Damaged rectum. Diseases and injuries of the rectum and pararectal tissue Treatment of surgical diseases and injuries of the rectum

If a person has damaged the rectum, then it is important for him to know the reasons, and they can be both external and internal, which destroy the integrity of the organ and the body as a whole. Such damage is serious and requires special treatment and caring for the injured area.

Advice: if you have injured your rectum, immediately consult a specialist for advice, diagnosis and advice on further treatment.

Causes

As mentioned above, wounds directly to the intestine can have external/internal factors. TO external factors include the following:

• gunshot wounds;
• knife wounds;
• injuries from medical instruments;
• injuries caused by falling on sharp objects;
• rupture of the rectum from the introduction of air.

Internal factors:

• high (exceeding normal) intra-abdominal pressure;
• excessive physical activity;
• complications during childbirth;
• difficulty with bowel movements;
• anatomical features of the body;
• sphincter injuries.

Please note: rectal trauma often affects other organs or bones. For example, if you get into an accident, the pelvic bones may be injured along with damage to the rectum and other internal organs.

Classification

Classification, for these damages there are several types:

• by the mechanism of injury;
• according to the amount of injury received.

In the first case, injuries are divided into the following types:

• received during mechanical actions (for example, surgery);
• falling, receiving mechanical injuries, bruises, wounds;
• during sexual intercourse without the use of special means;
• perineal burn;
• pelvic girdle injury.

Based on the volume of injury, injuries are divided into:

• those that are in abdominal cavity;
• those that are outside the abdominal cavity.

The above defects can be divided into:

• simple;
• complicated by impaired functioning of the sphincter;
• complicated by impaired functioning of other internal organs.

Symptoms

Injuries to the rectum have pronounced symptoms. If the muscle or mucous membrane of an organ is damaged, a person experiences the following symptoms:

• sharp pain in the area of ​​the damaged organ;
• presence of blood in secretions feces Oh;
• false urge to defecate;
• involuntary release of gas or feces (due to uneven enlargement of the anus);
• the presence of purulent discharge;
• progress of inflammatory/ infectious process.

Please note: if you notice any of the above symptoms that may develop after injury, contact your healthcare professional immediately. Ignoring manifestation painful sensations and violations normal functioning small intestine may cause fatal outcome . Take care of own health and contact a specialist, thereby increasing your chances of timely and.

effective treatment

Diagnostics After detecting the above symptoms and contacting a doctor, you should external inspection perineum and anus to determine damage to the rectum. Rectal injuries can be diagnosed different ways

depending on a number of factors (features of damage, degree, size, pain).

• Diagnostics consists of several stages:
• rectal examination (palpation);
• examination using a mirror (special medical rectal mirror);
• anoscopy (examination using a special instrument - anoscope);
• undergoing an ultrasound examination;
• abdominal radiograph;

use of a catheter for further examination of the body. The specialist may suggest several other inspection methods. It depends on the individual characteristics the patient, the nature of the injury, etc. Be careful when selecting medical worker

. You must completely trust the doctor, feel comfortable during the appointment and be confident in the doctor’s qualifications.

Treatment methods Damage rectum , depending on the size of the wound, it current state , size and the discomfort it brings to a person may be subject to various types

therapeutic therapy. The initial action that is carried out after contacting a medical center is debridement

. The damaged intestine is treated, then sutures are applied (this involves inserting a special gauze, which is covered with a medicinal antiseptic ointment, into the small intestine). In particular severe cases

, the damage is tamponed, disinfected, and sutured using a special technique (so as not to disrupt the connection with the intestine). If the damage to the small intestine is not critical, the patient is offered a form of conservative treatment such as bed rest

• , including:
• use of antibiotics, anti-inflammatory ointments, and antibacterial agents prescribed by the doctor;
• ingestion of essential oils;
• adherence to a specific diet (depending on the individual characteristics of the body, prepared by a doctor);
• suturing of defective areas of the organ;
• complete sanitation of the abdominal cavity;
• the rectum should not be overloaded (due to diet).

The duration of bed rest associated with rectal damage can vary from 2 months to six months.

