseases of the gastrointestinal tract and biliary system.

Rectal disease in women and men is one of the most common and very sensitive topics relevant today. Perhaps this is because many are embarrassed to seek help from a specialist.

The most terrible disease that can affect the rectum is cancer. Like other types of tumors, it is characterized by an asymptomatic course. Therefore, it is extremely important to pay attention to any changes in the rectum.

diseases, symptoms, treatment

The rectum is a pelvic organ that is part of the digestive system and is designed to remove processed food (feces) from the body.

The rectum begins at the level of the third sacral spine and ends at the anus. Its average length is 15-17 cm.

The organ consists of a mucous, submucosal and muscular layer. Thanks to this structure, the mucous membrane can shift - gather into folds or straighten out, depending on the overcrowding of the rectum.

The main function of the organ is bowel movement. Due to its purpose, the rectum is highly susceptible to various injuries and diseases.

Common diseases include fissures, polyps, proctitis, hemorrhoids, ulcers, and cancer. The same symptoms of rectal disease may indicate different ailments. In case of any ailments, you should immediately consult a doctor. A proctologist deals with problems of the rectum.

Polyps in the rectum: symptoms

Polyps are benign formations on the epithelium of the rectum. There are fibrous and adenomatous, villous and multiple polyps of mixed type.

• Fibrous polyps are formed from connective tissue.
• Adenomatous - from gland tissue (this type of polyp is the most dangerous, as it can degenerate into cancer).
• Villous polyps are epithelial growths that have many papillae-villi.
• Mixed type of polyps - combinations of previous types.

The main causes of the disease are untreated inflammation in the rectum (colitis, hemorrhoids, enteritis).

When polyps appear in the rectum, symptoms may be as follows:

• Blood during bowel movements.
• The stool is painful, sometimes accompanied by bleeding.
• If an infection occurs, fever and chills may increase.
• Constipation (if polyps are large).
• Feeling of a foreign body in

It should be borne in mind that very often it is difficult for the patient to detect the formation of polyps or simply inflammation of the rectum - symptoms as such may be absent.

Polyps are treated surgically. Other methods are simply ineffective and only provide temporary relief.

Single polyps are removed using electrocoagulation (cauterization). Transanal excision is used to treat large polyps. Treatment of polyps that have begun malignant degeneration is carried out by removing the affected area of ​​the rectum.

Paraproctitis: symptoms and treatment

Symptoms of rectal diseases can be very different, or may be completely absent. For example, the main sign indicating paraproctitis (purulent inflammation of the rectum) is discharge of pus in the anus.

The cause of the disease is the formation of micro-holes (fistulas) in the anal crypts, due to frequent constipation, diarrhea, heavy lifting, and hypothermia. Such suppuration either opens up independently or with the help of doctors. In its place, a fistula (chronic paraproctitis) appears.

Signs of the disease are malaise, weakness, headache, slight increase in temperature, chills, aching joints. Decreased appetite. Urination and bowel movements may be impaired.

There are several forms of paraproctitis:

• Subcutaneous. Symptoms are redness, swelling, compaction in the anus, which is accompanied by pain and discomfort.
• Pelvic-rectal. Symptoms - general weakness and intoxication, similar to a respiratory infection. There may also be painful urination and painful bowel movements.
• Ischiorectal. Symptoms are the formation of purulent inflammation in the ileorectal fossa, asymmetry of the buttocks, redness of the skin.
• Submucosal. This is the appearance of purulent foci on the mucous membrane. The symptoms resemble those of subcutaneous paraproctitis.
• Pelviorectal. The most severe form. Symptoms are chills, fever, pain in the pelvis and abdomen.
• Necrotic. Accompanied by tissue death - necrosis.

The most favorable treatment method is surgical. During the operation, not only the abscess is removed, but also the internal micro-hole. After such an operation, there is no relapse of the disease.

Hemorrhoids: causes and symptoms

Hemorrhoids are venous dilatation in the rectum, which is chronic in nature with periodic exacerbations.

The symptoms of such diseases of the rectum are quite unpleasant - itching, burning, pain during stool, bleeding, prolapse of part of the intestine.

The main cause of the disease is a sedentary lifestyle, frequent constipation, pregnancy, heavy lifting, and severe hypothermia.

If the disease is ignored and not treated, this can lead to the formation of polyps, blood clots, and cancer. Therefore, you should not postpone your visit to a specialist. Are effective traditional methods treatments - suppositories, ointments containing raw potatoes, beets, carrots, garlic, propolis and honey. Decoctions of herbs (millennium, rowan) and infusions of horse chestnut have proven themselves well.

You should not ignore the symptoms when the rectum becomes inflamed. Diseases, photos of which you won’t see in a regular hospital, are not only “inconvenient”, but sometimes life-threatening.

Thrombosis of hemorrhoids

This is a complication of hemorrhoids that occurs as a result of neglect of the disease. Timely diagnosis helps prevent its further development and relapses.

However, when the disease is ignored, blood clots appear, which have different degrees gravity:

I - the formation of clots that disrupt blood circulation in the nodes. The main symptom is the appearance of large sizes.

II - inflammatory processes begin. The pain becomes stronger, the temperature rises, and the swelling of the skin of the anus increases.

III - spread of inflammation to groin area with possible tissue necrosis.

The main symptoms of rectal disease to which you need to respond:

• Pain in the anus, perineum.
• Bloody stool.
• Defecation disorders (diarrhea, constipation).
• False urge to go to the toilet.
• and feces.

Of course, rectal diseases are a delicate problem, but they need to be solved. You can't leave everything to chance. Otherwise, health complications cannot be avoided, in particular the formation of malignant tumors.

guts

Rectal prolapse is the turning out of all layers of the distal colon. It occurs equally often in children, men and women. In the first case, this is explained by the anatomical features of the child’s body, in the second - by hard work, in the third - by bearing and giving birth to a child. Many diseases of the rectum in women are associated specifically with childbirth.

