RECTUM, DISEASES OF THE. The rectum is the seat of a number of congenital deformities. Imperforate anus or entire absence of the anus is sometimes found in newly horn children. Oc casionally the rectum opens into the vagina or urethra. These conditions have to be met with prompt surgical measures. An imperforate anus is punctured or incised and kept open by boogies until healing takes place, and a preternaturally narrowed rectum o• anus is dilated with rectal sounds, or with the finger. Sometimes an arti ficial anus has to be made, either at the natural site or higher up in the inguinal region. In feeble or ill-nourished children prolapse of the rectum or anus is apt to occur from diarrhea and exces sive straining at stool, or in connection with worms, stone in the bladder, or other irritation. Prolapse is reduced by the application of cold compresses. and gentle replacement of the pro truding tissue with the fingers. It is then re tained by a pad, and recurrence is combated by the use of astringent and antiseptic injections. A perfect cure, however, is only to be secured by the removal of the causative condition.
Adults are subject to numerous disorders of the rectum. Inflammation (proetitis) results from constipation and from chronic diarrhea and dysentery. Ulceration of the rectum may be due to abrasions from hardened fteeal masses, to syphilis, or to tuberculosis; it may be single or multiple. Ulcers are treated locally by cleansing and astringent injections, with constitutional remedies adapted to the individual ease. Spasm of the rectum (proetospasm) or sphincter ani is a not uncommon manifestation of neurasthenia and hysteria, but its most usual causes are anal fissure and hemorrhoids. Stricture, which may result in complete occlusion, may be simple or malignant. It is often caused by cancer of the rectum. When due to cancer the pain is intense and laneinating, and the patient has an emaciated appearance. The stools are often flat tened out like ribbons, and contain blood and mucus. Stricture of the rectum is best treated by laxatives, cleansing injections, and by grad mil dilatation with soft rubber bungles. In the case of cancer, however, these measures are only palliative. Here it is often necessary to remove a part or all of the rectum and stitch the colon to the edges of an artificial opening in the abdomi nal wall at the groin, thus forming a new anus.
Patients can thus live in comparative comfort.
Fissure of the anus is a crack at the anal open ing, producing spasm of the sphincter muscle. It causes violent burning pain during defection. and the dread of this suffering results in volun tary inaction of the bowels and habitual consti pation. Intense itching often accompanies fis sure. Strict cleanliness and the application of healing ointments usually suffice to cure this condition. Touching with the point of a stick of lunar caustic is a valuable remedy. Fistula in ano consists of the unhealed track of an abscess adjacent to the lower part of the rectum on the verge of the anus. An abscess in this region heals with great difficulty, because of the cony stant movement of these parts and the passage of firees, which reinfeet and irritate it. Fistula is not uncommonly associated with hemorrhoids. cancer, or stricture. These are the varieties of fistula: The blind external terminates in a eta de-sae near the bowel and opens at or near the margin of the external sphincter; the blind in terval fistula opens into the bowel and has no external orifice: the complete has both an in ternal and an external opening. The symptoms are passage of wind and fees through the open ing and of a discharge which stains the clothing. Repeated attacks of inflammation ensue and new abscesses form. Treatment in all varieties of fistula is free incision and cutting out of the fistulous tract. See FISTULA.
Hemorrhoids or piles are venous tumors situ ated either within, without, or on the margin of the anus, and are caused by congestions and in flammation of the abundant vascular areas of the rectum. (See Polypus of the rectum is a tumor attached by a narrow pediele, and origi nating in a relaxed fold of the mucous membrane, or in granulation tissue springing from an ulcer. or in a mass of hemorrhoids. The only remedy is removal.
Pruritis of the anus is a symptom of many diseases, both local and distant. It may and often does accompany such widely diverse affec tions as piles. fissure, seat worms, eczema, nerve disturbances. Bright's disease, jaundice. consti pation. The itching is almost unbearable and is worse at night. The general treatment will depend on the exciting cause. Locally sedative lotions and ointments are employed and strict cleanliness observed. Eczema (q.v.) often af fects this region.