When unpleasant, and often painful sensations in the rectal area. However, by the time the decision to visit a doctor is made, the disease often takes neglected form... Such a critical form of proctological diseases is purulent paraproctitis.
Folk remedies can be used to treat various diseases.
In order to rid the patient of inflammatory processes, the abscess must be opened, rinsed and removed from the accumulated pus. Also, if the paraproctitis was severely neglected, in addition to flushing and drainage (removal of pus), it is necessary to perform a procedure for cleaning the fistula - a purulent course that occurs in the presence of especially neglected abscesses. This procedure is extremely delicate, requiring an experienced specialist.
It should be remembered that an untimely visit to a doctor with an advanced case of paraproctitis threatens the patient with destruction of the rectal wall or urethra.
Symptoms of paraproctitis and its forms
Surgical treatment of paraproctitis
A rapidly developing disease requires immediate contact with a specialist doctor in the event that you have symptoms such as:
- (its manifestations may be fever, general weakness, headaches, body aches and loss of appetite)
- Constipation and when trying to go to the toilet
- Also, pain is accompanied by the urinary process.
- Unreasonable occurrence of foci of pain and swelling in the anus.
In addition to the listed main symptoms, there are also particular signs that accompany the following forms of paraproctitis:
- Spicy. It is characterized by pronounced manifestations of the above main symptoms, however, it requires an individual selection of treatment
- Chronic. Characterized by the occurrence of a fistula that destroys the walls small intestine and requires immediate surgery followed by regular drainage
- Purulent. Not just an abscess is formed, but a whole cavity filled with pus. Immediate action is required to prevent fistula from occurring
- Ishiorectal. The abscess itself is located in a deep layer of pararectal tissue (located under the skin), which is why this form of paraproctitis is difficult to diagnose. Many of the symptoms of ischiorectal paraproctitis are often mistaken for a respiratory infection.
Thus, almost every form of paraproctitis can be mistaken for an ordinary viral infection or one of the manifestations of hemorrhoids, not only by the patient himself, but also by doctors. To avoid serious consequences such an error will be helped by a thorough examination by a qualified specialist, performed using a rectal mirror, as well as an ultrasound procedure.
Paraproctitis: treatment
You need to use folk remedies with caution!
A disease such as paraproctitis, in most cases, requires surgery. It is the responsibility of the physician to refer the patient to the operating room immediately after confirming the diagnosis. There, the patient will perform an autopsy and drainage of the abscess.
In addition to draining the purulent focus, during the operation, the crypt, which is the source of the infection, is excised, and in especially advanced, acute cases of paraproctitis, the fistula is also excised, after which the procedure will be considered finally completed.
In the event that there were infiltrated areas in the canal, it would be appropriate to prescribe a course of anti-inflammatory and antibacterial therapy in the preoperative period, but even in this case, surgery should in no case be postponed for a long time. However, in some cases, the operation is impossible. These are cases such as:
- Fairly old age
- Strong weakening of the body
- Decompensated diseases of internal organs.
Treatment of the disease with folk remedies
Folk remedies are more effective in the early stages of the disease
Often in the event that it is undesirable to operate on paraproctitis for one reason or another, patients resort to remedies traditional medicine... And in the event that the disease has not yet had time to acquire an acute form, such treatment can have a positive effect.
Treatment of paraproctitis tried by many generations folk remedies in the early stages of the disease, it often helps to avoid opening the abscess by the doctor, allowing it to open spontaneously. However, even in this case, you need to see a doctor in order to treat the burst abscess, remove the pus and excise the fistula.
There are several ways to treat paraproctitis at home: using medicinal baths, and using special medicinal teas... Among the most effective solutions for baths consider:
- Saline bath to relieve inflammation and reduce pain... To prepare it, you need to take 1 tbsp. l. salt and 1 tbsp. l. soda, mix and dilute in 5 liters. distilled water.
- The course of treatment is 15 procedures, after each of which it is recommended to use the ointment prescribed by the doctor.
- Mummy solution. To prepare this composition, you will need 200 ml of boiled water and 10 mummy tablets. The expressed solution must be dissolved in five liters of boiled warm water.
- The procedure is also effective, in which a mixture of 2 liters of warmed milk, 2 onions and 5-6 cloves of garlic is used as a bath. The mixture must be cooked for 3-4 minutes, then cool thoroughly. When taking this bath, you need to ensure that the patient's body is warm.
Treatment of paraproctitis with folk remedies should be carried out under the supervision of a doctor!
Microclysters and tampons impregnated with special formulations are good both in themselves and in conjunction with treatment with baths:
- A solution of 100 ml of water and 1 tbsp. l. mix honey with separately prepared infusion of sage, chamomile and yarrow. Inject 40 ml immediately after the cleaning procedure.
- Squeeze the juice of a small well-peeled potato and inject 1 tbsp each with an enema. l. in 10 days. It is advisable to perform the procedure before bedtime.
Strengthen the body and relieve discomfort healing infusions and teas help:
- You can brew a collection of plantain, yarrow and marshmallow leaves and apply 150 ml 4 times a day.
- Pour 3 liters. boiling water 3 grams of stone oil and leave for 3 days. Take 200 grams after each meal, if the body accepts such an infusion well.
