rectum and anal canal

The rectum, also called the rectum, is the last part of the large intestine and ends with the anus. The rectum is divided into 3 thirds and is about 18cm long. It serves as a reservoir for the chair.

Benign diseases

hemorrhoids

It is an arterially fed cavernous body that, together with the sphincter muscles, maintains continence. In this area there is also a highly specialized mucous membrane, the anoderm, which allows the distinction between "wind", liquid and solid stool. Chronic constipation, frequent bowel movements, increased pressing, or, more generally speaking, an increase in pressure in the abdominal cavity that hinders the venous outflow, the hemorrhoids can enlarge and also prolapse. Type. Symptoms: burning and /or itching around the anus, bleeding, pain, etc.

Hemorrhoids are divided into 4 grades:

Grade I: The hemorrhoids are not visible from the outside, they can only be shown proctoscopically. The nodes bulge only slightly inside the intestinal tube. Fully reversible, there is usually no pain.

Grade II: The knots fall forward when pressed into the anal canal, but after a short time they pull back on their own. The enlarged hemorrhoids are no longer able to regress on their own.

Grade III: One or more lumps can appear spontaneously during exertion. After a bowel movement, they no longer withdraw on their own. The reduction (pushing in) is still possible. Entrapment and bleeding may occur.

Grade IV: Corresponds to an anal prolapse (stepping deeper). The reduction (pushing in) is no longer possible.

The therapy is stage-appropriate and depends on the severity of the disease. If an ointment /suppository cure does not lead to the goal, an operative rehabilitation should be considered.

Here, too, the therapy depends on the severity of the disease (stage-appropriate therapy approach ) and is decided individually: the hemorrhoids (and the anoderm) are the most important continence organ as possible. Only pathologically enlarged parts should be treated. Various techniques are available here. The most elegant method is not to touch the hemorrhoid itself, but simply to locate the supplying artery using an ultrasound and to prevent it selectively (HAL - hemorrhoid arteria ligation). This leaves the hemorrhoid fully intact and shrinks to a normal size. This technique is extremely painless because nothing is cut away, it preserves the hemorrhoids and also the continence. If the hemorrhoids also occur, the above-mentioned technique is expanded and a RAR (recto anal repair) is connected to the HAL. With this technique, the haemorrhoid that has occurred is relocated back to the anatomically correct location, namely in the anal canal, and fixed there. This means that hemorrhoids up to stage 3 can be optimally treated. This procedure also preserves the hemorrhoids and is as painless as the HAL. The laser technology also shows very good results and enjoys high patient satisfaction.

Other techniques such as rubber band ligation (Baron), Milligan Morgan, Parks, Longo, Starr, etc. are used much less frequently these days. Most of the techniques are performed under anesthesia. In the case of bleeding from the anal canal in particular, a profound intestinal examination in the sense of a colonoscopy (colonoscopy) to rule out another cause of bleeding and to exclude carcinoma is mandatory, even with proven hemorrhoids.

Anal fissure

An anal fissure is a painful tear in the mucous membrane in the anal canal. This tear in the mucous membrane can occur acutely with pain and bleeding, or it can be chronically recurrent. On the one hand, this is based on an excessively strong sphincter muscle that tears in the mucous membrane with or without a stool problem.

The therapy begins with stool regulation and a suppository and ointment treatment. As an alternative to this, especially in the case of a chronic fissure, the underlying pathology, namely the increased sphincter tone, is treated with dilation (stretching) or, much better, with Botox. The sphincter is only temporarily weakened and the fissure can heal. Partial spincter severance is now extremely rarely performed.

Anal fistula

The starting point are small abscesses in the crypts in the anal area, which are connected to the anal glands and then spread further against or through the sphincter in the surrounding tissue and can sometimes assume a fox-like shape. Ultimately, the fistula breaks through to the outside. The symptoms depend on the localization and also on whether there is a larger abscess cavity and can range from bleeding, fever, fatigue to purulent discharges, and many more. Inflammatory Bowel Disease (IBD), especially Crohn's disease.

Endoscopy (at least rectoscopy) and magnetic resonance imaging of the small pelvis is recommended for diagnosis. The therapy can only be performed surgically and depends on the course, the localization and, above all, the positional relationship to the sphincter muscle and ranges from fistula splitting, through fistula extirpation, to endless drainage. Newer techniques with lasers or plugs of different materials are promising alternatives. A profound intestinal examination in the sense of a colonoscopy to rule out Crohn's disease is mandatory.

Rectocele

A rectocele is the forward protrusion of the rectum wall - in women towards the vagina, in men towards the urethra - due to a weakness of the wall layers or the pelvic floor. Initially, the patient feels a feeling of pressure in the pelvis, later on it comes to chronic constipation due to problems with draining (outlet obstruction).

