Anal and Rectal Disorders Causes | Rectal Prolapse | Anus Prolapse Causes

Anal and Rectal Disorders:

• Prolapse of rectum can be differentiated into
  • Partial Prolapse
  • Complete Prolapse.

Partial prolapse – when only the mucosa of the rectum comes out through the anus it is called partial prolapse. The length of such prolapse is never more than 3.75cm. If this prolapsed mass is palpated with one finger inside the anus and the thumb on the outside of the anus, it will be evident that it is composed of the two layers of mucous membrane with sub-mucosa in between.

Complete prolapse – in this condition the rectum comes out through the anus and the protrusion consists of all the layers of the rectal wall. It is descending sliding hernia. It is always more than 3.75cm in length and usually about 10cm in length. If palpated between finger and the thumb, double thickness of the entire wall of the rectum can be palpated.

Complete prolapse contains a pouch of peritoneum anteriorly between its walls. When the prolapse is a very large one this peritoneal cavity contains even coils of small intestine. Complete prolapse is rare in children, but it may occur at any age but is more common in the elderly. Women are affected five times more than the men. It is often accompanied with prolapse of uterus.

Anorectal abscess:

Abscesses around lower rectum and anal canal are known as anorectal abscesses. These are important as this often culminates in fistula-in-ano.

Classification -

a. Perianal (60%),

b. Ischiorectal (30%),

c. sub-mucous and

d. Pelvi-rectal.

a. Perianal- majority of these abscesses arise from acute inflammation of anal gland. Inflammation of a thrombosed external pile may also result in perianal abscess.

b. Ischiorectal abscess- commonest cause if extension if anal gland inflammation. Infection continues for a very long due to poor vascularization.

c. Sub-mucous abscess- this abscess is situated just deep to the mucous membrane of the anal canal above the dentate line. It occurs usually from spread of infection from the anal gland or even after injection of hemorrhoids.

d. Pelvi-rectal abscess- this is situated above the pelvic floor and below the pelvic peritoneum.

Fistula-in-ano:

Fistula-in-ano is an inflammatory track which has an external opening (secondary opening) in the perianal skin and an internal opening (primary opening) in the anal canal or rectum. This track is lined by unhealthy granulation tissue and fibrous tissue.

Fistula-in-ano usually originates from infection in anal gland, ulcerative colitis, Crohn’s disease, tuberculosis and colloid carcinoma of the rectum.

Anal fistula can be divided into two groups-

i. low fistula and

ii. High fistula depending on whether the internal opening is below or above the anorectal ring respectively.

Hemorrhoids (piles):

These are dilated veins within the anal canal in the sub-epithelial region formed by radicles of the superior, middle and inferior rectal veins.

Hemorrhoids are clearly divided into two categories-

i. internal and

ii. External.

Internal hemorrhoid means it is situated within the anal canal and internal orifice. It is covered with mucous membrane and it is bright red or purple in color. It is usually commences at the anorectal ring and ends at the dentate line.

The external hemorrhoid is situated outside the anal orifice and is covered by skin. The two varieties may co-exist and is called as interno-external hemorrhoids.

Fissure-in-ano:

Fissure-in-ano is a very common and painful condition. Fissures occur most commonly in the midline posteriorly, the least protected part of the anal canal.

In males, fissures usually occur in the midline posteriorly (90%) and much less commonly anteriorly (10%).

In females fissures on the midline posteriorly are slightly commoner than anteriorly (60:40). The relative frequency of the anterior fissures in the females can be explained due to trauma caused by fetal head on the anterior wall of the anal canal during delivery.

Neoplasms or carcinoma of the rectum and anal canal.

Congenital abnormalities: Imperforate anus -

This is common congenital abnormality in which there is imperfect fusion between the hindgut and lower part of the anal canal below the dentate line. This can be low anomaly and high anomaly depending on whether the termination of the bowel is below or above the pelvic floor respectively.

Pilonidal sinus:

This is an acquired condition and seen in adult males. This is hardly seen in females. While sitting the buttocks move and hairs broken off by friction and collect in the cleft. When toilet paper is used hair entangled in fecal matter will also be swept into the cleft. Such loose hairs travel down the inter-gluteal furrow to penetrate the soft and moistened skin at that region or enter the open mouth of a sudoriferous gland. After the initial entry dermatitis and inflammation start around the loose hairs and once the sinus is formed, intermittent negative pressure of the area may suck other loose hairs in the pit.

This sinus extends into the sub-cutaneous tissue. Tuft of hair is always seen within such sinus embedded in granulation tissue.

Proctitis:

Inflammation of the rectal mucosa is known as proctitis. Here the mucosa of the rectum is swollen and tender.

Pruritus ani:

It is a common problem. It means intractable itching around the anus. It can be due to various ano-rectal diseases e.g. anal fissure, fistula-in-ano, carcinoma of the anal canal and other causes are dermatitis, jaundice, diarrhea, parasitic causes, allergy, moniliasis etc.

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