Diseases and injuries of the rectum.

Features of the examination.

During the examination, the nurse should be able to identify symptoms of diseases and injuries to the rectum.

A patient with rectal pathology may complain:

1. for pain in the anal area (read all diseases and injuries)

2. Itching, burning. (proctitis)

3. Presence of a tumor-like formation in the anal area (hemorrhoids)

4. Fecal incontinence (rectal prolapse)

5. Discharge of blood and mucus from the rectum (rectal tumors)

General state can vary from satisfactory (uncommon processes - fissures, hemorrhoids, polyps) to extremely severe (septic paraproctitis, stage 4 cancer).

Great value has the nature of nutrition, motor mode.

Objectively, the rectum is easily accessible for examination. In the patient's squatting position, simulating the act of defecation, the patient can see rectal prolapse and external hemorrhoids. A digital examination is carried out with the patient lying on his side with his legs brought to the stomach. To do this, wear a glove. Forefinger generously lubricate with Vaseline and carefully insert into the rectum. Digital examination makes it possible to determine pathological infiltration of the rectum and pararectal tissue, thrombosed internal hemorrhoids, compacted edges with rectal fissures, etc. Before conducting an instrumental examination, the patient is thoroughly cleaned with enemas of the colon and rectum. The study is carried out in the knee-elbow position. The rectal speculum is lubricated with Vaseline and carefully inserted to a depth of 8-10 cm. Inspection is carried out by carefully removing it. Much diagnostic data can be obtained from sigmoidoscopy. The sigmoidoscope is lubricated with Vaseline and inserted to a depth of 25-30 cm.

Using a balloon, air is pumped into the intestine and when the instrument is removed, the intestinal mucosa is examined. To examine the mucous membrane of not only the rectum, but also the colon, a colonofiberscope is used - a device with elastic optics that can be bent at the desired angle and allows you to examine large parts of the colon.

Rectal injuries.

Damage from various objects falling on them,

Pelvic fractures

Gunshot wounds

Medical manipulations(sigmoidoscopy, insertion of enema tips)

Birth injury

A feature of rectal injuries is the frequent infection of the wound, the frequent combination of this injury with damage to nearby tissues and organs, and the danger of damage to the sphincter.

Clinically, with rectal trauma there are pain in the area anus which can lead to fainting, nausea and vomiting, bleeding and possible prolapse of intestinal loops from the anus. An external examination may reveal damage to the anus.

Intestinal contents enter the abdominal cavity and symptoms appear peritonitis. Bleeding into the abdominal cavity leads to the development shock.

In addition to shock and peritonitis, rectal ruptures are complicated by the development of acute surgical infection: phlegmon, sepsis, anaerobic infection.

Treatment. Surgery comes down to suturing the defect in the intestinal wall, draining pelvic tissue; An unloading colostomy is often performed.

Statistics show that diseases and injuries of the rectum represent a group pathological conditions, with which people are in no hurry to contact a specialist. Patients ignore the problem for a long time, which is why the disease only continues to progress, and in addition other pathologies or complications arise.

In order to avoid unpleasant and dangerous consequences pathologies of the rectum and anus, you should consult a specialist in a timely manner and not self-medicate.

Since the rectum is the final section gastrointestinal tract, it is most vulnerable to the effects of pathogenic agents. The risk of developing the disease is especially high in people who eat poorly (spicy, fatty or too spicy foods) and are susceptible to bad habits, little movement and those who don't follow the rules intimate hygiene.

Each of the anal diseases in humans has its own characteristics in etiology, clinical picture, diagnosis and treatment, so they should be considered separately.

Proctitis is an inflammatory process in the mucous membranes of the rectum. Pathology occurs when infectious agents enter the intestine. These include:

The development of an infectious process is possible in the presence of microtraumas of the mucous membrane, therefore important role Human nutrition plays a role here.

Symptoms of rectal disease in women and men are as follows:

• Pain in the lower abdomen;
• Pain from the rectum, which intensifies with defecation;
• Burning and feeling of heaviness in the affected area;
• Discharge from the rectum of various nature(usually purulent);
• General signs of intoxication (fever, weakness);
• Tenesmus (frequent, false and painful urge to defecate);
• The appearance of blood in the stool.