A suitable therapy is planned depending on the degree of severity and relevance for the patient. With the exception of chair optimization, there is no drug therapy. Surgically, the sagging wall can be gathered with a partial Delorme, full-wall sliding flap, a Longo or Trans-STARR if it is less pronounced. If it is more severe, if it has a prolapse (rectal prolapse), intussusception and cul-de-sac syndrome, other techniques such as Altemeier and /or a laparoscopic ventral mesh rectopexy are indicated.

Rectal prolapse

A rectal prolapse is a prolapse of the rectum, which results in an insufficient blood supply to the intestinal wall with associated pain. If the upper rectum invades into the lower rectum without passing through the anal canal, it is an intussusception and otherwise a prolapse in the real sense.

The leading symptom in intussusception is the feeling of incomplete emptying and in prolapse the pain and also the continence disorder. Due to the insufficient blood flow, medical help should be sought immediately, especially if it is a new prolapse with pain, or if a chronic prolapse has circulatory disorders (rosy color of the mucous membrane changes). The aim is to restore the blood circulation as quickly as possible and then to carry out a final rehabilitation.

Depending on the local situation, the condition of the upstream intestine, the general condition and the patient's request, an operation according to Rehn-Delorme with resection of the excess mucous membrane and ruffling of the muscular wall, an operation according to Altemeier (perineal rectosigmoideectomy) or a laparoscopic mesh rectopexy is performed. Here, the intestine is mobilized via a laparoscopy, stretched and then fastened so that it can no longer invade.

The laparoscopic ventral mesh rectopexy is the most modern technique and shows the best short-term and long-term results. Depending on the severity of the pathology, the laparoscopic ventral mesh rectopexy can be combined with an intestinal resection (sigma resection). The appropriate method must be decided individually depending on the severity and complaints. The diagnosis must include an intestinal examination, e.g. colonoscopy and defecography. The bowel prolapses are often coupled with incidents of the female genital tract with or without involvement of the urological system. In this case, the rehabilitation must be planned together with a gynecourologist.

Incontinence

Fecal incontinence is the uncontrollable discharge of stool and gases from the intestine. Although faecal incontinence is common, many patients find it uncomfortable to see a doctor, although in many cases they can be helped. First of all, the cause of the incontinence must be found. Frequent causes are greatly enlarged hemorrhoids with or without anal prolapse, rectal prolapse, inflammatory diseases, fistulas, diarrhea, paradoxical diarrhea, damage to the sphincter muscle through surgery, childbirth, but also nerve diseases (e.g. diabetes, diabetes mellitus) can cause incontinence. The necessary examinations include a detailed anamnesis, an examination of the anal canal and an endosonography, a pressure measurement of the sphincter and an X-ray examination of the defecation process.

The basic therapy for faecal incontinence consists on the one hand of a diet rich in fiber and pelvic floor exercises. These measures are intended to improve the consistency of the stool, enable regular defecation and strengthen the muscles of the pelvic floor. Furthermore, the use of biofeedback can be useful in order to be able to better control stool evacuation by making the activity of the sphincter muscles more aware. If these conservative measures are not sufficient, sacral nerve stimulation can stimulate the pelvic floor nerves by means of electricity and thus lead to better sensitivity of the rectum. In the case of selected defects of the sphincter, surgical procedures are also used that aim to tighten or restore the damaged sphincter.

Not benign diseases

Colon cancer, colon cancer, rectal cancer, colorectal cancer, colon cancer, rectal cancer

You can find detailed information about colon cancer, colon cancer, rectal cancer, colorectal cancer, colon cancer, rectal cancer here.

Anal cancer

It is a squamous cell carcinoma and therefore does not, by definition, originate from the intestinal mucosa but from the (outer) anal mucosa. The disease occurs more frequently with HPV infections (human papilloma virus; wart virus), with immunosuppression as part of an HIV infection, with chronic. inflammatory dramatic diseases (IBD) with involvement of the anus (fisting, etc.) and with anal intercourse.

Symptoms that can occur with anal cancer and should therefore be clarified are blood deposits on the stool, pain in the anal canal area, irregular stool and itching, pain, swelling, tumors in the area of ​​the anus. In order to be able to make the diagnosis of anal cancer, a rectal examination and a procto-rectoscopy with sampling must be performed.

The therapy for anal cancer consists in the very early stages of Aldara. This therapy is also used in part for genital warts (STD). In more advanced stages from a primary combination of chemotherapy and radiation and possibly subsequent surgical removal of the tumor, depending on the stage and extent.