Sometimes the causes of the disease can be injuries to the buttocks, falls, bruises of the sacrum or spinal cord.

There are three degrees of the disease:

1. The intestine falls out during defecation, and then returns to its place on its own.
2. The intestine falls out during bowel movements and physical exertion. It can only be returned back by repositioning it.
3. Prolapse occurs during coughing, laughter and may be accompanied by fecal and urinary incontinence.

Symptoms of rectal disease in such cases may begin suddenly or appear “increasingly.” This may result in mucus or blood discharge, abdominal pain, and constipation.

Treatment of prolax (intestinal prolapse) is most effective if performed surgically. Drug therapy is used as an additional method.

Rectal cancer: risk group

In most cases, the disease does not arise out of the blue. It is always preceded by inflammatory processes in the organ, which for a long time were ignored and not treated. These are all kinds of fistulas, fissures, polyps, hemorrhoids.

The tumor is most often found in those over fifty. The risk group includes people:

1. With a hereditary predisposition.
2. Suffering from dysbacteriosis.
3. Leading a sedentary lifestyle.
4. WITH diabetes mellitus or those who suffer from obesity.
5. Abuse of carcinogenic substances (nicotine, alcohol).
6. Who has precancerous conditions.

There is probably nothing more terrible and unpleasant than the condition when the rectum becomes inflamed. The symptoms of the disease may be the same, but the treatment will be different.

It should be remembered that rectal cancer remains asymptomatic for a long time and is detected only at the stage of metastasis. Therefore, people at risk need to pay attention to this organ Special attention.

Diagnosis of rectal diseases

To diagnose diseases in proctology, a large arsenal of a variety of methods is used:

1. The most accurate and reliable is rectoscopy. It involves the insertion of a special rectoscope device (tube with lighting) into the rectum to a depth of about thirty centimeters. This helps to identify various inflammatory processes in the patient (ulcers, polyps, tumors). The procedure will cause a little discomfort, but is practically painless. The use of a rectoscope also allows for the treatment of diseases of the rectum (electrocoagulation).
2. Colonoscopy is an examination of the rectum using a probe. Used for tumor formations. Contraindications: acute pain, infectious diseases, heart and pulmonary failure.
3. Biopsy is the removal of tissue or cells from the rectum for further diagnosis under a microscope.
4. (introduction of a special sensor).
5. Blood, urine, stool tests.

Thanks to a variety of methods for examining the rectum, it is possible to most accurately diagnose any inflammation and diseases of this organ and select the most correct treatment regimen.

Treatment methods for proctological diseases

Depending on the complexity of the disease, the following methods are used for treatment:

1. Medicines. Effective only in the initial stages of disease. With the help of medications you can relieve pain and inflammation (suppositories, ointments).
2. Surgery. The main method that is successful in almost 100% of cases. Used at any stage in combination with medications.
3. Cryosurgery. Treatment of neoplasms with low temperatures. The method is powerful in various areas of medicine.
4. Laser therapy. Impact of electromagnetic radiation on disease.
5. Hypothermia. Therapy using temperature. A device with a temperature limitation is used - from -5 to +35 degrees. Hypothermia is often used after surgery, for proctitis, and fissures.

Treatment with diet

For different ailments of the rectum, different diets are prescribed. For example, if you have constipation and fissures, it is recommended to adhere to diet No. 3. Namely, include thermal and mechanical irritants in the diet to stimulate the rectum. This is vegetable coarse fiber - meat, bread, eggs (hard-boiled, omelettes), fish and dairy products, cereals and pasta, fats, vegetables.

The diet for diseases of the rectum is adjusted depending on the stage and complexity of the disease. In any case, you need to exclude alcohol and carbonated drinks, spices, spicy foods, and other foods that cause flatulence. Meals should be as balanced and fractional as possible. Don't forget about vitamins (fruits, vegetables, raw and in the form of juices).

After surgery in the anus, you need to fast for one or two days to avoid bowel movements and, accordingly, irritation of the anus.

Traditional methods of treatment

Traditional medicine for rectal ailments can be quite effective if you know how to use it correctly. It is used as an additional treatment method. People know thousands of recipes for relieving not only pain, but also other symptoms.

All recipes can be divided into two types:

1. For oral administration. Decoctions of millennial, spotted arum, elderberry, bittersweet, tartar, nettle, chamomile.
2. For local application- suppositories, ointments, baths, microenemas. They use celandine for this, sea ​​buckthorn oil, camphor oil, calendula.

In any case, before using traditional medicine, you need to consult a proctologist, otherwise the treatment may not alleviate the course of the disease, but, on the contrary, do harm.

Conclusion

Diseases of the rectum are a delicate problem, but one that needs urgent resolution. Prolonged ignoring of symptoms leads to chronic inflammation that are difficult to treat. The worst consequence of chronic rectal ailments is cancer, which can only manifest itself in the third or fourth stage, when there is no way out...

The rectum is the “straight” organ in lower mammals – hence its Latin name. However, in humans, it curves adjacent to the sacral cavity, starting at the promontory of the sacrum and ending below the coccyx. The relationship of the rectum with the anal canal is of paramount importance, since the work of the sphincter apparatus, which controls the evacuation of feces, is ensured by nerves located in the danger zone, which can be damaged during surgical interventions in the depths of the pelvis. The rectum is located deep in the pelvis and is in close contact with many vital important bodies and therefore operations on it are extremely difficult. Particularly great difficulties arise when it is necessary to restore intestinal continuity, since the operation takes place in a limited space.