Proctitis can be either acute or chronic. At the same time, the clinical picture of chronic pathology is approximately the same, but less pronounced.

Paraproctitis is an inflammatory process in the fatty tissue that is located next to the rectum. This pathology is a complication of proctitis and is characterized by an increase in pain and symptoms of intoxication. If chronic paraproctitis forms, that is, a fistula, then the clinic will largely depend on its location.

Diagnosis of both pathologies should include standard instrumental studies at the proctologist, as well as laboratory diagnostics to detect the infectious agent. Based on the diagnostic results, treatment tactics will be formed.

Has a good effect on proctitis local treatment enemas with hormonal ointments, which are used after fading acute process. When paraproctitis occurs, treatment is often surgical.

Haemorrhoids

Called pathological vasodilatation venous network located in close proximity to the rectum (hemorrhoidal veins). On initial stages The pathology does not reveal itself in any way, but as the disease progresses, nodes form, which are associated with the clinical picture.

The main etiological factors for hemorrhoids:

1. Frequent and;
2. Passive lifestyle;
3. Excessive physical activity;
4. Errors in nutrition (too hot and spicy food);
5. A large number of pregnancies and births.

Signs of this disease there are no differences between women and men. In addition, a certain stage is observed in the development of pathology:

• The period of precursors or the onset of the disease. The clinic notes discomfort in the rectum, a feeling foreign body, itching or burning may occur, and certain difficulties may arise during bowel movements.
• Bleeding period. At this stage, the patient begins to see blood from the anus. First, as an impurity in feces, and then, regardless of bowel movements. Important feature is the color of the blood - it is bright scarlet, which indicates damage specifically in the rectum.
• Period of nodes falling out. At this stage, the formed nodes may fall out of the anus, but the patient can push them back by hand.
• The most recent period of nodes that cannot be reduced. The danger of such running process the fact is that the nodes may be pinched, and then the patient will require immediate surgical assistance.

As practice shows, the most dangerous thing is not the fact that patients ignore hemorrhoidal varicose veins, but the fact that they mistake other rectal pathologies for hemorrhoids.

Bleeding is enough common symptom diseases of the rectum in men and women, so if it appears, you should immediately contact a proctologist.

Depending on the stage of hemorrhoids, it can be treated conservatively or surgically. Gentle therapy is dominated by local remedies: ointments, lotions and so on. Surgical interventions consist of cutting out nodes, coagulating them and ligating dilated veins.

Polyps

An intestinal polyp is called benign tumor, growing into its lumen. This pathology is considered a precancerous condition, since the risk of malignancy is very high. The reasons for the formation of a polyp still remain poorly understood, but it has been proven that the pathology does not develop on healthy intestinal tissues. Accordingly, we can conclude that most often a polyp grows in people suffering from chronic diseases intestines.

The clinical picture of polyps is poor and may be absent altogether. In most cases, they are discovered incidentally during endoscopic examinations. The appearance of mucus, bloody discharge or pus in the stool indicates an inflammatory process in the polyp.

If a person develops widespread polyposis, then the following signs appear:

1. Bleeding from the anus;
2. Increased bowel movements;
3. Pain during bowel movements;
4. Mucus discharge.

If the polyps are located close to the anus, they can fall out and become strangulated in the same way as hemorrhoids.

Since the neoplasm has a tendency to become malignant, if it is detected, treatment should be started immediately. The only treatment option for a polyp is its excision during surgical intervention. In addition, therapeutic manipulations should be aimed at the underlying pathology, if any.

Rectal prolapse

Implies its exit from the anus into the surrounding space. This pathology is a consequence various diseases rectum, for example, hemorrhoids. This condition can also be caused by labor activity, too much physical activity.