Paraproctitis is an extremely dangerous and inconvenient disease. And, as you know, it is easier to avoid it than to completely cure it. In order not to encounter paraproctitis, you must drink to consume enough fluids, and lead a healthy, active lifestyle.
How to behave in case of an "uncomfortable" illness, the video will tell:
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- an inflammatory process in the area of rectal fiber. It is manifested by a sharp soreness in the area anus and perineum, high fever, chills, defecation and urination disorders. Localized edema and redness of the anal area, the formation of infiltration and abscess. Complications include the development of chronic paraproctitis, fistulas, involvement of organs in the inflammatory process genitourinary system, sepsis. Treatment is always surgical, with acute inflammation carry out an autopsy, drainage, with chronic fistula excision.
General information
- a disease characterized by inflammation and suppuration of the tissues surrounding the rectum as a result of penetration bacterial infection from the lumen of the rectum through the anal glands of the bottom of Morgan crypts into the deep layers of the pararectal region. In modern proctology, paraproctitis is divided into acute (first identified) and chronic (long-term, recurrent). Chronic paraproctitis is the result of insufficient or wrong treatment acute paraproctitis.
Chronic paraproctitis usually covers the morganic crypt, the space between the internal and external sphincters, and peri-rectal tissue. The result of long-standing chronic paraproctitis of this magnitude can be pararectal fistulas of the rectum (pathological canals connecting the rectum to the skin or nearby hollow organs). Identification of a pararectal fistula indicates an acute paraproctitis that has taken place.
Causes of paraproctitis
The causative agent of infection is most often a mixed flora: staphylococci and streptococci, Escherichia coli. In some cases, a specific infection may occur: clostridia, actinomycosis, tuberculosis. Specific paraproctitis occurs no more often than in 1-2% of patients. The development of paraproctitis is facilitated by a decrease immune properties organism, general exhaustion, chronic diseases of organs and systems, acute or chronic infection digestive tract, specific infectious diseases, stool disorders (constipation or diarrhea), proctological pathologies (proctitis, hemorrhoids, anal fissure, cryptitis, papillitis).
Classification
Paraproctitis, depending on the location and extent of the process, is divided into subcutaneous paraproctitis (pararectal abscess), intrasphincteric, ishiorectal and pelviorectal paraproctitis. Subcutaneous paraproctitis is characterized by purulent fusion of subcutaneous tissue in the perianal region. This type of paraproctitis is the most easily treatable and has the most favorable prognosis.
With intrasphincteric paraproctitis, inflammation affects the tissues of the anal sphincter, with ishiorectal paraproctitis, the purulent process is localized in the ilio-rectal fossa. Inflammation in pelviorectal paraproctitis develops inside the small pelvis.
Symptoms of paraproctitis
Acute paraproctitis is manifested by symptoms characteristic of local purulent inflammation, pain, hyperemia, hyperthermia and tissue edema, and suppuration. Unlike nonspecific aerobic flora, anaerobic microorganisms contribute not to purulent fusion, but to necrotic tissue destruction. The predominance of putrefactive anaerobic flora contributes to the development of putrefactive paraproctitis, which is characterized by large-scale lesions, a high rate of tissue destruction and severe intoxication. With non-clostridial anaerobic paraproctitis, muscles and fascial structures are often involved in the pathological purulent process.
Chronic paraproctitis is the result of untreated acute paraproctitis, therefore its symptomatology most often repeats that of acute paraproctitis, but their severity is usually less. In chronic paraproctitis, a pararectal fistula often develops, which is manifested by secretions in the perineal region of ichor or pus. Constant discharge can irritate the skin of the perineum and cause itching.
A well-drained (having a free outlet for pus) pararectal fistula usually does not bother the patient with pain or discomfort. Pain symptom characteristic of an incomplete internal fistula. In this case, the pain increases during bowel movements and subsides after it (this is due to improved drainage of the fistula at the time of stretching of the anal valve).
Clinical signs of a pararectal fistula appear in waves, subside and aggravate again. This is due to the periodic blockage of the fistulous lumen, the formation purulent abscess, after opening which comes relief. The fistula does not heal on its own, the purulent processes in it continue. If blood impurities appear in the purulent discharge, it is necessary to conduct research for a malignant formation.
Complications
The most dangerous complication of acute paraproctitis is the penetration of a purulent process into the tissue-filled space of the small pelvis, as well as purulent fusion of all layers of the intestinal wall above the anorectal line. At the same time, there is an exit feces into the pararectal tissue, affecting nearby organs and threatening the release of the infection into the bloodstream (the development of sepsis).
Anatomical proximity pelvic peritoneum makes possible the spread of infection with the development of peritonitis. The proximity of pelvic tissue with retroperitoneal tissue allows pus to break through into the retroperitoneal space. Such a spread of the purulent process is typical for the elderly and weakened persons with a late visit to the doctor.
Among other things, paraproctitis can be complicated by the breakthrough of an abscess into the rectum, vagina, and on the skin of the perineum. Usually, after spontaneous opening of the abscess without the implementation of drainage measures, a fistulous passage is formed. If the fistula has not formed, but the focus of infection is preserved, then a relapse occurs over time - the formation of a new abscess.
The prolonged existence of a fistula of the rectum, especially having a complex structure of the canal (areas of infiltration, purulent cavities), contributes to a significant deterioration general condition sick. Chronic course purulent process leads to cicatricial changes, deformation of the anal canal, rectum.