The rectum extends from the sigmoid colon to the anus and has a length of 12–16 cm. There are two main sections of the rectum: pelvic and perineal. The first lies above the pelvic diaphragm, the second below. In the pelvic region there is an ampulla and a small area above it - the supramullary part. The perineal section of the rectum is also called the anal canal.

The supramullary part of the intestine is covered by peritoneum on all sides. Next, the intestine begins to lose its peritoneal cover, first from the back, being covered with peritoneum only in front and on the sides, and even lower, at the level of the 4th sacral vertebra (and partly the 5th), the peritoneum covers only the anterior surface of the intestine and passes into the back surface Bladder. The lower part of the rectal ampulla lies under the peritoneum.

The mucous membrane of the rectum has longitudinal folds, which are often called Morganian columns. Between them are the anal (Morgani) sinuses, bounded below by the semilunar anal valves. Transverse folds of the mucosa, which do not disappear when the rectum is filled, are located in its different parts. One of them corresponds to position n. sphincter tertius and is located on the border between the ampullary and supramullary parts of the intestine. The intestinal mucosa forms folds: closer to the anus - longitudinal, and higher - transverse. In the ampullary part there is one fold on the right wall, two on the left. At the border of the ampullary and anal parts of the rectum, corresponding to the position of the internal sphincter, there is a well-defined fold, especially on the posterior wall of the intestine - valvula Houstoni. When the intestine fills, these folds can straighten and increase its volume.

At a distance of 3–4 cm from the anus, the circular muscle fibers, thickening, form the internal sphincter, and at a distance of approximately 10 cm from the anus there is another thickening of the circular muscle fibers, known as Hepner’s muscle (m.sphincter tertius). The external sphincter of the rectum is located in the circumference of the anus and consists of striated muscle fibers (Fig. 193).

The blood supply to the rectum is carried out by 5 arteries: one unpaired – a. rectales superior ( final branch inferior mesenteric artery) and two paired ones – a. rectales media (branch of a. iliaca interna) and a. rectalis inferior (branch of a. pudenda interna) (Fig. 194).

The veins of the rectum (Fig. 195) belong to the systems of the inferior vena cava and portal veins and form a plexus, which is located in different layers of the intestinal wall. There are external and internal hemorrhoidal plexuses. The external plexus is located under the skin of the anus, in the circumference and on the surface of the external sphincter of the rectum. The submucosal plexus, the most developed, is located in the submucosa; it can be divided into three sections: upper, middle, lower. In the final section of the rectum, the veins of the submucosal plexus have a special cavernous structure. The subfascial plexus lies between the longitudinal muscle layer and the rectal fascia. In the area of ​​the rectum between the longitudinal folds and the anus - zona hemmoroidalis (venous ring) - the submucosal plexus consists of tangles of veins penetrating between the circular bundles. Outflow venous blood from the rectum it is carried out through the rectal veins, of which the upper one is the beginning of the inferior mesenteric vein and belongs to the portal vein system, and the middle and lower ones belong to the inferior vena cava system: the middle ones flow into the internal iliac veins, and the lower ones into the internal pudendal veins (Fig. 195) .

Rice. 193. Anatomy of the rectum. 1 – middle transverse fold (valvula Houstoni); 2 – upper transverse fold (valvula Houstoni); 3 – muscle that lifts the anus (m. levator ani); 4 – lower transverse fold (valvula Houstoni); 5 – anal (anal) columns (Morgani); 6 – jagged line; 7 – internal hemorrhoidal plexus; 8 – anal gland; 9 – internal anal sphincter; 10 – external hemorrhoidal plexus; 11 – anal crypts; 12 – external anal sphincter

Rice. 194. Blood supply to the rectum. 1 – inferior mesenteric artery; 2 – sigmoid arteries; 3 – mesentery of the sigmoid colon; 4 – superior rectal artery; 5 – superior rectal artery (branching); 6 – internal pudendal artery; 7 – inferior rectal artery; 8 – internal iliac artery; 9 – obturator artery; 10 – median sacral artery; 11 – superior cystic artery; 12 – inferior cystic artery; 13 – middle rectal artery; 14 – superior rectal artery

Rice. 195. Veins of the rectum. 1 – inferior vena cava; 2 – common iliac veins; 3 – median sacral vein; 4 – inferior mesenteric vein; 5 – sigmoid veins; 6 – superior rectal vein; 7 – external iliac vein; 8 – internal iliac vein; 9 – obturator vein; 10 – cystic (upper) and uterine veins; 11 – middle rectal vein; 12 – internal pudendal vein; 13 – portocaval anastomoses; 14 – inferior cystic veins; 15 – internal pudendal vein; 16 – inferior rectal vein; 17 – venous plexus of the rectum; 18 – external hemorrhoidal plexus; 19 – internal hemorrhoidal plexus

The innervation of the rectum is carried out by sympathetic, parasympathetic and sensory fibers. Lymphatic vessels accompany arterial vessels. Lymphatic drainage is carried out from the upper and middle sections of the rectum to the lower mesenteric nodes, and from the lower section to the lower mesenteric and/or iliac and periaortic nodes. Below the dentate line, lymphatic drainage occurs into the iliac nodes.

For successful surgical interventions in the pelvis, knowledge of the detailed anatomy of the mesorectum and its contents in adults plays a critical role.

Mesorectum (a set of tissues located between the wall of the rectum and its visceral fascia) is not described as an identifiable structure in most works on human anatomy, although it is mentioned by many embryologists.

The mesorectum is derived from the dorsal mesentery, a general visceral mesentery surrounding the rectum, and is covered by a layer of visceral fascia, providing a relatively bloodless layer, the so-called “holy plane” mentioned by Heald. The goal of surgery is to gain access while remaining within this fascial layer. Posteriorly, this layer passes between the visceral fascia surrounding the mesorectum and the parietal presacral fascia (Fig. 196). The last layer is usually referred to as Waldeyer's fascia. Inferiorly, at the S4 level, these fascial layers (mesorectal and Waldeyer) unite into the rectosacral ligament, which must be divided when mobilizing the rectum.