There are two mechanisms for the development of the disease:

• Spicy. It is characterized by a sudden prolapse of the intestine after a sharp strain on the abdominal girdle, for example, when sneezing, lifting a load, or pushing during childbirth. It is noted strong pain up to shock, which occurs due to tension in the peritoneum.
• Gradual. This course of pathology is more like a chronic one, when first there is prolapse of the mucous membrane, which is reduced on its own. Then intestinal prolapse occurs during defecation or when physical activity and the patient has to adjust it himself. And finally final stage characterized by prolapse of the intestine even at rest and it cannot be reduced back.

The following symptoms are also characteristic of the pathology:

1. Bleeding;
2. Soreness;
3. Presence of ulcerations;
4. Inflammatory process (with frequent hair loss).

Assessment of symptoms of rectal disease and treatment should only be carried out by a proctologist. Therapy can only be surgical and involves several treatment options:

• Working with the prolapsed part of the rectum;
• Partial resections;
• Strengthening the anus and pelvic floor;
• Fixation of the intestines.

Often, the doctor combines these methods to achieve long-term remission of the disease. However, even after the operation this pathology may happen again.

Anal fissure

This pathology is a defect in the wall of the anus or passage and is a consequence of many pathologies of the rectum. The crack can be acute, that is, a rupture of the skin occurs, for example, with constipation, after which it quickly heals and disappears. In this case, pain appears at the beginning of defecation, which quickly subsides. Drops of blood on toilet paper may also be observed.

Chronic anal fissure is characterized by pain at the end of defecation, can become inflamed and progress deeper. It is a defect with hard edges and the presence of granulations. The pain associated with fissures is quite intense, so patients subconsciously try to have fewer bowel movements, which only aggravates the problem, as hard stool forms.

Detection of this disease of the rectum and its treatment should be as early as possible, as the chance of getting rid of the fissure in a low-traumatic way increases. An acute anal fissure is treated conservatively with ointments or a special laser. Chronic pathology requires surgical intervention, that is, excision of the resulting defect. Medicinal and cleansing enemas for any course of the disease.

Constipation

Constipation is not only a pathology of the rectum in itself, but is also the cause of the development of many other diseases. This condition meaning a decrease in the number of bowel movements. In this case, the feces come out hard, dry, and the person never feels like they have a bowel movement.

The main reasons for the development of constipation:

1. Errors in nutrition;
2. Psychological factors (mostly referring to the weakening or complete disappearance of the reflex to defecation);
3. Sedentary lifestyle;
4. A vicious circle with diseases of the rectum (constipation can cause them, but the opposite situation also happens);
5. Tumor process in the intestinal lumen;
6. Adhesive disease;
7. Toxic factors (taking some poisons, excessive use laxative);
8. Taking certain medications (many medications have constipation as a side effect);
9. Problems with the endocrine system.

Treatment for this rectal disease will depend on the cause that caused it. However general principles therapies are as follows:

• Treatment of the underlying pathology that caused constipation;
• Normalization of sleep and rest patterns;
• Fighting physical inactivity (moderate);
• Elimination of dietary errors (more consumption of plant foods);
• Drug treatment (consists of taking laxatives, which should be used only after consulting a doctor);
• The use of cleansing enemas;
• Spa treatment.

Many people do not consider constipation a serious pathology and prefer to suffer without doing anything to get rid of the disease.

However, constipation is the main etiological factor for the appearance anal fissures and development of dilation of hemorrhoidal veins.

Gunshot injuries to the rectum are very common during military operations. IN Peaceful time diseases and injuries to the rectum occur due to a person falling on the perineum or due to fractures of the pelvic bones. The danger is that in this case, all the contents leak into the space surrounding it, causing the development of putrefactive phlegmon in the surrounding tissues, which develops into peritonitis.

Often the causes of rectal trauma can be accidents, falls from various heights, and impacts. If you sharply press a person, for example, with a car against a wall or with some other weight, an intestinal bruise can occur, and sometimes it can rupture.

A bruise can also be dangerous due to hematomas that form during injury and permeate all layers of the intestinal wall, followed by necrosis and rupture. This condition is aggravated by the fact that damage does not occur immediately, but over time, and is combined with the development of bleeding, shock and inflammatory processes in the organs and bones of the pelvis.

