RECTUM, DISEASES OF. The terminal portion of the intestinal canal, named from its comparatively straight course, the rectum, is the seat of various affections requiring medical or surgical assistance. Some of these affections, as piles, prolapsus ani, and hemorrhage from the rectum, have already been considered. Among the other diseases of the rectum of sufficient importance to claim notice in these pages are 1. Stricture of the rectum, which may be either spasmodic or permanent. Spasmodic stricture is comparatively rare. Permanent stricture may be either of a simple or malig nant nature. Simple stricture consists in a thickening and induration of the mucous coat of the rectum so as to form a ring encroaching on the caliber of the tube. It is situated about two or three inches from the anus, and the contraction is so great and unyielding that it is often difficult to pass a finger through it. The symptoms are constipation and great pain, and a straining in evacuating the feces, which are passed in a narrow, flat tened, or worm-like form, which is very significant of the nature of the case. In an advanced stage of the disease, diarrheea and prolapsus often supervene. However great' may be the constipation„strong irritant purgatives must be altogether avoided. Soft and unirritating evacuations must be procured by such medicines as the confection of senua combined with sulphur (see PH.Es), or injections of castor-oil or of tepid water. The diet should be regulated so as to assist the iretion of the medicines. Nutritious soups are serviceable, since, at the same time, they support the strength, and leave little matter to be excreted. When much local irritation is present, it may be relieved by the hip-bath and by sedative injections; till it is subdued surgical interference would do more harm than good. A bougie capable of being passed with moderate pressure through the stricture should be inserted in the gut every third or fourth day, and should be allowed to remain for about a quarter of an hour; and its size should be gradually increased. Nothing is gained by the forcible passage of large boogies. The cure is to be effected by pressure so applied as to produce absorption, not by mere mechanical dilatation. Malignant stricture—moM, commonly due to the scirrhous, but sometimes to the epithelial form of cancer—is by no means a very rare affection, and is more common in the female than the male sex. Until ulceration sets in, the symptoms are like those of simple stricture, only exaggerated in degree; but afterward there is a discharge of fetid mucolmrulent matter streaked with blood. In this disease, the treatment can be only palliative unless the surgeon resort to the formation of an artificial anus in the loins as a hut resource.
2. Spasm of the sphincter ani muscle is characterized by extreme pain in the region of the anus, especially when an attempt is made to evacuate the bowels. The muscle con
tracts so firmly that the surgeon cannot easily introduce the finger into the rectum. The spasm may be caused by piles, by fissure of the anus, by ulceration of the rectum, and sometimes apparently by mere constipation. It is often relieved by the application of the belladonna ointment of the British pharmacopeia.
3. Neuralgia (g`' Me rectum, known also as proctalgia, is a common disorder, and is especially prone to attack children and gouty persons. It is usually relieved by the judicious use of aperient medicines.
4. Cm/gee/on, sometimes proceeding to inflammation, is not uncommon in the rectum. The congestion occasions a sense of weight and fullness in and about the rectum, together with a variety of other symptoms. Amongst the causes of this affection are stone in the bladtrer, stricture of the urethra, an enlarged prostate gland, the presence of thread worms, the abuse of irritating purgatives, exposure to cold draughts in the water-closet, etc.; and there can be no doubt that sedentary habits strongly favor the predisposition to this affection. The great object of treatment is to relieve the overloaded vessels of the rectum. The bowels should be freely opened with castor-oil, leeches should be applied to the verge of the anus, and after their removal a warm hip-bath is advisable.
5. Pruritus podicis, or itching of the -anus, is a very common and extremely trouble some affectica. Sometimes it depends on the presence of thread-worms or of old piles, while in other eases it is one of the manifestations of the skin-disease known as p•urigo (q.v.). The treatment must depend upon the exciting cause.
- 6. Fissure of the anus is a small crack which gives intense pain during the passage of the feces, and often persisting for several hours. Free purgatives, and the application of astringent lotions or ointments (as tannin lotion or ointment of galls) should be tried; and if they fail, partial division of the sphincter muscle must be resorted to—an opera tion easily performed, and certain to give relief.
7. Fistula in alto signifies a fistulous or pipe-like track by the side of the sphincter ani muscle. It may occur as a complete fistula, which has an external opening near the anus, and an internal opening into the bowel; or as a blind external fistula, which has no actual opening into the bowel, although it extends to its outer coat; or as a blind internal fistula, in which the preceding conditions are reversed. A sketch of the mode of treatment is given in the article FISTULA.
For a detailed description of these diseases of the rectum, and for information on many other less important affections of this part of the body, the reader is referred to Bushes Treatise on the Rectum, and to the more recent works of Mr. Ashton and Mr. Henry Smith on the same subject.