A more accurate understanding of the rectum, mesorectum, innervation and vascularization of them and surrounding structures has appeared recently. New developments in imaging techniques such as endorectal ultrasound (ERUS) and magnetic resonance imaging (MRI) will undoubtedly shed light on the “normal” anatomy of these structures.

Rice. 196. Mesorectum. 1 – mesorectum; 2 – lymph nodes; 3 – visceral fascia; 4 – lumen of the rectum. T – tumor growing into the mesorectum

What is Hemorrhoids

Hemorrhoids are a pathological enlargement of the cavernous vascular plexuses with the formation of hemorrhoids, their prolapse from the anal canal with periodic bleeding and frequent inflammation. According to various authors, this disease affects up to 10–15% of the adult population. The share of hemorrhoids in the structure of coloproctological diseases is 35–40%. From 10 to 60% of patients with this disease seek medical help. Many patients self-medicate for a long time and seek help only when various complications develop that they cannot cope with on their own.

Translated from Greek, the word “hemorrhoids” means bleeding, and it is the main symptom of this disease. Hemorrhoids are one of the most ancient human diseases. Even 2 thousand years BC, in Egypt, hemorrhoids were known and isolated as a separate disease. Doctors of that time even tried to operate on patients with hemorrhoids, removing hemorrhoids that prolapsed from the anus. The symptoms of this disease are mentioned in the works of Hippocrates, who wrote that hemorrhoids are associated with frequent constipation, with the fact that people who drink a lot of strong drinks and spicy foods are more susceptible to this disease.

Only in the 18th century were cavernous formations discovered in the distal part of the rectum. The mechanisms of the pathogenesis of hemorrhoids were studied much later, a hundred years later, a great contribution to this was made by famous Russian surgeons N.V. Sklifosovsky, A.V. Starkov, P.A. Butkovsky and A.N. Ryzhikh.

In the 30s of the 20th century, Milligan and Morgan proposed an operation - hemorrhoidectomy - to treat hemorrhoids. Various modifications of it are still used today.

Etiology and pathogenesis

Hemorrhoids are nothing more than an increase in the size of the cavernous submucosal plexus of the rectum. These plexuses are arteriovenous anastomoses and are located in typical places - at 3, 7 and 11 o'clock (with the patient in the supine position), respectively, the three terminal branches of the division of the superior rectal artery (Fig. 197).

Rice. 197. Localization of hemorrhoids. 1 – on the posterolateral wall (at 7 o’clock on the dial); 2 – on the anterolateral (at 11 o’clock); 3 – on the side wall (at 3 o’clock); 4 – superior rectal artery

Cavernous plexuses are not a pathology, but normal cavernous vascular formations that form during normal embryogenesis and are present in people of any age, including embryos and children. In children, the cavernous formations of the rectum are poorly developed, their sizes are small, and the cavernous cavities (sinuses) are unclear. With age, the size of the sinuses and individual cavernous plexuses increases and this is the anatomical substrate of the future main internal hemorrhoids. The hemorrhoidal plexuses are an important anatomical formation that plays a decisive role in the so-called “thin” anal holding of stool. Due to their elastic consistency, there is a delay in the venous outflow of blood when the m is tense. sphincter ani internus. All this makes it possible to retain solid components of feces, air and liquid in the rectal ampulla. Relaxation of the sphincter during defecation leads to the outflow of blood from the hemorrhoidal plexuses and emptying of the rectal ampulla. It should be noted that such a physiological mechanism occurs during the formation of normal feces. Too hard stool inhibits the urge to defecate, while the hemorrhoidal plexuses become overfilled with blood for much longer. Subsequently, their pathological expansion and further transformation into hemorrhoids occurs. On the other hand, loose stools stimulate too frequent emptying of the rectum, which usually occurs against the background of an incompletely relaxed sphincter and still overcrowded hemorrhoidal plexuses. Their constant traumatization occurs, which ultimately leads to secondary changes, i.e., to the formation of hemorrhoids. An important role in the development of hemorrhoids is the disturbed relationship between the inflow and outflow of blood from the cavernous bodies. Factors such as pregnancy and childbirth, obesity, excessive alcohol and coffee consumption, chronic diarrhea, sedentary, sedentary lifestyle, straining during bowel movements, smoking, heavy lifting, prolonged cough lead to increased intra-abdominal pressure and stagnation of blood in the pelvis. Hemorrhoids increase in size. The development of dystrophic processes in the common longitudinal muscle of the submucosal layer of the rectum and the ligament of Parks, which hold the cavernous bodies in the anal canal, leads to a gradual but irreversible displacement hemorrhoids in the distal direction and their subsequent loss from the anal canal.

Classification

By etiology:

1) congenital (or hereditary);

2) acquired: primary or secondary (symptomatic). By localization (Fig. 198):

1) external hemorrhoids (subcutaneous);

2) internal hemorrhoids (submucosal);

3) combined.

According to the clinical course:

1) spicy;

2) chronic.

Highlight 4 stages of chronic hemorrhoids:

Stage I manifested by bleeding, hemorrhoids do not fall out.

Stage II– hemorrhoids fall out when straining and are reduced on their own.

Stage III– hemorrhoids fall out and can only be adjusted manually. Moreover, at first the nodes fall out only during defecation, and then with an increase in intra-abdominal pressure.

IV stage– hemorrhoids fall out even at rest, are not reduced or fall out again immediately after reduction.

In addition, there are three degree of severity acute hemorrhoids:

I degree– external hemorrhoids are small in size, have a tight-elastic consistency, are painful on palpation, the perianal skin is slightly hyperemic, patients experience a burning sensation and itching, which intensifies with defecation.