1. Gunshot and knife wounds of the intestine and sphincter itself.
2. Falling onto a pointed object with the crotch.
3. Rupture of the intestine with sharp bone fragments, with a fracture of the pelvic bones.
4. Burns.
5. On examination, injury from medical instruments.
6. When performing surgery on the pelvic organs.
7. After radiation therapy, produced for the treatment of female genital organs.
8. Targeted introduction of air into the intestine.
9. Rupture of the intestine during childbirth or during severe physical exertion.
10. Promotion intra-abdominal pressure.
11. Deformation by hard feces during defecation.

This type of damage occurs much less frequently during sexual intercourse. They are clearly visible and not isolated, are often combined with injuries to the bladder and vagina, and if left untreated, lead to the development of fistulas.

Symptoms that indicate that a rectal injury has occurred. They may depend on the degree of damage, as well as internal and external predisposing factors. Heaviness clinical picture depends on the extent of the injury.

• severe pain after injury, which can develop into a state of shock;
• involuntary passage of gases and feces through the damaged external sphincter;
• urge to perform an act of defecation, regardless of the fullness of the rectum, even when its ampoule is empty;
• if affected bladder, there is a possibility of urine leaking into the rectum;
• blood clots in stool;
• if there is a wound area in the intestinal wall, feces fall out and gases pass through it;
• development of peritonitis and putrefactive phlegmon or abscess;
• internal bleeding.

If development occurs internal bleeding, symptoms may appear acute blood loss: a fall blood pressure, pale skin, tachycardia, acrocyanosis and confusion. Therefore, in the absence of external injuries, the patient must be urgently taken to the hospital for diagnosis and treatment.

Using an anoscope or rectal speculum, you can detect the presence of pus, blood, mucus and urine in the rectum.

• Proctosigmoidoscopy.
• Cystoscopy with bladder catheterization.
• X-ray and ultrasound of the abdominal organs.

Such injuries can be classified into several types:

1. Based on the mechanism of the injury that occurred, they can be divided into subtypes: injuries to the bones and pelvic organs, burns of the sphincter and perineum, surgical intervention, compression and falls, gunshot and cut wounds received during sexual intercourse.
2. By analyzing the volume of the injury, its localization is determined, which can be in the abdominal cavity or outside it.
3. Also, the defect may differ in the degree of injury, which can be simple, more complex due to problems in the functioning of the sphincter, and complicated due to damage to nearby organs.

• In case of minor injuries, these are cracks, excoriations, tears of the mucous membrane and folds in the anal ring. Typically, healing occurs quickly without treatment.
• Treatment methods moderate severity: extraperitoneal dissection of the walls of the rectum and its damage without injury to the peritoneum itself require diagnostic examination and treatment.
• If the integrity of the peritoneum and surrounding organs is compromised, as well as the development infectious inflammation in tissues, then we can claim a severe degree.

Rectal thermometry, cleansing enemas, and speculum examination can lead to superficial traumatic injuries.

Therapeutic manipulations are performed in surgical department medical institution. They will depend on the severity and type of injury. Mandatory procedure is disinfection and suturing of wounds, introduction into the intestinal lumen of gauze with an antiseptic drug in the form of an ointment.

In severe cases, with large areas of disruption of the integrity of tissue surfaces, a colostomy is performed.

• in some cases, enemas;
• diet to avoid intestinal overload;
• antibacterial and anti-inflammatory therapy;
• oil treatment.

If necessary, the doctor additionally individually prescribes the treatment he needs for each patient. Mandatory rule for such patients is compliance with bed rest, which can be long, from 1 to 6 months.

Rectal injuries

Rectal injuries may be caused by : lifting weights, chronic constipation, childbirth complicated by perineal rupture, fall on a protruding object, injury bone fragments in case of a fracture of the pelvic bones, violation of the technique of performing manipulations during sigmoidoscopy, anoscopy, measurement rectal temperature, administering an enema, gunshot wounds.

Features of rectal injuries - this is a frequent infection of the wound, a frequent combination of this injury with damage to nearby tissues and organs, and the danger of damage to the sphincter.

