RECTUM, DISEASES OF.—The rectum is the lower end of the large intestine, and extends from the sigmoid flexure to the anus (see p. 149). This part of the intestinal tract may be the seat of a number of severe and painful diseases. The most common of these affections is due to dilated veins, constituting the condition known as piles, or H.EMORRHOIDS (which see). Some of the other affections of the rectum are discussed in the following paragraphs.
Cancer of the Rectum.—This is a very grave disease which gives promise of permanent cure only if the cancerous growth be removed early and com pletely. Prompt recognition of the affection and speedy surgical treat ment are, therefore, of the utmost importance. The first manifestations of rectal cancer consist in a certain feeling of malaise, some pressure in the rectum, and the discharge of blood and mucus, especially on defecation. The form of the faeces is often thinner than usual, sometimes only as thick as a pipe-stem. As a rule the condition is accompanied by constipation and by pain at stools.
An individual over forty years of age who has haemorrhages from the rectum, or who discharges mucus and blood with the stools, should never rest content with a diagnosis of haemorrhoids. A careful ex amination of the rectum by a physician is always necessary ; and not only the anal opening must he inspected, but it is essential to have the entire rectum explored. Owing to the fact that many patients who suffer from rectal cancer fail to submit to an early examination, it frequently happens that surgical treatment is deferred until the cancerous growth has advanced so far that the prospects of a permanent cure are but slight, or that an operation is no longer hopeful.
The technique for the operative removal of rectal cancer has made great progress during recent years. Surgeons are able to remove cancerous growths which are situated high up in the rectum. Even in cases where the cancer can no longer be removed, the patients can be afforded relief by means of an artificial anus. The stools are passed through this artificial opening,
and in this way the violent pain caused by defmcation is avoided. The artificial anus is closed by specially constructed pads, which are removed only for the purpose of discharging excrements.
Catarrh of the Rectum.—This condition is due to chronic irritation of the mucous membrane lining the rectum. Hardened masses of excre ments which remain in the rectum for some time may be the chief causes of irritation ; or enemas given continuously and unskilfully may act as irritants. Exposure to cold and the presence of intestinal worms are like wise causative factors. The catarrhal inflammation very often develops in consequence of other affections of the rectum, following or accompany ing hemorrhoids and ulcers particularly. The symptoms of rectal catarrh are a constant inclination to defzecate, pain in the anus, and the passage of blood and mucus, either alone or with the freces. In some cases pus may be discharged. The affection may be accompanied by periodic diarrhoea, but, in the majority of cases, the stools are rather hard. Blood and mucus are often passed constantly, but in small quantities only, being present as a thin covering on top of the excrements.
Treatment of the affection requires, above all, the removal of the cause, particularly of the persistent constipation. Regulation of the bowel move ments is the first step in the treatment of rectal catarrh. The use of laxa tives is permissible, but only under proper medical guidance. The rectum may be cleansed of mucus and other substances by washing it out with warm water or with soda solutions. Special treatment with astringent remedies must he left to the physician. It is of great importance that the anus be kept clean, and for this purpose lukewarm sitz-baths may be re commended. These baths also exert a favourable influence on the disease itself. If worms be recognised as the cause of the catarrh, it is obvious that these parasites must be destroyed.