II degree– characterized by pronounced swelling of most of the perianal area and its hyperemia, pain on palpation and digital examination of the rectum, severe pain in the anus, especially when walking and sitting.

Rice. 198. Localization of hemorrhoids. 1 – internal; 2 – external

III degree– the entire circumference of the anus is involved in the inflammatory infiltrate, palpation is sharply painful, in the area of ​​the anus purple or bluish-purple internal hemorrhoids covered with fibrin deposits are visible. If left untreated, node necrosis may occur. Clinical picture and objective examination data

Complaints. The patient develops complaints, as a rule, when complications of hemorrhoids occur - thrombosis of hemorrhoids or bleeding from these nodes. In this case, patients are concerned about the prolapse or protrusion of a dense, painful node from the anus (during thrombosis), the presence of scarlet blood in the stool (during bleeding) - from small drops and streaks to heavy bleeding. These complaints are usually associated with the act of defecation and are accompanied by a feeling of discomfort, bloating or even pain in the anus, anal itching - the latter often precedes episodes of bleeding. These symptoms are especially aggravated after eating a lot of spicy food, which is due to stagnation of blood in the pelvic area.

In external hemorrhoids, the hemorrhoidal plexuses are located distal to the dentate line, in the anal canal, lined with anoderm. It, together with the adjacent skin, is innervated by somatic sensory nerves, which have nociception (the physiological ability to perceive and transmit pain), which is the cause of severe pain in the anus during exacerbation of external hemorrhoids and interventions in this area. In internal hemorrhoids, the nodes are located proximal to the dentate line of the anal canal, under the mucous membrane, which is innervated by autonomic nerves and is relatively insensitive to pain. All this explains the painless course of internal hemorrhoids.

When collecting anamnesis, you can trace a certain sequence of complaints. One of the first symptoms is anal itching. Bleeding usually appears later. The resulting bleeding is often persistent, prolonged and intense, sometimes leading to severe anemia. Subsequently, patients begin to notice protrusion and prolapse of the nodes, often with a tendency to become inflamed or pinched.

It is also necessary to keep in mind the diseases that cause secondary hemorrhoids (portal hypertension, pelvic tumors, etc.).

An objective examination of the patient begins with examination of the anal area. In this case, you can see enlarged, collapsed or compacted and inflamed hemorrhoids at 3, 7 and 11 o’clock (Fig. 199). In some patients, the nodes are not clearly grouped in the indicated places, which indicates the scattered nature of the cavernous bodies of the rectum. The internal nodes may resemble a mulberry and bleed easily on contact. When the patient strains, the nodes may protrude outward. With a digital examination, hemorrhoids can be identified, which during an exacerbation become dense and sharply painful. Therefore, in case of obvious thrombosis of hemorrhoids, digital examination should be carried out with extreme caution or even refrain from it. With long-standing hemorrhoids, even a decrease in the tone of the rectal closure apparatus may develop.

It is mandatory to carry out sigmoidoscopy, allowing to assess the form and stage of the pathological process. In addition, it is necessary to examine the upper parts of the rectum and exclude other diseases, in particular a tumor process.

To do this, you should perform irrigoscopy and/or fibrocolonoscopy. Differential diagnosis

First of all, it is necessary to exclude tumors of the colon, as well as inflammatory diseases or diverticulosis of the colon, in which there is bleeding from the rectum. In this case, special attention should be paid to the presence of such alarming symptoms in the patient as the presence of alternating constipation and diarrhea, bloating, periodic cramping abdominal pain, the appearance of pathological impurities (mucus, blood) in the stool, weight loss, fever, anemia, etc. In addition, rectal bleeding can also be caused by adenomatous polyps, ulcers, and anal fissures.

Itching in the anus can also occur with helminthiasis, contact dermatitis, insufficient hygiene of the anorectal area. Pain during defecation or palpation of hemorrhoids can be a sign not only of thrombosis of external hemorrhoids, but also of anal fissure (maybe concomitant disease in 20% of people suffering from hemorrhoids) or perianal (intersphincteric) abscess.

In addition, as already indicated, portal hypertension can be the cause of varicose veins of the rectum.

Complications

1. Bleeding. Occurs when the mucous membrane over the hemorrhoidal node becomes thinner, while blood flows out from erosions or diffusely. It is fresh and liquid. Blood appears on toilet paper or drips after defecation from the anus. Patients note such bleeding periodically; it is more often observed with constipation. In case of rectal cancer or ulcerative colitis, blood in the stool is observed with any stool (not necessarily dense), with tenesmus and is mixed with stool, and with hemorrhoids, blood covers the stool. Repeated, even small, hemorrhoidal bleeding, as already noted, can lead to anemia.

2. Inflammation. When inflamed, internal hemorrhoids are red, enlarged, painful, bleeding from superficial erosions. Reflex spasms of the anus occur, and digital examination can be painful.

3. Thrombosis of internal hemorrhoids occurs suddenly: one of the nodes becomes significantly enlarged, purple, very painful on palpation and defecation. Acute condition lasts 3–5 days, after which the node undergoes connective tissue changes. Then, during rectal examination, it is felt in the form of a dense nodule.

4. Prolapse of hemorrhoids. If internal hemorrhoids reach large sizes, then they extend beyond the anorectal line and appear in front of the anus either only when straining (descending hemorrhoids), or constantly (prolapsed hemorrhoids).

Treatment of hemorrhoids can be conservative or surgical.