Clinically In case of rectal trauma, the following are observed: pain in the anus, which can lead to fainting, nausea, vomiting, bleeding and possible prolapse of intestinal loops from the anus. An external examination may reveal damage to the anus.

When the rectum ruptures, victims complain of abdominal pain. This occurs due to pneumoperitoneum - air entering the abdominal cavity, which stretches the abdomen. On examination, the abdomen in this case is swollen. In this case, the air interferes with the movement of the diaphragm and complaints of difficulty breathing appear.

The contents of the intestine enter the abdominal cavity, and symptoms of peritonitis appear. Bleeding into the abdominal cavity leads to the development of shock. The victim's condition is rapidly deteriorating. In addition to shock and peritonitis, rectal ruptures are complicated by the development of acute surgical infection: phlegmon, sepsis, anaerobic infection.

To diagnose rectal injuries, the following are used: digital examination, anoscopy, sigmoidoscopy. Treatment is surgical.

Major diseases of the rectum

Non-tumor diseases of the rectum. Clinic, diagnosis, treatment principles.

Sh Developmental defects. Among the developmental defects, atresia is the most common - complete absence lumen of the rectum. There are fusion of the anus, pelvic part of the rectum, or fusion of both sections.

Atresia may be accompanied by an internal or external fistula. An internal fistula opens into the bladder or urethra, external fistula - in the vagina in women and in the scrotum in men.

Clinical picture. On the first day after birth, the child develops intestinal obstruction: vomiting meconium, bloating, severe intoxication. Complete atresia ends in death. In the presence of fistulas, feces are excreted in the urine, so there are no signs of obstruction.

Treatment. Surgery is indicated.

Clinical picture . The main symptom is pain during bowel movements. Droplets of blood are found on the stool. The stool has a ribbon-like appearance as a result of spasm of the anal sphincter. Patients delay defecation for a long time due to pain. When examining the anus, a slit-shaped crack is found in the area of ​​the posterior commissure. Its edges may be dense and calloused.

During digital examination of the rectum, excruciating pain and sphincter spasm occur. Cracks are often combined with inflammation of the skin around the anus.

Treatment. Prescribe suppositories with anesthesin, ascending shower, sitz baths, diet, herbal laxatives. Good effect allows the introduction of various analgesic mixtures under the crack.

Surgical treatment is used if there is no effect from drug therapy. Sphincter stretches are used. The mucous membrane damaged in this way heals quickly. For old cracks, they are excised and sutures are placed on the mucous membrane. IN postoperative period Prescribe jelly, broth, tea, juices. To retain stool for 4-5 days, give 8 drops of opium tincture 2-3 times a day, and then a laxative: castor oil, vaseline oil. After defecation, the patient takes sitz baths with potassium permanganate or sodium bicarbonate.

Sh Haemorrhoids -- varicose veins veins of the rectum, resulting from the formation of arteriovenous anastomoses and arterialization venous blood. Stagnation and disruption of the outflow of venous blood through the portal and mesenteric systems also lead to expansion of the venous nodes. In these cases, they speak of secondary hemorrhoids.

Predisposing factors include: weakness of the venous wall, prolonged chronic constipation, diarrhea, urinary disorders, endocrine disorders, skin diseases in the anal area. Hemorrhoids more often occur in people engaged in sedentary work, in men with constant intake of alcohol, rough, fatty foods, and in women after pregnancy and childbirth.

By location, external and internal hemorrhoids are distinguished. With external hemorrhoids, the nodes are located at the junction of the mucous membrane with the skin, with internal hemorrhoids - above the sphincter of the rectum.

Secondary hemorrhoids are a consequence of heart disease (circulatory failure stage III), liver cirrhosis (impaired portal circulation) or tumors of the abdominal cavity and pelvis (impaired blood flow in the inferior vena cava).

Clinical picture. At the beginning of the disease, itching and burning, a feeling of fullness in the anus, occur. Constant irritation of the mucous membrane leads to higher department mucus, frequent urges to defecate, during which bleeding of varying intensity is observed - from a few drops to a stream. Blood is usually not mixed with stool, which makes it possible to differentiate between hemorrhoidal and gastrointestinal bleeding.