Deformation leads to tonic insufficiency of the anal sphincter, incomplete closure anal passage, leakage of intestinal contents. Another common complication of chronic paraproctitis is pathological scarring (pectenosis) of the anal canal walls and a decrease in their elasticity, which leads to impaired bowel movement. A long-standing fistula (more than 5 years) can become malignant.
Diagnostics
For the preliminary diagnosis of paraproctitis, the proctologist has enough data from the survey, examination and physical examination. Typical clinical signs: fever, local soreness, symptoms of purulent inflammation. Due to the extreme pain of the procedures, digital examination of the anus and methods instrumental diagnostics proctological diseases (anoscopy, sigmoidoscopy) are not performed. In the study of blood, signs of purulent inflammation are noted: leukocytosis with neutrophilia, increased ESR.
Acute paraproctitis basically has to be differentiated from suppurative teratoma of peri-rectal tissue, tumors of the rectum and surrounding tissues, abscess of the Douglas space. The need for additional research to differentiate paraproctitis from other diseases usually arises in the case of a high location of the abscess (in the small pelvis or ileal-rectal fossa).
The formed pararectal fistula must be differentiated from the cyst of the peri-rectal fat, osteomyelitis of the terminal spine, tuberculous fistula, epithelial coccygeal passage and fistula in patients with Crohn's disease. For differential diagnosis significant data of anamnesis, laboratory tests, radiography of the small pelvis.
Paraproctitis treatment
The disease requires surgical treatment. Immediately after establishing the diagnosis of acute paraproctitis, it is necessary to perform an operation to open and drain the purulent focus. Since muscle relaxation and quality pain relief are important factors, it is necessary complete anesthesia operating area. The operation is currently performed under epidural or sacral anesthesia, in some cases (with damage to the abdominal cavity), general anesthesia is given. Local anesthesia is not performed when opening pararectal abscesses.
During the operation, the accumulation of pus is found and opened, the contents are pumped out, after which the crypt, which is the source of the infection, is found and excised along with the purulent passage. After complete removal of the focus of infection and high-quality drainage of the abscess cavity, you can count on recovery. The most difficult task is to open the abscess located in the pelvic cavity.
In chronic paraproctitis, the formed fistula must be excised. However, surgery for removal of the fistula during the period of active purulent inflammation is impossible. First, the existing abscesses are opened, thorough drainage is performed, only after that the fistula can be removed. In the case of infiltrated areas in the canal, a course of anti-inflammatory and antibacterial therapy is prescribed as a preoperative preparation, often combined with methods of physiotherapy. It is advisable to carry out surgery to remove the fistulous tract as soon as possible, since the recurrence of inflammation and suppuration can occur quite quickly.
In some cases ( old age, weakened body, severe decompensated diseases of organs and systems), the operation becomes impossible. However, in such cases, it is desirable conservative methods to treat pathologies, improve the patient's condition and then perform an operation. In some cases, when the closure of the fistulous passages occurs during prolonged remission, the operation is postponed, since it becomes problematic to clearly define the canal to be excised. It is advisable to operate when there is a well-visualized landmark - an open fistulous passage.
Forecast and prevention
After a timely full surgical treatment acute paraproctitis (with excision of the affected crypt and purulent passage into the rectum), recovery occurs. In the absence of treatment or insufficient drainage, failure to remove the source of infection, paraproctitis becomes chronic and a fistulous tract is formed.
Excision of fistulas located in the lower parts of the peri-intestinal space, as a rule, also leads to complete recovery... Higher fistulas can most often be removed without complications, but sometimes long-standing fistulous passages contribute to the spread of sluggish purulent inflammation in the anatomical formations of the small pelvis that are difficult to access, which leads to incomplete removal of the infection and subsequent relapses. An extensive, prolonged purulent process can provoke cicatricial changes in the walls of the anal canal, sphincters, and adhesions in the small pelvis.
Increasing pain in the perineum, heat and problematic sitting in a chair are delicate problems, but they interfere so much with the usual pace of life that they force even the most shy people to seek medical help.
In a quarter of cases of rectal pathology, a proctologist diagnoses paraproctitis and prescribes an operation.
In search of an opportunity to avoid surgical intervention, the patient must clearly understand the danger of complications of paraproctitis in case of untimely or inadequate treatment.
Paraproctitis: what is it?
Paraproctitis is acute, in the absence or ineffectiveness of treatment, turning into a chronic form purulent inflammation fiber of the pararectal zone. In other words, in the peri-rectal space filled with fatty tissue, an abscess forms - an abscess.
The purulent process that has begun cannot be stopped: in any case, necrosis of infected tissues occurs. Besides acute paraproctitis has a high chance of becoming chronic.
Spontaneous opening of an abscess gives only temporary relief, and repeated suppuration is fraught with the formation of a fistula that either goes into the lumen of the rectum or through the skin of the anal zone.
Most often, paraproctitis is diagnosed in men. It is extremely rare that the disease develops in children after surgical elimination of congenital defects in the development of the anus and narrowing of the rectum.
The severity of the symptoms of paraproctitis, the lack of chances for self-healing and the effectiveness of non-surgical therapy, as well as serious complications require immediate medical care with the appearance of the first symptoms of the disease and qualified surgical care.