Diet. If you have hemorrhoids, you need to eat regularly, at the same time, eat more plant fiber against the background of increased water consumption (1.5–2 liters per day). You should limit products made from white refined flour and whole milk, while fermented milk products can and should be consumed daily, especially those enriched with bifidobacteria and lactobacilli. Strengthens intestinal motility by drinking mineral waters. Highly and moderately mineralized waters are recommended, as well as waters containing magnesium ions and sulfates, such as “Essentuki”, “Moskovskaya”. It is necessary to exclude alcoholic drinks, as well as hot, spicy, fried, smoked foods, since the consumption of these products leads to an increase in blood flow in the perianal area and blood stagnation in the pelvic area.

The tasks that drug therapy should solve are the following: relief of pain, thrombosis of the hemorrhoid, elimination inflammatory process and prevention of re-exacerbation of hemorrhoids. When choosing local treatment acute hemorrhoids, it is necessary to take into account the prevalence of any of the symptoms. In case of bleeding, the amount of blood loss, its intensity and severity should be assessed posthemorrhagic anemia. It should be noted that the prevention of exacerbation, first of all, consists in normalizing the activity of the digestive tract, treating constipation, which occurs in more than 75% of patients with hemorrhoids. Increased intake of fiber and fluid leads to softening of stool, prevention of constipation and a decrease in the duration and intensity of straining during bowel movements. The optimal dose of insoluble fiber is 25–30 g per day. You can get it by eating fiber-rich foods such as breakfast cereals, wholemeal bread, brown rice and wholemeal pasta, fruits, vegetables and salads (at least three servings of vegetables and fruits daily), and legumes (lentils, beans, peas, etc.). If diet therapy is ineffective, you should resort to laxatives (for example, Fibodel, Regulan, Normacol, Normacol-plus, methyl cellulose).

Indication for conservative treatment is the initial stage of chronic hemorrhoids. It consists of general and local use of painkillers and anti-inflammatory drugs, cleansing enemas, ointment dressings and physiotherapy.

To eliminate pain, the use of non-narcotic analgesics and local combined painkillers in the form of gels, ointments and suppositories is indicated. For local therapy, drugs such as aurobin, ultraproct, proctoglivenol, etc. are used. In addition, new painkillers nefluan and emla, which have a high concentration of lidocaine and neomycin, are effective.

Combination drugs, containing analgesic, thrombolytic and anti-inflammatory components, are indicated for thrombosis of hemorrhoids, complicated by their inflammation. This group of drugs includes proctosedyl and hepatothrombin G, produced in the form of ointment, gel bases and suppositories. The pharmacokinetics of the latter drug is that heparin and allantoin, binding plasma factors coagulation and having an inhibitory effect on hemostasis, cause a thrombolytic effect, and panthenol stimulates metabolic processes, granulation and epithelialization of tissues. Polidocanol, which is part of it, provides an analgesic effect. To relieve inflammation, in addition to local treatment, nonsteroidal anti-inflammatory drugs are used that have a combined effect, including analgesic (ketoprofen, diclofenac, indomethacin, etc.).

basis general treatment is the use of phlebotropic medicines, affecting the increase in the tone of the veins, improvement of microcirculation in the cavernous bodies and normalization of blood flow in them. This group includes drugs such as escin, tribenoside, troxerutin, as well as new generation drugs: Detralex, Cyclo-3 Forte, Ginkor-Forte, Endotelon, etc.

If conservative treatment is ineffective, especially in the later stages of the disease, combined treatment should be carried out, including conservative and minimally invasive methods or conservative and surgical methods.

There are the following main types of minimally invasive interventions for hemorrhoids: injection sclerotherapy, infrared coagulation, latex ring ligation, cryotherapy, diathermic coagulation, bipolar coagulation.

At stage I of hemorrhoids, sclerotherapy has proven itself to be quite effective. A sclerosing drug (ethoxysclerol, thrombovar, fibrovein) is injected circularly subcutaneously just above the dentate line. As a rule, 1 ml of sclerosing agent is sufficient, the procedure is repeated 2-3 times within two weeks. For sclerotherapy according to Blanchard (Fig. 200), a sclerosant solution is injected directly into the area of ​​the vascular pedicle of the hemorrhoid in typical places (3, 7, 11 hours).

Rice. 200. Introduction of sclerosant into the area of ​​the vascular pedicle of the hemorrhoid (according to Blanchard)

The therapeutic effect does not consist in disrupting the blood supply to hemorrhoids, as previously assumed, but in their fixation above the dentate line. The advantage of sclerotherapy is a fairly low level postoperative complications. The main drawback limiting the use of this minimally invasive technique is the high rate of relapses - up to 70% three years after therapy. An effective method, especially indicated for bleeding hemorrhoids in stage I, is infrared coagulation of hemorrhoids. The therapeutic effect is based on stimulation of necrosis of the mucous membrane through thermocoagulation.

The technique of ligating enlarged hemorrhoids (optimally performed in stage II of the disease) using a rubber ring, leading to their necrosis and rejection, was proposed in 1958 by R. S. Blaisdell, and subsequently simply improved and simplified by J. Barron (1963) . Currently this method treatment of hemorrhoids is effectively used by many proctologists (Fig. 201).

Surgical treatment carried out in patients with stages III and IV of the disease.