Hemorrhoids can fall out during defecation, straining, or physical work. At first, the nodes correct themselves, but as the disease progresses, the nodes fall out permanently. They fall out even when walking, but after reduction they immediately appear again. This course of the disease may continue long time with periodic exacerbations after drinking alcohol or heavy physical work.

The course of hemorrhoids can be complicated. Constant, sometimes intense blood loss leads to chronic anemia. In advanced cases, the amount of hemoglobin decreases to 10-20 g/l.

Thrombosis occurs during infection or injury hemorrhoids. Hemorrhoids become dense, increase in volume, and their color is purple-bluish. The nodes fall out of the anus and, as a result of swelling and reflex spasm of the sphincter, are not set back, which gives grounds to talk about infringement of the nodes. Poor circulation is accompanied by necrosis of the mucous membrane.

Body temperature rises, leukocytosis is detected in the blood, and hypercoagulation is detected. Thrombosis may spread to the pelvic veins, which is accompanied by intoxication and serious condition, development of pyelophlebitis, liver abscesses.

Hemorrhoids may be accompanied by anal fissures, ulcers, fistulas, and node abscesses. Dermatitis, weeping eczema, and condylomas may occur in the anus area.

Diagnosis established by examining the anus area, during which external nodes are identified. It is necessary to examine the rectum with a finger, perform sigmoidoscopy and anoscopy and, if indicated, colonoscopy, since the source of bleeding can be an intestinal tumor, polyps, or ulcerative colitis.

Treatment conservative. It is necessary to achieve regular bowel movements by prescribing a diet, rich in fruits and vegetables, constant intake of herbal laxatives (infusion of Alexandria leaf), purgen (2 tablets per day) or Vaseline oil, enemas. Anuzol suppositories are prescribed. Good results They give physiotherapeutic procedures (rising shower). Patients are taught the rules of personal hygiene.

For thrombosis of hemorrhoids, bed rest is required, cold is applied to the anus, suppositories with anesthetics, or the nodes are lubricated with an ointment containing anesthesin and heparin. For hypercoagulation, anticoagulants (heparin, phenylin, fraxiparin) are prescribed.

For complicated hemorrhoids (thrombosis of hemorrhoids, bleeding), surgical treatment is indicated. The operation is performed under local anesthesia or under anesthesia. Two types of intervention are used. The simplest and most common method is ligation of hemorrhoids at the base with a silk ligature: the nodes become dead and fall off after 5-8 days. More radical surgery-- excision of nodes with suturing of the mucous membrane (hemorrhoidectomy).

3 days before the operation, the patient is transferred to a diet that does not contain fiber: a laxative is prescribed the day before, the intestines are thoroughly cleansed with enemas the night before and on the morning of the operation. In the postoperative period, bed rest must be observed for 3-4 days. Liquid food give 3 times a day. A laxative is prescribed on the 7th-8th day. After defecation, the patient takes a sitz bath with a solution of potassium permanganate.

Sh Rectal prolapse. Prolapse of the mucous membrane or the entire wall of the rectum occurs through anus. In the development of the disease, weakening of the tone of the anal sphincter is important. Plays an important role in children sharp increase intra-abdominal pressure when coughing, crying, screaming. Rectal prolapse is caused by: prolonged diarrhea or constipation, weakening of the pelvic floor muscles, elderly age and emaciation, as well congenital anomalies(long mesentery upper section rectum, insufficient curvature of the sacrum).

There is prolapse of the mucous membrane of the anus (the mucous membrane falls out along with the muscle ring), rectum (cylindrical protrusion 6-18 cm long), anus and rectum.

Clinical picture. Initially, the rectum falls out only during bowel movements and is reduced on its own. After some time, the intestine begins to prolapse with any increase in intra-abdominal pressure and, finally, while walking. Patients complain of discomfort in the anus, mucous membranes and bloody issues. The mucous membrane of the prolapsed section ulcerates, swells, and the patient does not retain feces and gases well. The prolapsed area may become pinched and necrotic.

Diagnosis. The patient is asked to strain in a squatting position and the size of the prolapsed area is determined. It is necessary to establish sphincter tone using digital examination of the rectum.

