Proctitis and Rectal Prolapse
The anus is an aperture at the end of the gastro-intestinal tract from where bowels are passed out of the body. The anus constitutes partly the skin surface and partially the intestine from within. The anal sphincter controls the opening of the anal passage. The rectum is the portion of the intestinal tract right above the anal region where the bowels are held before defecation. The rectal wall is lined by mucus glands and supplied profusely with blood vessels and nerves. However, the rectal lining is comparatively insensitive to pain. As opposed to it, the anal region is highly sensitive and delicate. Together, the ano-rectal part of the digestive tract is a very important segment of the last process of digestion. The ano-rectal area can have various types of disorders like haemorrhoids, fissures, abscesses and cancer.
An inflammation of the rectal mucosa, proctosis is either very painful or painless. The inflamed lining can occur due to an infection or due to any other gastro-intestinal disease. Proctosis is quite a common problem, severely affecting people with Crohn’s disease and ulcerative colitis. The problem is more prevalent among homosexual men who easily contract sexually transmitted diseases (STDs) and a high risk of developing in people whose immune system is compromised due to herpes and cytomegaloviral infections. Non-sexually transmitted Salmonella bacteria can also cause Proctosis. Sometimes consistent use of antibiotics impairs the functions of intestinal microbiota, thereby making the rectal lining easily susceptible to infections. Radiation therapy during ano-rectal cancer treatment is another reason that the rectal mucosa becomes frail, causing inflammation and infections.
Antibiotics like metronidazole or vancomycin are helpful in destroying the pathogenic bacteria and in regaining the normal intestinal microenvironment, thereby alleviating inflammation. If proctosis occurs because of radiation, costicosteroids are given topically or mesalamine is alternately given orally as an anti-inflammatory drug. Some other anti-inflammatory drugs can be administered rectally to provide immediate comfort. If the inflammation is accompanied by bleeding, laser treatment and electro-coagulation are used to clot the blood.
Rectal prolapse is caused due to excessive straining of the rectum while emptying the bowel, because of which the rectal portion turns inside out. In such a case, the rectum can be seen hanging out of the anus as a visibly dark red, moist and finger-like part outside the body. Rectal prolapse leads to bleeding and incontinence wherein a person loses voluntary control of their bowel movement. In rare cases, in females the rectal lining may protrude into the vaginal part (rectocele). The problem is generally mostly painless and temporary, causing pain and discomfort only in acute or severe cases. Usually, in infants due to constipation and strained stools, the rectal mucosa projects out and recuperates on its own. However, in adults the rectal portion might also turn inside out, worsening the condition and causing excruciating pain and bleeding. When the complete rectum prolapses, generally occuring in women beyond the age of 60 years, the condition is known as procidentia.
A rectal prolapse usually heals without surgery in infants and children. Strapping of kids’ buttocks during defecation helps undo the straining and thereby soothes the problem. In adults and in older people facing the problem, surgical correction or removal of rectum is the solution, depending on the severity of the condition. Surgery is done to correct the prolapse by lifting the entire portion, pulls back and attaches the part to the pelvic bone, or a portion of the rectum is removed and remaining portion is attached back. In older population, who are fragile to rectal surgery, abdomen is operated and rectal lining is corrected. In another technique called as Thiersch procedure, a wire is encircled around the anal sphincter to pull up the protruded rectal part. If all else fails, then the final resort is to excise the excess segment.
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