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Diseases of the Rectum and Anus

stool, pain, ulcer, piles, muscle, water, treatment and blood

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Fissure of the Anus is an extremely painful affection caused by a small crack or ulcer. The pain on passing the motions is intense, and lasts for a considerable time afterwards. The crack or fissure may be very trifling, but is just within the anus, where it is grasped by the circular muscle or sphincter which keeps the bowel closed. It is its position that makes it so pain ful. A careful inspection of the parts will reveal its presence. The pain caused during and after going to stool leads those troubled with fissure to delay as long as possible, and thus tends to create costiveness and similar troubles.

Treatment.—The object of treatment is to ensure rest of the sphincter muscle for a few days, since it is its movements that prevent the ulcer healing. Therefore complete division of the muscle by the knife was found the most effectual treatment. It was found, however, that division of the fibres of the muscle just under the ulcer was sufficient. This has been further simplified by simply stretching the anus forcibly, so as to paralyse the muscle for a little time. This is done by passing up the well-oiled thumb of each hand into the rectum, and then, by stretching the fingers over the buttocks and pulling on them, the thumbs are drawn apart and the sphincter forcibly stretched. This is all that need be done. It is not even necessary that the patient should be confined to bed.

Ulcer of the Rectum is higher up than the preceding. It produces uneasiness in the rectum, and a desire to go to stool, especially on rising in the morning. At such times what passes may be streaked with blood or contain matter, or the motion may be of the coffee-ground appearance, significant of blood being mixed with it. This ulcer, not being so low down as the preceding, will not be visible to ordinary inspection. A surgeon would probably require to give chloroform before making a satisfactory examination.

The treatment consists in clearing out the bowels well with castor-oil. Thereafter various kinds of injections may be used to heal the ulcer. Without surgical advice one should use only an injection of tepid water, or of thin arrowroot and water, or thin starch and water, employing a pint of the solution after every motion. The division of the ulcer may be necessary before it heals.

Piles (licemorrhoids) are a form of varicose veins (p. 326). They consist of folds of the lin ing membrane of the bowel which are swollen, thickened, and congested, and contain enlarged vessels. If they have grown to any extent

they are forced out by straining at stool, and the pressure thus occasioned may cause them to bleed. They may thus form little tumours of the size of a pea or a nut, which produce great discomfort and pain. This is the form called internal piles.

They are caused by anything which produces overfulness of the veins of the belly. Thus any thing interfering with the return of blood to the heart will tend to produce them, congested liver, pressure on the large veins such as is frequently exercised by the pregnant womb, &c. Luxurious living, with lack of exercise, and costiveness, produce them.

External piles or blind piles are little masses at the margin of the anus, consisting chiefly of overgrown skin and connective tissue.

Symptoms. — There is pain at stool, with heat, and throbbing, and straining, and often with the discharge of blood. Irritability of the bladder may be produced, and in women irritability of the womb with discharge. The general health may be affected, and the com plexion become sallow, the liver, stomach, and bowels become deranged, and loss of flesh may result. Sometimes, after being forced down at stool, the piles may become so swollen and en gorged by the pressure that the person is unable to return them, and they remain down, bleeding perhaps and exquisitely painful. They are, if not returned, liable to slough.

Treatment. — The bowels must be moved regularly, and the motion must be soft and easy to save pain and straining. For this purpose perhaps nothing is better than the old sulphur electuary, made of 4 ounces of sulphur, 1 ounce of cream-of-tartar, and 4 ounces of syrup or treacle, of which a tea-spoonful, or the quantity that is found necessary, should be taken every morning before breakfast. After each stool the parts should be sponged with cold water, and then an ointment of galls and opium applied- the gall-and-opium ointment of the chemists. An injection of cold water into the rectum both before and after stool is useful. The food should be plain and nourishing, no highly spiced, very fat, or sweet dishes being allowed. If piles cannot be replaced after they have come down, iced cloths should be applied till their size is so reduced that replacement is possible. If they have become strangled and tend to slough, poultices must be employed, the pain being relieved by opium (1 grain for a dose). The radical cure is removal, which can easily be done by operation.

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