Treatment. Conservative treatment is possible in children if the cause of the prolapse (for example, diarrhea) can be eliminated medicines. In adults conservative treatment(reduction) is used for loss after heavy lifting or dysenteric diarrhea. The reduction can be performed by a paramedic with the patient on the left side with the head end of the table lowered or in the knee-elbow position. Erosions and ulcers are cauterized with silver nitrate (lapis) before repositioning the intestine. Surgical treatment is indicated in cases where the prolapse becomes permanent.

Of the numerous operations, the most commonly used are strengthening the anus by narrowing it, fixing the rectosigmoid region inside the pelvis, and removing part of the rectal mucosa.

In the postoperative period, bed rest and a diet with limited fiber are prescribed. Heavy physical work after these operations is contraindicated.

Sh Paraproctitis- inflammation of the peri-rectal tissue. Occurs as a result of infection through the mucous membrane or skin during injury, hemorrhoids, constipation, and diarrhea. In cases of infection with anaerobic microbes, a putrefactive course is observed. Ulcers can be located under the mucous membrane or under the skin. There is a very deep location of abscesses along the rectum to the border of the small pelvis. Purulent melting can capture the entire tissue of the pelvis.

Clinical picture . The disease usually begins acutely, with an increase in body temperature to 39-40 C and chills. Pain appears in the anus, intensifying with defecation. Upon examination, swelling, pain, and hyperemia are determined skin, and with a superficial location of the abscess - fluctuation. Regional inguinal The lymph nodes increase.

With deeply located ulcers, the pain is localized in the lower abdomen, and there may be a urge to defecate and frequent urination. Soreness and softening are determined only with a deep digital examination of the walls of the rectum. Diagnostic errors occur when acute paraproctitis mistaken for appendicitis or inflammation of the female genital organs.

Treatment in the initial phase it is conservative: antibiotics, heat baths. You should not hesitate to open the abscess. If the abscess opens on its own, a fistula is formed, through which purulent cavity is not completely emptied, which leads to the occurrence of chronic recurrent paraproctitis and fistulas.

The abscess is opened under local anesthesia or general anesthesia, the pus is removed, the cavity is examined with a finger, all pockets are opened, loosely tamponed with ointment napkins. Perform periodic dressings with changing tampons and wash the cavity with antiseptic solutions. For granulating wounds, warm baths with antiseptic solutions are used. It is necessary to achieve granulation of the cavity from the inside and not allow the skin wound to close prematurely.

For anaerobic infection, anti-gangrenous serum and antibiotics are administered wide range, sulfonamide drugs. In case of severe intoxication, fluid transfusion is indicated: 5% glucose solution, hemodez, blood. The food should be high-calorie, slag-free.

Sh Pararectal fistulas occur after non-radical treatment of acute paraproctitis, with rectal tuberculosis, as a result of trauma and damage.

Clinical picture . Fistula tracts open on the skin around the anus or inside the rectum on the mucous membrane; in some cases, the fistula tract can be complete - open on the skin and in the rectum on the mucous membrane. Fistulas usually have a tortuous course, granulation and scar tissue develops around them. Through the fistulous tract, pus and feces are separated (with complete fistulas). When the fistula tract is blocked, inflammation occurs with hyperemia of the skin and infiltration of surrounding tissues. After the fistula breaks through and the pus separates, the inflammation subsides.

Diagnosis established on the basis of anamnestic data - indications of acute paraproctitis, complaints of constant separation of pus and feces from the fistula, pain, itching, burning in the anus. The course of the fistula is determined using fistulography: a contrast agent is injected into the fistula tract, after which an x-ray is taken. The progress is clarified using a probe.

Treatment. The main method is surgical. But relapses of the disease are possible.

The operation is performed under general anesthesia. The fistula tract is excised from the internal opening to the external one, the wound is not sutured. Also used ligature method: the passage is gradually cut with a silk ligature inserted into the lumen of the fistula, which is gradually tightened during the treatment process. You can also cut the fistula, turning it into open wound, which heals by secondary intention.