Forms of pathology
- downstream - acute (first formed) and chronic (formed fistulas);
- by the depth of the location of the pathology - superficial, deep;
- by localization of purulent foci - subcutaneous, submucous, intrasphincteral (located between the fibers of the external and internal sphincter), ischio-rectal (abscess located in the perineum, outside the anal sphincter), pelvio-rectal (high location, high threat of total purulent process);
- by the presence of a fistulous outlet - incomplete (there is only an entrance through the anal crypt) and complete (an abscess found an outlet through the skin, into abdominal space or into the lumen of the rectum);
- in relation to the fistula to the anal sphincter - intra-, extra- and transsphincter;
- by the complexity of the structure of the fistulous passages - simple and complex (the presence of several passages, leaks and purulent pockets).
The main culprits of paraproctitis are anaerobic bacteria: Escherichia coli, often in collaboration with staphylococci and streptococci.
The infection enters the tissue surrounding the rectum through the glandular ducts (Morgan crypts) that open into the anal canal or through microdamage to the rectal mucosa.
The hematogenous / lymphogenous pathway of spreading the infection is not excluded. The causative agent from chronic foci of infection (caries, sinusitis, chronic tonsillitis) with the flow of blood or lymph reaches the anal zone and multiplies in the peri-rectal tissue.
Factors provoking the development of paraproctitis:
- haemorrhoids,
- nonspecific ulcerative colitis,
- anal and rectal fissures,
- Crohn's disease,
- constipation
- reduced immunity,
- atherosclerosis of rectal vessels,
- gynecological diseases in women and prostatitis in men,
- diabetes,
- surgery on the rectum.
Symptoms and signs of paraproctitis, photo
Acute paraproctitis always begins suddenly.
Common symptoms:
- temperature increase,
- weakness,
- muscle pain, lack of appetite.
Specific signs of paraproctitis:
- sharp pains of a pulsating / twitching nature in the rectal region, spreading during bowel movements to the entire pelvic region;
- painful urination;
- upset stool and painful urge to have bowel movements;
- with a superficial location of a purulent focus - edema and redness of the skin with possible opening and outflow of pus.
Self-opening of an abscess can occur through the skin (the most favorable option), into the lumen of the vagina in women, into the rectum, into the abdominal space with formation.
The walls of the purulent cavity and fistulous course are gradually lined with epithelium, chronic paraproctitis is formed with periodic exacerbation and release of purulent contents.
During remission, it is characterized by an imaginary recovery: the patient's well-being is normalized, working capacity is restored, the wound is tightened with scar tissue. However, recurrent exacerbations can lead to insomnia, neurasthenia, impotence in men.
Diagnostics of the paraproctitis
Diagnostic examination is designed to accurately determine the location of the fistula and the degree of damage to the sphincter muscle fibers for selection effective treatment paraproctitis.
A patient with suspected paraproctitis is carried out:
- digital examination of the rectum (identification of the internal mouth of the fistula);
- examination with a probe;
- transrectal ultrasound;
- fistulography.
Paraproctitis treatment and surgery
For many patients, the question arises: is surgery necessary for paraproctitis? In this case, the answer is categorical - treatment of paraproctitis without surgery is impossible, and delay will only aggravate the purulent process.
Radical treatment is carried out in two stages:
- Opening of the formed abscess and removal of pus, often with drainage. In acute paraproctitis, after an operation to open a purulent cavity, a fistula is almost always formed.
- Removal of the fistulous tract and closure of the connection between the rectum and the purulent cavity.
Often with prompt removal fistula is performed by surgical treatment of hemorrhoids.
Surgical intervention is easily tolerated, postoperative period does not differ in severe soreness.
At the same time, antibiotic therapy and immunostimulation are carried out.
Only such a treatment for paraproctitis, which involves two operations under general anesthesia and drug therapy, gives a complete cure for the patient.
When the first signs of paraproctitis appear, emergency surgical care is needed. The prognosis of the disease depends on the timing of its provision.
Chronic paraproctitis is characterized by a high risk of developing complications:
- Spontaneous opening of the abscess.
- Purulent fusion and necrotization of the walls of the vagina, urethra.
- The release of feces into the peri-rectal tissue through the necrotic wall of the rectum, the lightning-fast spread of the purulent process.
- Breakthrough of an abscess into the abdominal space and the development of fatal peritonitis.
- Insufficiency of the anal sphincter due to severe damage to its fibers, leakage of feces.
- The growth of scar tissue and a decrease in the elasticity of the walls of the anal canal.
- Cancer in the presence of a fistula for more than 5 years.
Prevention of the formation of paraproctitis
- Timely and complete treatment of rectal pathology.
- Fight constipation.
- Proper hygiene of the anal area to avoid the formation of cracks in the anus.
- Maintaining immunity, eliminating chronic foci of infection in the body.
Paraproctitis according to mkb 10
In the international classifier of diseases, pathology is:
Class XI. Diseases of the digestive system (K00-K93)
K55-K63 - Other bowel diseases
K61 - Abscess of anus and rectum (Includes: abscess or phlegmon of anus and rectum with or without fistula)
- K61.0 Anal abscess
K62 - Other diseases of anus and rectum
- K62.8 Other specified diseases of anus and rectum / perforation (nontraumatic) of rectum / proctitis NOS
Paraproctitis(from the Greek. para- "around, around" and proktos- "anus") is a purulent inflammation of the fatty tissue located around the rectum. The disease can be acute or chronic. Often paraproctitis is also called a pararectal abscess.