Rice. 201. Ligation of internal hemorrhoids. A – capture of the hemorrhoid with a clamp; B – dropping the latex ring onto the neck of the knot; B – the leg of the node is ligated. 1 – internal hemorrhoidal node; 2 – ligator; 3 – latex ring; 4 – clamp

The most common method currently is the Milligan-Morgan hemorrhoidectomy, which gives good results. The essence of the operation is to excise hemorrhoids from the outside inward with ligation of the vascular pedicle of the node, cutting off the node. As a rule, three external and corresponding three internal nodes are excised at 3, 7, 11 o'clock, with the obligatory leaving of bridges of the mucous membrane between them in order to avoid narrowing of the anal canal. Three modifications of the operation are used:

Closed hemorrhoidectomy with restoration of the anal mucosa with sutures (Fig. 202);

Open - leaving an unsutured wound (if there is a risk of narrowing of the anal canal and complications such as anal fissure, paraproctitis) (Fig. 203);

Submucosal hemorrhoidectomy (from under the mucous layer a node is acutely removed using a high-frequency coagulator, leaving the stump of the node in the submucosal layer under the sutured mucosa. Transanal resection of the mucosa using the Longo method is an alternative to classical surgical intervention for excision of hemorrhoids (Fig. 204). In 1993 Italian Antonio Longo developed a fundamentally new approach to surgical intervention for hemorrhoids. The essence of the operation is to perform a circular resection and suturing of the prolapsed mucosa with hemorrhoids. During the Longo operation, only the part of the rectal mucosa that is located above the dentate line is removed.

Rice. 202. Closed hemorrhoidectomy. A – excision of the hemorrhoid;

B – wound of the anal canal after removal of the node;

B – suturing the anal canal wound with a continuous suture

Rice. 203. Open hemorrhoidectomy. The anal canal wound remains open

The mucosal defect is stitched using a circular stapler using the “end to end” type. As a result, hemorrhoids are not removed, but are pulled up and sharply reduced in volume due to a decrease in blood flow into the cavernous bodies. Due to the excision of the circular strip of the mucosa, conditions are created under which the blood supply to the nodes decreases, which leads to their gradual desolation and zobliteration.

Rice. 204. Operation Longo. A – application of a circular purse-string suture to the mucous membrane of the rectum above the hemorrhoid; B – tightening the purse-string suture between the head and the base of the stapler; B – appearance of the anal canal after suturing the mucosa, hemorrhoidal vessels and tightening the hemorrhoids

The prognosis for hemorrhoids is usually favorable. Application conservative therapy, minimally invasive methods, both independently and in combination with each other or with surgical methods, allow achieving good results in 85–90% of patients.

Acute paraproctitis

Acute paraproctitis is an acute purulent inflammation of the peri-rectal tissue. In this case, the infection penetrates into the tissues of the peri-rectal region from the lumen of the rectum, in particular from the anal crypts and anal glands.

Paraproctitis ranks 4th in frequency after hemorrhoids, anal fissures and colitis (up to 40% of all diseases of the rectum). Men suffer from paraproctitis more often than women. This ratio ranges from 1.5:1 to 4.7:1.

Etiology and pathogenesis

As already noted, acute paraproctitis occurs as a result of infection in the perirectal tissue. The causative agents of the disease are Escherichia coli, staphylococcus, gram-negative and gram-positive bacilli. Most often, polymicrobial flora is detected. Inflammation caused by anaerobes is accompanied by particularly severe manifestations of the disease - gaseous cellulitis of the pelvic tissue, putrefactive paraproctitis, anaerobic sepsis. The causative agents of tuberculosis, syphilis, actinomycosis are very rarely the cause of specific paraproctitis.

The routes of infection are varied. Microbes penetrate into the perirectal tissue from the anal glands, which open into the anal crypts. As a result of the inflammatory process in anal gland its duct is blocked, an abscess is formed in the intersphincteric space, which breaks into the perianal or pararectal space. The transition of the process from the inflamed gland to the perirectal tissue is also possible through the lymphogenous route. In the development of paraproctitis, injuries to the rectal mucosa by foreign bodies contained in feces, hemorrhoids, anal fissures, ulcerative colitis, and Crohn's disease can play a certain role. Paraproctitis can be secondary. In this case, the inflammatory process moves to the perirectal tissue with prostate gland, urethra, female genital organs. Rectal injuries are rare cause development of post-traumatic paraproctitis. The spread of pus through the pararectal tissue spaces can go in different directions, which leads to the formation of various forms of paraproctitis.

Classification

According to etiology, paraproctitis is divided into banal, specific And post-traumatic.

According to the activity of the inflammatory process - on acute, infiltrative And chronic (rectal fistulas).

According to the localization of abscesses, infiltrates, leaks - subcutaneous, submucosal, intermuscular (when the abscess is located between the internal and external sphincter), ischiorectal (ischiorectal), pelvic-rectal (pelviorectal), retrorectal (one of the types of pelvic-rectal) (Fig. 205).

You can select 4 levels of difficulty acute paraproctitis.

Paraproctitis of the first degree of complexity includes subcutaneous, submucosal, ischiorectal forms that have an intrasphincteric connection with the lumen of the rectum, intermuscular (intersphincteric) paraproctitis.

To the II degree of complexity - ischial, retrorectal forms of paraproctitis with transsphincteric communication through the superficial portion of the anal sphincter (less than 1/2 portion, i.e. less than 1.5 cm).

Paraproctitis of the III degree of complexity includes forms as in the II degree, but with streaks, pelviorectal paraproctitis with the capture of 1/2 portion of the anal sphincter (more than 1.5 cm in thickness), recurrent forms.

Paraproctitis of the IV degree of complexity includes all forms (ischial, retro, pelviorectal) with an extrasphincteric course, with multiple leaks, anaerobic paraproctitis.

Rice. 205. Options for localizing ulcers: 1 – subcutaneous; 2 – intermuscular;

3 – ischiorectal; 4 – pelviorectal.

There are subcutaneous, ischeorectal and pelviorectal paraproctitis (more about this below). Clinical picture and objective examination data

The onset of the disease is usually acute. In this case, increasing pain appears in the rectum, perineum or pelvis, accompanied by an increase in body temperature and chills. The severity of the symptoms of acute paraproctitis depends on the localization of the inflammatory process, its prevalence, the nature of the pathogen, and the reactivity of the body.

