Proctitis

PROCTITIS, proctitis, inflammation of the mucous membrane of the rectum. Acute and chronic forms of P. are distinguished. Acute P. as a manifestation of general colitis can be caused primarily by chemical irritations, for example, prolonged consumption of very spicy food, abuse of laxatives, especially Alexandrian leaf, colocynth and jalap. Acute P. as a local phenomenon can be caused by the use of various irritating substances in enemas, mainly glycerin, soap, strong solutions of garlic, etc. The cause of P. can also be mechanical factors, among which stagnant fecal masses play an important role, which in addition to prolonged pressure cause chemical irritation of the mucous membrane. P. of ulcerative and even perforating character can be observed with frequent and unskillful use of enemas. The cause of P. are also various general diseases associated with lesions of the small and large intestines (e.g. dysentery), then hemorrhoids, prolapse of the rectum, polyps, cancer, etc. P. often develops as a result of inflammation of neighboring organs. Pathoanatomical changes in acute P. are usually expressed in a sharp swelling and reddening of the mucous membrane with the discharge of pus, mucus, fibrin, blood and swelling of the follicles; the latter sometimes, suppurating, burst and can lead to the formation of ulcers. Clinically, acute P. begins with an increase in temperature, a feeling of heat and pain in the area of the rectum, radiating to the sacrum, thighs, bladder, sexual organs, etc. The most pronounced symptom is tenesmus. When attempting to empty the rectum, a small amount of mucus is secreted, sometimes mixed with blood. In children, the swollen mucosa often protrudes through the anus, so that inflammatory prolapse (ectropium ani Roser's) occurs. Often due to irritation of neighboring organs, dysuria, urinary retention, erection, etc. are added. Treatment of acute P. should begin with establishing the causes of the disease and their elimination. If there are severe disorders and pains, the patient should observe bed rest. From food, substances that give a lot of slag should be eliminated. The rectum should be regularly emptied. After mild laxatives, washings with warm water, oil, etc. are done. For pain relief, opium is added to the enemas or suppositories with cocaine, belladonna are prescribed. Ice on the area of the anus also brings significant relief. With such treatment, acute proctitis usually passes within 8-14 days. Chronic P. develops from acute P. under prolonged exposure to the harmful factors mentioned above or immediately manifests in a chronic form. Chronic P. is characterized by proliferation of the interglandular connective tissue, and in severe cases, involvement of the submucosal tissue, which leads to thickening and swelling of the folds of the mucous membrane, and then to the appearance of polypoid growths. Expansion of Lieberkühn's crypts is noted, formation of cysts in their place, especially around ulcers. With prolonged existence of catarrh, inflammatory infiltration of the deep layers of the intestinal wall (muscular and subserous) is added. Simple P. is localized in the ampulla of the rectum and usually extends into the portio analis. Clinically, chronic P. for a long time can give only minor symptoms, namely-a feeling of pressure and fullness in the pelvis. Patients note frequent discharge of glassy mucus, and later purulent mucus. In far-advanced cases, especially if there are ulcers, the disorders are more intense. Patients complain of constipation or frequent urges to the lower part, of diarrhea and discharge of mucus and pus. Frequent secretion of irritant affects the skin in the area of the anus and can lead to the formation of cracks, relaxation of the sphincter, etc. Chronic P. can be complicated by paraproctitis; in the final stage of chronic P., symptoms of stricture are added. Absorption of pus affects the general condition of the patient and leads to digestive disorders, headache, weight loss, etc. In each case of the complaints listed above, careful examination is necessary to exclude the presence of cancerous lesions of the rectum. Treatment in a long-lasting process is difficult. In all cases, diet should be maintained and the intestine regulated with enemas. In fresh cases, the local application of various astringent solutions (silver nitrate, manganese, bismuth, etc.), as well as insufflation of antiseptic powders, often brings benefit. Reclus recommended irrigation of the rectum with hot water (up to 50°). Hot baths have the same effect. In severe cases, appendicostomy (for the introduction of medicinal substances) or anus praeternaturalis, as well as removal of the rectum, is recommended.