Paraproctitis in numbers and facts:
- This is one of the most common proctological diseases, which makes up 20-40% of all rectal pathologies.
- In terms of prevalence, paraproctitis is second only to anal fissures, hemorrhoids and colitis (inflammation of the large intestine).
- Men get sick 1.5-4 times more often than women.
- Paraproctitis occurs almost exclusively in adults. Very few cases have been described in children.
- The prevalence of paraproctitis among the population is 0.5% (5 people out of 1000 have the disease).
- Most often people get sick at the age of 30-50 years.
Features of the anatomy of the rectum
Rectum- the final section of the intestine 15-20 cm long (in an adult), which is located in the pelvic cavity. The rectum passes into the anus, which opens outward with the anus.
Rectal wall layers:- Mucous membrane – the inner layer... It does not have, unlike the mucous membrane of the colon, villi and contains a large number of cells that produce mucus.
- Muscle layer... Consists of two layers: in one the muscles go in the longitudinal direction, and in the other - in the transverse direction. In the area of the anus, the muscles form two powerful rings - sphincters. One of them works involuntarily, the second obeys the will of a person. The sphincters are designed to hold the stool. During bowel movements, they relax.
- Serous membrane. Outer layer composed of connective tissue.
Outside, the rectum is surrounded by adipose tissue - pararectal tissue. 
At the junction of the rectum into the anal canal, crypts are located on the mucous membrane - depressions in the form of bags. At the bottom of each crypt, ducts of mucous glands (called anal glands), located in the thickness of the sphincters, open. This anatomical feature is important in the development of paraproctitis. The causes of paraproctitis
The main reason for the development of paraproctitis is the infection in the peri-rectal fatty tissue. Microorganisms that can cause paraproctitis:
Symptoms of chronic paraproctitis
Most often, chronic paraproctitis occurs in waves. Following an improvement in the condition and an apparent recovery, another exacerbation occurs.| Paraproctitis stage | Description | Symptoms |
| Aggravation | A large amount of pus accumulates in the closed fistula. The patient's condition worsens. At a certain point in time, the fistula opens again, and pus begins to stand out from it. |
|
| Improvement of the condition | After cleansing the fistula of pus, the inflammation subsides. Gradually, the fistula closes. But the disease does not go away. | The patient's condition is improving. The temperature decreases, the pain decreases and goes away completely. |
Complications of chronic paraproctitis
- Proctitis- inflammation of the rectal mucosa.
- Proctosigmoiditis- inflammation of the mucous membrane of the rectum and sigmoid colon.
- Scarring of the walls of the anal canal and the muscle that compresses the anus... In this case, incontinence of gases, feces occurs.
- Malignancy- development of a malignant tumor at the site of the fistula. It usually occurs when the fistula has been present for 5 years or more.
Diagnostics of the paraproctitis
Which doctor should I contact if there are signs of paraproctitis?
Rectal diseases are diagnosed and treated by a proctologist. If you experience symptoms that resemble paraproctitis, you can contact the surgeon at the local polyclinic.What happens in the doctor's office?
First, the doctor interviews the patient.He can ask questions:
- What symptoms are troubling?
- How long ago did they appear? Then? How has it changed over time?
- Did your body temperature rise? To what values?
- Are sleep and appetite normal?
Then an inspection is carried out. The doctor asks the patient to undress and take the knee-elbow position - get on all fours on the couch, leaning on your elbows and knees. The doctor examines the lesion on the skin, feels it. Then he conducts a finger examination - puts on a latex glove, lubricates his forefinger Vaseline and inserts it into the rectum, feels it from the inside. The procedure can be quite painful. If pain occurs, tell the doctor about it, and he will perform a local anesthesia, for example, with lidocaine gel. In general, the diagnosis of acute paraproctitis is quite simple. Usually the doctor makes the diagnosis right after the examination.
