Fistula of the Rectum.—A fistula is an abnormal canal, opening either into a body cavity or into the external skin, or terminating blindly in some organ or tissue. A suppurating canal extending from the interior of the rectum to the skin in the neighbourhood of the anus, establishing communi cation between the rectum and the external air, is designated as a complete rectal fistula (see Fig. 341a). If the canal reach the external skin without rupturing the same, it is called a blind internal rectal fistula (see Fig. 3.1.1b) and if it extend from the external skin to the rectum without perforating the mucous membrane of the latter, it is termed a blind external rectal fistula (see Fig. 341c). These fistulae are extremely annoying to the patient, owing to the constant discharge of small amounts of pus and blood. They are, moreover, healed with great difficulty, since they, in the majority of cases, burrow in different directions, thus becoming very complex. The only rational treatment of such fistula: is by operation. This can be done painlessly by aid of a local anesthetic (cocaine), arid as a rule the patient is confined to his room for only a few days.
Rectal fistulae are very frequently of a tuberculous nature, in which case they are more serious, and require careful local and general treatment. The use of salves, powders, suppositories, etc., in the treatment of fistuhe is fruitless. Only quacks or incompetent physicians will claim to be able to " cure " fistulae by such means. Rectal fistulae may extend also into the urethra (recto-urethral fistake), into the bladder (recto-vesical Iistulcv), or into the vagina (redo-vaginal fistalcv), giving rise to severe complications.
Prolapse of the Rectum. A condition in which a smaller or larger portion of the rectum protrudes through the anal opening. In children this unpleasant condition generally affects only the mucous membrane of the rectum ; and occasionally this is the case in adults also. The affection
may be very severe. In some cases, portions more than one foot long have been extruded from the anus. Violent straining at stools is often the cause of this condition. This may occur in persistent constipation, in the presence of a stone in the bladder, in narrowing of the urethra, etc. Prolapse of the rectum is observed also after the bearing of many children. The mucous membrane of the extruded part usually becomes inflamed and bleeds slightly.
In children, the affection may be readily cored. The diet and the bowels should be regulated, and the prolapse retained by suitable bandages. In adults regulation of the bowels is equally important. Bladder-stones should be removed, and a narrowed urethra widened. I f the condition persist, operative treatment is necessary, and is usually successful.
Tenesmus of the Rectum.—This is a frequent accompaniment of many diseases of the bowels, particularly of the rectum, and is characterised by a frequent or constant inclination to defiecate, without being able to do so. This rectal tenesmus is caused by a spasmodic contraction of the muscles of the anus, resulting from an abnormal irritation in the rectum. Accom panying this, there is frequently an itching sensation in that portion of the gut. Among the causes of rectal tenesmus may be mentioned : Fissures, catarrh, swellings and ulcers in the rectum or in the colon, and hardened masses of faeces following constipation. The condition persists until the cause is removed. Lukewarm or warm sitz-baths are very efficacious in allaying some of the painful symptoms. Medicine in the form of suppositories may be taken to cure the spasms of the anal ring-muscles, or sphincters. Attention should be paid to regular and easy evacuation of the bowels.