When the abscess is localized in the subcutaneous tissue, there is a painful infiltrate in the anus and skin hyperemia, accompanied by an increase in body temperature. Increasing pain, intensifying when walking and sitting, when coughing, when defecating. On palpation, in addition to pain, there is softening and fluctuation in the center of the infiltrate.

The clinical picture of ischiorectal abscess begins with general symptoms: feeling unwell, chilling. Then dull pain appears in the pelvis and rectum, aggravated by defecation. Local changes - asymmetry of the buttocks, infiltration, skin hyperemia - appear in the late stage (on the 5th-6th day).

Pelviorectal paraproctitis, in which the abscess is located deep in the pelvis, is the most severe. In the first days of the disease, general symptoms inflammation: fever, chills

The rectum is the final section of the large intestine and the entire digestive tract as a whole. Its length in an adult is 14-18 cm, and its diameter ranges from 4-7.5 cm.

The rectum has three main parts:
supramullary part - located immediately after the end of the sigmoid colon;
ampoule or ampullary part; The ampullary part of the rectum received its name for its characteristic shape in the form of an expansion;
anal canal – the lower, narrower part of the rectum; passes through the perineum and ends at the anus ( anus).
Since the first two parts are located in the pelvic cavity, they form the pelvic rectum. The anal canal is otherwise called the perineal section of the rectum.

Structure and function of the rectum

The rectum is located in the pelvic cavity. Its main function is the accumulation and final formation of feces. Thanks to two anal sphincters - external and internal - the lumen of the rectum closes, holding feces.

The rectal wall consists of four layers:
mucous membrane;
submucosal layer;
the muscular membrane responsible for the forward movement of feces;
connective tissue membrane.

The rectal mucosa forms many small vertical folds in which feces can be retained and create the preconditions for inflammation.

The subcutaneous fat surrounding the anus contains a venous plexus, which becomes the anatomical basis for the formation of nodes in hemorrhoids.

The rectum contains numerous nerve endings, which is associated with the importance of the evacuation function and the complexity of the act of defecation, which is largely controlled by consciousness.

Embryonic development

Initially, the human embryo develops a cloaca - a single channel for removing all waste products ( both urine and feces). At the seventh week of embryonic development, the urinary-rectal septum divides the cloaca into two sections and gives rise to the subsequent formation of the rectum.

Violation of the mechanisms of formation of the rectum leads to various congenital defects in children - this can be anal atresia, rectal atresia and congenital fistulas connecting the rectum and the genitourinary system ( bladder or urethra).

Diseases of the rectum

1.Haemorrhoids
Hemorrhoids are the expansion and inflammation of hemorrhoidal venous nodes located in the fatty tissue of the anus. In fact, hemorrhoids are vascular disease, having the same origin and mechanism as the well-known varicose veins.

The causes of hemorrhoids are hereditary predisposition, chronic constipation, sedentary lifestyle, and heavy lifting. In women, hemorrhoids often first appear during pregnancy or childbirth.

Symptoms of hemorrhoids are:
formation of protrusion in the anus;
bowel disorder ( usually constipation);
pain at rest and during bowel movements;
bleeding from damaged nodes.

Regular blood loss can lead to the development of anemia - anemia. Hemorrhoids can be complicated by necrosis and thrombosis of hemorrhoids - conditions that are life-threatening for the patient.

To treat hemorrhoids, suppositories, ointments, gels, and sclerotherapy are used. For moderately severe hemorrhoids, folk remedies can be successfully used - suppositories made from potatoes, propolis, garlic, honey, etc. In severe cases, surgical treatment is resorted to.
2. Proctitis
Proctitis is an inflammation of the rectum, or more precisely, its mucous membrane. The disease is manifested by pain, bleeding, a feeling of incomplete bowel movements, and fever. Long-term inflammation of the rectum can lead to the formation of ulcers and fistulas.
Proctitis is treated with anti-inflammatory drugs, antibiotics, and diet therapy.
3. Rectal prolapse
Rectal prolapse ( otherwise rectal prolapse) is a consequence of weakness of the pelvic floor muscles. In children, rectal prolapse is usually treated conservatively; in elderly patients, as a rule, it is necessary to resort to surgery.
4. Anal fissure
The crack is formed due to mechanical injury (for example, hard stool for constipation) or inflammatory process. In children, an anal fissure can form as a result of scratching during itching from helminthiasis.
A rectal fissure is manifested by pain, bleeding and spasm during bowel movements. In the treatment of rectal fissures, local emollients, healing and anti-inflammatory agents are used. To avoid injury to the fissure during defecation, a milk diet and cleansing enemas are prescribed.
5. Rectal polyps
Polyps are growths on the intestinal wall. People with polyps usually have no pain - the disease is asymptomatic. However, it should be remembered that this pathology can cause inflammation and cancer formation.
6. Rectal cancer
Malignant tumor of the rectum is a serious disease with a poor prognosis. Rectal cancer quickly spreads to neighboring organs and metastasizes.

Signs of adenocarcinoma and other types malignant neoplasms rectum:
pain radiating to the lumbar region, perineum, tailbone;
bleeding;
an admixture of mucus and blood in the stool;
weakness, weight loss;
feeling foreign body in the anus;
painful bowel movement.
In the later stages, the pain becomes almost constant, feces may appear in the urine or vaginal discharge.

Early diagnosis rectal cancer is difficult due to the lack of specific complaints. Patients may regard the presence of blood in the stool as a manifestation of hemorrhoids or fissures. Regular examination by a specialist for these diseases and the use of various examination methods ( Ultrasound, examination using a colonoscope, laboratory analysis of blood, urine and feces, taking a smear from the rectal mucosa) will help you make the correct diagnosis and start timely treatment.

To treat rectal cancer in modern oncology, surgical treatment is used, as well as chemotherapy and radiotherapy. Surgical treatment consists of resection ( partial removal) or complete removal of the rectum.