Examination for paraproctitis
In acute paraproctitis, the diagnosis is clear without additional examination. The surgeon prescribes general analysis blood, urine. Studies in which special instruments are introduced into the rectum (anoscopy, sigmoidoscopy) are not performed, since in acute paraproctitis they are very painful, and the diagnosis is clear even without them.Examination for chronic paraproctitis:
| Study title | Description | How is it done? |
| Fistula probing | A study during which a metal probe is inserted into the fistula. Objectives of the:
| Typically, the patient is placed on his back with legs apart on a gynecological chair. The procedure can be painful, so the doctor will usually administer anesthetics or pain relievers to the patient. The probe is a thin metal rod, at the end of which there is a rounded club-shaped extension. At the same time, the doctor can insert a finger into the rectum in order to feel the tissue between the finger and the probe, to determine their thickness (this indirect sign the complexity of the fistula).  |
| Anoscopy | Endoscopic examination, during which a special instrument is inserted into the rectum - an anoscope - with a diameter of about 1 cm, with a miniature video camera at the end.  | On average, the survey takes 15 minutes. It is usually painless. If the patient is concerned about pain, the doctor may use an anesthetic such as lidocaine. The patient is placed on his side, or asked to stand on all fours on the couch, leaning on his knees and elbows. The doctor inserts the anoscope into the patient's anus and examines it. In this case, you can assess the condition of the mucous membrane, see large fistulous holes, scars.  |
| Sigmoidoscopy | Endoscopic examination, during which a sigmoidoscope, a metal instrument with a video camera, is inserted into the rectum. Sigmoidoscopy differs from anoscopy in that the instrument is inserted deeper, the doctor can examine the rectum and the overlying part of the intestine - the sigmoid colon.  | The patient is placed on the left side or asked to stand on all fours on a couch. The doctor lubricates the sigmoidoscope with petroleum jelly and inserts it into the patient's anus. During this time, the patient is asked to relax the right shoulder. While advancing the instrument, the doctor examines the mucous membrane of the rectum, sigmoid colon. Usually sigmoidoscopy is performed in order to distinguish paraproctitis from other diseases.  |
| Dye test | Target: Find the inner opening of the fistula, which is located on the mucous membrane of the rectum. Method essence: A dye is injected into the outer opening of the fistula on the skin. It goes through the entire fistula and reaches the inner opening, from which it begins to stand out. | For a test with a dye, usually 1 %
methylene blue solution. This substance has a bright blue color and is an antiseptic. Anoscopy is used to detect the release of methylene blue from the internal opening of the fistula.  |
| Fistulography | X-ray examination, during which the fistula is stained with a radiopaque substance. In this case, all branches, pockets, existing along the fistula, become visible. | An X-ray contrast solution is injected into the external opening of the fistula. Thereafter, x-rays are taken. The pictures clearly show the fistula and all its branches. The study is painless and safe.  |
| Ultrasound using rectal probe | A special ultrasound sensor is used, which is inserted into the rectum. In this case, the doctor can detect the affected crypt and the fistulous passage. | Preparation for research: Before the ultrasound scan, the patient is given a cleansing enema. Conducting research: A special thin probe is used that is inserted into the rectum. For hygiene reasons, the doctor puts a condom on the transducer. The patient is placed on the left side or asked to stand on all fours on a couch. In the position on the left side at the time of insertion of the sensor, they are asked to relax the right shoulder. The doctor assesses the condition of the rectum, crypts, the presence of a fistulous tract from the image that he sees on the monitor. The study is safe and painless (but be prepared for some discomfort).  |
Paraproctitis treatment
Treatment of acute paraproctitis
In acute paraproctitis, surgery is indicated. It must be performed as early as possible (surgical intervention for acute paraproctitis is classified as urgent). Otherwise, complications may develop and the transition of acute to chronic paraproctitis.Before the operation, a standard examination is prescribed, including:
- examination by an anesthesiologist.
Local anesthesia during surgery for acute paraproctitis cannot be used, since it is most often not able to completely eliminate pain. Inserting a needle can help spread the pus.
General anesthesia is used: mask or intravenous.
Operation progress:
- The surgeon specifies the location of the abscess by examining the rectum on rectal mirrors.
- Then the abscess is opened and the pus is removed. The surgeon must carefully examine the cavity, open all pockets, destroy the existing partitions.
- The abscess cavity is washed with an antiseptic solution.
- A drainage is left in the wound (a graduate through which pus flows out, ichor).
- A special tube can be inserted into the rectum to remove gases.
- In the future, dressings are carried out daily, the patient is prescribed antibiotics.
Three main tasks that the doctor must solve during the operation:
- open and clean the abscess;
- excision of the affected crypt - since it is a source of purulent infection;
- dissect and cleanse the purulent passage that connects the crypt and the abscess.
Prognosis after surgical treatment of acute paraproctitis
With a timely operation, the prognosis is favorable. If the patient does not go to the doctor on time, then acute paraproctitis becomes chronic, complications develop.Treatment of chronic paraproctitis
Conservative treatment of chronic paraproctitisChronic paraproctitis is rarely cured without surgery.
Indications for conservative therapy:
- in elderly patients with contraindications for surgery;
- during preparation for surgery.
| Method | Description | Application * |
| Sitz baths | A warm bath helps to relieve the course of the disease and reduce symptoms. | Sitting baths are taken after the act of defecation 1 time per day for 15 minutes. You can add decoctions of medicinal plants (chamomile, calendula) to the water. The duration of the course of treatment is 2 weeks. |
| Fistula flushing antiseptic solutions | Antiseptics introduced into the fistulous tract contribute to the destruction of infection, quick and effective cleansing. | An antiseptic solution is injected into the fistula on the skin using a thin catheter or syringe. You can use different solutions, for example, chlorhexidine, furacilin, "Dekasan". 5-10 ml of antiseptic is injected into the fistula once a day.  |
| The introduction of antibiotics into the fistulous tract | Antibacterial drugs destroy the causative agents of paraproctitis. Before starting treatment, you need to carry out bacteriological examination pus from the fistula, to determine the sensitivity of pathogens to antibiotics. | Different antibiotics are used as prescribed by the doctor. They are injected into the fistula on the skin in the form of solutions using a catheter or syringe. |
Microclysters:
| Properties of sea buckthorn oil:
Antiseptic, destroys pathogens.  | For microclysters, use a rubber syringe or a 150-200 ml syringe. They recruit sea buckthorn oil or collargol solution warmed to 37 ° C. Carrying out the procedure:
 |
Terms of surgical treatment for chronic paraproctitis:
- during an exacerbation- urgent surgical intervention, without delay;
- with subacute course(when there are inflammatory seals in the wall of the rectum): the operation is performed after conservative treatment within 1-3 weeks;
- during the improvement of the condition- held conservative therapy until the next exacerbation.
