The rectum serves as a stool reservoir. It is the lower part of the large intestine and merges into the anus. The sphincter muscle is located in the lower part of the rectum. This plays an important role in controlling bowel movements. It makes it possible to hold stool and bowel movements.
Rectal diseases often affect the anus and the lowest part of the rectum, including the sphincter muscle. These disorders can be very painful and distressing for the patient.
Rectal diseases often respond well to topical and medicinal treatment with suppositories and ointments. In some cases, surgery is necessary.
The anatomy of the bowel © bilderzwerg | AdobeStock
The most common rectal diseases are listed below:
Everyone has hemorrhoids. Hemorrhoids are cushions consisting of blood vessels that line the inside of the lower part of the rectum. They support the sphincter muscle in its function.
If you suffer from haemorrhoids, these cushions often become swollen and enlarged due to inflammation.
The typical symptoms are
If they are very enlarged, haemorrhoids can also protrude outwards in front of the anus (so-called prolapse).
Enlarged haemorrhoids can be very painful © Sagittaria | AdobeStock
Anal abscesses are purulent inflammations around the anus. They are often located just under the skin. An inflammatory swelling can then be felt and seen next to the anus, which is very painful. O
t is often the case that the abscesses are caused and maintained by so-called fistulas. These are small ducts that can only affect the skin and fatty tissue around the anus, but can also extend into the rectum.
As a result, germs from the intestine repeatedly enter the subcutaneous fatty tissue.
A fissure is a tear in the mucous membrane of the anus. This rectal disease is often the result of hard stools and leads to severe pain and blood loss during bowel movements.
If a fresh fissure does not heal properly, it can become chronic and lead to permanent discomfort.
Patients with defecation problems cannot hold their stool(faecal incontinence) or cannot empty their bowels completely despite the urge to defecate.
The causes of these rectal disorders are complex. For example, the sphincter muscle may no longer function properly. It can then no longer hold liquid or solid stools. This weakness of the sphincter can be the result of
for example.
Patients suffer from
In the long term, this leads to a severe impairment of social life.
After a detailed discussion about the symptoms, the rectum is examined in several stages.
First, the anus is viewed and examined from the outside, followed by palpation with a finger.
Before each examination, which takes about 3 to 5 minutes, it is essential to cleanse the rectum with an enema.
Although the examination is unpleasant due to the insertion of the devices via the anus, it is not painful due to the application of a pain-reducing lubricant.
It is carried out in a quiet and secluded room to protect the patient's privacy.
In both examinations, a straight instrument is inserted into the rectum. A proctoscope can be used to assess the lower 5 cm of the rectum. It is used to examine hemorrhoids, fistulas and fissures.
A rectoscope can be used to examine the entire 15 cm length of the rectum. Air is pumped into the rectum with a bellows so that it unfolds well during the examination.
Here you can see a colonoscopy. The rectoscopy works in the same way © bilderzwerg | AdobeStock
To examine the sphincter function, an approx. 5 cm long pressure probe is inserted into the anus. This can be used to measure the resting pressure, the maximum pinch pressure and the continuous pressure.
A direct ultrasound examination of the rectum is required for special questions. A special probe is inserted into the rectum for this purpose.
This examination can be used to
The treatment methods differ depending on the rectal disease.
The symptoms of haemorrhoids can be treated well in the short term with ointments, suppositories and sitz baths. In the long term, moderately enlarged haemorrhoids can be sclerosed or treated with a rubber band ligation.
Severely enlarged and prolapsing haemorrhoids must be treated surgically. Modern surgical techniques with special staplers (haemorrhoid staplers) and accompanying pain therapy have taken the fear out of surgery.
Anal abscesses must be opened and excised under short anesthesia. This is followed by wound treatment with regular douching of the wound until it has healed from the inside out.
The treatment of anal fistulas requires a great deal of experience, as the sphincter muscle is often also affected. They rarely heal without surgery. Treatment methods range from cutting out the fistula to inserting sutures into the fistula tract.
Anal fissures cause the sphincter muscle to tighten as a reflex to the pain. This further intensifies the discomfort.
Treatment ranges from a special ointment to relax the sphincter to treatment with so-called anal dilators. In addition, bowel movements should be kept soft.
If a fissure becomes chronic, surgery is required.
There are various sphincter training options for sphincter weakness. These include
If there is an organic cause, such as a prolapse of the rectum, surgical intervention is indicated.
As this rectal disorder is a complex clinical picture, clarification takes place as part of an inpatient stay.
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