During the surgical intervention, the fistula and scars are excised, all purulent cavities are opened and cleaned. Surgical tactics, which the surgeon chooses, and the severity of the operation depends on the location and size of the fistula.
Diet for paraproctitis
In acute and chronic paraproctitis does not exist special diet... But adherence to some dietary recommendations will help alleviate the course of the disease:Purulent diseases are not only unpleasant, but also dangerous. Therefore, if their first symptoms made themselves felt, you should not hesitate to visit a doctor. This article will focus on paraproctitis, which can cause a lot of discomfort. Patients faced with this problem will find it useful to know the features of its development, symptoms and possible methods impact on the disease in the home.
A little about the disease itself
Before considering the treatment of chronic paraproctitis without surgery, it makes sense to touch general characteristics the disease in question.
Paraproctitis is called adipose tissue, which is located around.This disease can be both chronic and acute. The causes of this disease include the effect of an infection that gets through the mouth of the anal glands from the rectum into adjacent tissues.
If we turn to the data of medical statistics, then it will be possible to find out that about 40% of all visitors come to doctors-proctologists with this problem. That is why the treatment of chronic paraproctitis in adults is more than a relevant topic.
Why does the disease appear
The key reason for the development of a disease such as paraproctitis is the pathological flora, which gets from the rectum into the deep layers of cellular tissue surrounding it.
Enterococci can be identified as the main pathogens, colibacillus, anaerobic microbes and staphylococci. The most common pathways for bacteria to enter are morgana crypts and anal sinuses. It should be noted that both various damage intestinal mucosa greatly contribute to the infection process.
An inflamed prostate gland, as well as abscesses and wounds on the skin, can act as alternative routes of entry. In this case, there is always the likelihood that self-infection of the body will occur. We are talking about the transfer of pathogenic bacteria from extraintestinal foci to the site of inflammation along the bloodstream.
In this case, the object of damage to pathogens can be various cellular spaces that surround the intestines:
Subcutaneous fat layer;
Submucous layer of the rectum;
Pelvic-rectal region;
Iliac-rectal zone, etc.
Such hard cases, in which the inflammatory process covered several of the indicated zones.
What contributes to the formation of the disease
It is worth knowing that there are factors, the presence of which significantly increases the risk of paraproctitis:
Haemorrhoids;
Frequent constipation
Diabetes;
Anal intercourse;
Vascular lesion by atherosclerosis;
Cracks in the anus;
Weakened immunity, both local and general.
As you can see, problems with the intestines or even a poor state of the immune system can lead to a problem such as paraproctitis. Treatment without surgery is, of course, possible, but the choice should be made only after consultation with a qualified specialist.
Types of inflammation
Initially, it should be noted that paraproctitis can have two forms: acute and chronic.
Under acute it is necessary to understand inflammation, which makes itself felt for the first time (before that it did not appear) and leads to the formation of suppuration in the fatty tissue. When it can go beyond the focus, as a result of which a channel is formed between the abscess itself and the skin or adjacent hollow organs.
As for chronic paraproctitis, in most cases it does not cause painful sensations. But it is still possible to manifest it through purulent fistulas, the outlets of which can be located on the buttocks and near the anus. It is from them that pus flows, possibly even with an admixture of feces. In the event that the mouth of the canal closes, pus begins to accumulate and new abscesses develop, which is not good, because they come out, forming new fistulas, or penetrate the intestines.
Treatment of chronic paraproctitis at home - it is realistic and acceptable if it is not possible to use the services qualified doctor... Indeed, in a neglected state, such a disease leads to the fact that the so-called purulent passages form clusters of foci that have a branched structure and contribute to the appearance of numerous holes. Needless to say, such a state can be called extremely difficult.
Acute symptoms
For such paraproctitis, the standard signs of the inflammatory process are characteristic:
Violation of bowel movements and urination;
Heat;
Feeling of pain in the area of inflammation (small pelvis, lower abdomen);
Signs of intoxication such as lack of appetite, headaches, chills, and weakness.
But in some cases, the picture of the manifestation of paraproctitis can be quite specific, and it depends to a greater extent on the place of its localization.
The most common subcutaneous paraproctitis can be cited as an example. It manifests itself through the formation of an abscess in subcutaneous tissue with rather vivid symptoms. More specifically, a noticeable swelling appears on the patient's body in the immediate vicinity of the anus. The skin over the abscess becomes red, swollen and thickened.
Moreover, the entire area subject to the inflammatory process becomes a source of painful sensations, which intensify during squatting and palpation. Some time later, the pain may become pulsating. The troubles do not end there: the patient develops nervousness, sleep and bowel movements are disturbed.
Chronic paraproctitis
This form of the disease practically does not cause pain. Therefore, the treatment of chronic paraproctitis with folk remedies can be carried out without any haste, in contrast to the situation with acute pain syndrome.
But purulent fistulas with this form are still formed. They are located most often on the buttocks and near the anus.
It is important to realize the fact that the chronic form of this disease is not able to pass on its own, without affecting it. If you ignore this fact, then you will inevitably have to face relapses, during which the scale pathological process will only grow. As a result, the human body will be extremely destructive.
Talking about complications chronic form, it is worth mentioning such negative consequences diseases, like the degeneration of paraproctitis into necrosis.
Survey
With a problem such as paraproctitis, treatment without surgery - with folk remedies, still implies a diagnosis that will accurately identify the type of problem and the condition of a particular patient.
To undergo a high-quality examination, you need to consult a doctor of a surgical and proctological profile. As for the preliminary diagnosis, it is based on clinical picture and the complaints of the patient himself. At the same time, it is not worth setting yourself up for an instrumental and manual examination, since, due to its pain, in most cases it is not carried out.
But you cannot ignore the diagnosis, because the symptoms may indicate not only paraproctitis. The development of other diseases with similar symptoms, for example, intestinal tumors or wen, is possible.
How to deal with the disease
Initially, it should be understood that with a problem such as paraproctitis, treatment without surgery is not the best option. The surgical way to neutralize the disease in this situation can be considered the most effective. But if for some reason such measures are not available or acceptable, you can influence the patient's condition with the help of folk remedies.
As an example of such a treatment, it makes sense to give several recipes for oral agents:
Squeeze juice from ripe red mountain ash and take it in an amount of 40 ml three times a day before meals. But you can use dry, as well as frozen berries, for this, in the amount of two tablespoons, you need to pour 0.5 liters of boiling water and use the resulting product with honey instead of tea.
If paraproctitis has developed, treatment without surgery may include the use (3 g), filled with three liters of cold boiled water. All this must be left for two days, then the liquid must be drained and taken as a medicine several times a day. You can start by using 200 ml of the product after a meal, and if the body reacts positively, then before eating.
Unrefined sunflower oil and vodka are also relevant for treatment. These components in an amount of 20 ml are mixed in a glass container and shaken thoroughly until the vodka is completely dissolved in oil. Then the resulting mixture is quickly drunk. After this procedure, you need to refrain from eating for three hours.
On this folk methods overcoming paraproctitis does not end
Application of compresses
Treatment of paraproctitis without surgery has conflicting reviews, since different people conditions and complications differ. In some cases, alternative methods, due to the relatively light form diseases, give a tangible effect, but there are people who have found a way out only in surgical intervention.
However, if you go away from the hospital and return to treatment at home, then inevitably you should pay attention the following types compresses:
You can start with pre-grated raw potatoes. It must be wrapped in a clean cloth and applied to the place where the focus of the disease is for one hour.
Heat the red silicate brick thoroughly in the oven, place it in an enamel bucket and cover with chopped 3-4 cloves of garlic. The rim of the bucket will have to be wrapped thick cloth to avoid burns and sit on it. You need to stay in this position until the brick gives off heat. To obtain a tangible effect, this procedure can be repeated daily.
St. John's wort can also help if it is in the amount of 3 tbsp. l. pour into boiling water (300-350 ml) and keep on fire for 15 minutes. Next, you should strain it and immediately place it on a polyethylene film. It is on it that the patient will have to sit down and wait until the St. John's wort cools down. In conclusion, you need to wash off with the broth that remained after straining.
Baths with healing effect
If paraproctitis made itself felt, treatment without surgery should also include baths. One example of such a technique can be next recipe: 3 liters of water holds 40 g sea salt... Such a bath is taken for half an hour twice a day. If there was a breakthrough of the abscess, then the techniques can be reduced to one time.
For those who are focused on the treatment of chronic paraproctitis, the peculiarities of using the baths will be reduced to the use of herbal decoctions. For these purposes, yarrow, St. John's wort, oak bark, oregano, string, incense, calendula, calamus and other herbs that can give an astringent, disinfecting and anti-inflammatory effect are perfect.
The principle of preparing the broth is as follows: 60 g of any plants are poured with 0.5 liters of boiling water and boiled for 15 minutes. Then the broth is cooled for 40 minutes, filtered and poured into the basin, where there is already prepared warm water... Such procedures should last 15 minutes, and the cycle itself is designed for a period of 2 to 3 weeks.
It is also worth noting the fact that the treatment of chronic paraproctitis with homeopathy can be quite tangible result. But maximum effect will be obtained only if data are available after professional examination.
How to treat children
With such a problem as paraproctitis in a beloved child, you need to act competently and without delay. As mentioned above, the key to successfully overcoming the disease is examination by a qualified specialist. And only after the results of diagnostics and consultation with a doctor should you think about how to neutralize paraproctitis in a child. Treatment without surgery in this case will be one of the most relevant options.
As a noteworthy method within the framework of such a treatment, one can define They are excellent for influencing children's organism... But the addition of propolis is already undesirable, since such suppositories can cause an allergic reaction in a child. Such a treatment for paraproctitis without surgery has positive reviews, since it has a healing and restorative effect.
Outcomes
Paraproctitis, as you can see, is a difficult disease that can become a source of extremely unpleasant and even dangerous complications.
Therefore, you should not pin all your hopes on treatment at home. Therapy under the supervision of an experienced specialist is always the best way fight the disease.
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