What is the name of the procedure for checking the rectum. Rectum: diseases, symptoms. Signs of major rectal diseases. Instrumental research methods

Good afternoon, my name is Tatyana, 27 years old. I've been having pain in my lower abdomen for a couple of weeks now. And yesterday there was something like an attack: sharp pain in the abdomen and an incessant urge to defecate. I sat in the toilet until the morning, the diarrhea seemed to have ended, but my stomach hurt. According to gynecology, everything is fine, I saw the doctor a month ago. I understand that I need to go to a proctologist, but how can I imagine this horror... Please tell me what methods the doctor uses to check the rectum?

Hello Tatiana! You should put aside your fear and urgently make an appointment with a qualified specialist. Modern proctology has at its disposal a wide range of methods that quickly and practically painlessly diagnose all parts of the large intestine, including the rectum. First, the doctor will conduct an initial consultation, including a general examination, digital examination and anoscopy. Perhaps the diagnosis will be made at this stage. If necessary, the proctologist may prescribe additional diagnostic tests, such as sigmoidoscopy, intestinal X-ray (irrigoscopy) or colonoscopy.

Reasons for visiting a proctologist

Intestinal diseases are diverse clinical manifestations. At the initial stage, some diseases, as a rule, do not have pronounced symptoms. They are often difficult to notice and almost impossible to associate with a specific illness. In addition, many people suffering from intestinal diseases consider visiting a proctologist something “inconvenient” and “shameful” and ignore bothersome symptoms, turning to a doctor at a time when the disease is already causing a lot of problems and is actively progressing. Unfortunately, this approach is fraught with serious problems for the patient: treatment of intestinal diseases in advanced stages is a very long, unpleasant and financially expensive process. Moreover, long-standing bowel problems can lead to cancer. So, consultation with a proctologist and thorough examination rectum are necessary if at least one of the following symptoms is present:

discomfort or pain in the anus;
pain during or outside of bowel movements or anal itching;
bloody, mucous or purulent discharge from the anus;
prolapsed hemorrhoids;
change in the usual rhythm of bowel movements;
painful lumps (bumps) in perianal area
pulling sensations in the perineum;
bloating and abdominal pain;
constipation, diarrhea, difficulty defecating, flatulence;
unmotivated weight loss, increased general weakness, lack or loss of appetite.

People with a negative hereditary and family history, as well as elderly patients, are at particular risk. One of the most threatening symptoms, if present, you should visit a proctologist immediately, are sharp pains, false urge to have a bowel movement, constipation alternating with diarrhea, daily discharge of blood or pus from the anus, rapid weight loss and general weakness. The most important thing in coloproctological diagnosis is not to miss a malignant tumor!

The main diagnostic methods include instrumental and non-instrumental rectal examination methods, as well as x-rays. Any examination of a patient begins with the doctor familiarizing himself with the patient’s complaints and general examination. The choice of diagnostic methods required for a particular patient is determined by the doctor based on the results of a general clinical examination. The task of the proctologist is to obtain accurate diagnosis, as well as information about general condition large intestine, regardless of the location of the pathological area.

Preparing for a proctological examination

Before visiting a specialist, the patient needs to properly prepare for the examination. At the initial consultation, it is enough to clean the final sections of the rectum from the contents using a micro-enema. If a consultation with a proctologist involves, in addition to a general examination and digital rectal examination, other examinations, such as anoscopy, sigmoidoscopy and irrigoscopy, then the intestines should be cleansed more thoroughly. There are several ways to prepare the bowel for examination.

Water cleansing enemas. The day before the examination, you should eat liquid food, reduce the amount of vegetables, fruits, cereals, flour products, as well as any foods that provoke flatulence in your diet. If the appointment is scheduled for the morning, then the night before you need to do 2 to 3 enemas with water room temperature volume of 1.5–2 liters with an interval between enemas from 30 minutes to 1 hour. In the morning you should give 2 or 3 more of these enemas. If the examination is carried out in the afternoon, then cleansing enemas should be given several hours before consultation. In this case, the last enema should be given no later than 2 hours before the doctor’s appointment. This method, although it requires a significant amount of time, is most effective for completely cleansing the intestines.
Special microenemas. The patient or doctor inserts a microenema (Norgalax, Normacol, Adulax, etc.) into the rectum. The solution included in the microenema irritates the receptors of the rectum and causes the urge to defecate. After administering such a microenema, the patient recovers on his own (about 2 times with a break of 10 to 20 minutes). This technique is quite comfortable for the patient: it is carried out quickly; does not require prior changes in diet. However, microenemas can cause allergic and inflammatory reactions in the rectum, therefore, if Crohn's disease or ulcerative colitis is suspected, such rectal cleansing with microenemas is undesirable.
Medicinal preparations for colon cleansing based on polyethylene glycol, such as fortrans, flit phosphosoda, endofalk, etc. The preparations must be dissolved in a large amount of water (1–4 l) according to the instructions and drunk a certain time before the examination. Usually, after taking such a solution, the rectum is completely cleansed within half a day. This method is often used for complex instrumental diagnostics, such as fibrocolonoscopy, irrigoscopy. For the initial examination of the rectum, these drugs are usually not used.

The choice of bowel cleansing technique should be previously discussed with a proctologist, who will conduct a proctological examination.

If the reason for visiting a proctologist is severe pain in the rectal area or heavy bleeding, then self-cleansing of the intestines cannot be carried out.

General examination of a proctological patient

Through examination, the doctor can determine general bloating of the abdomen or its individual areas, the intensity of perilstatics, neoplasms palpable on the anterior abdominal wall, external openings of intestinal fistulas, etc. By palpation, the proctologist can determine spastic contractions of the intestinal loops, establish tension in the abdominal muscles, determine the size, location , mobility and consistency of intestinal tumors, ascites and other pathologies. Afterwards, the doctor proceeds to examine the perianal and intergluteal area, as well as the perineum and (if necessary) the genitals. The main attention is paid to the condition of the anus, the presence of pigmentation and depigmentation, infiltration and hyperkeratosis of the skin. In addition, the proctologist identifies the presence of perianal polyps and tumor-like protrusions (fimbriae, external hemorrhoids), and also checks for anal reflux. The next stages of examination are digital rectal examination of the rectum, recto- or anoscopy.

Digital examination of the rectum

Rectal digital examination is a mandatory procedure when diagnosing proctological diseases. It is carried out when the patient complains of abdominal pain, disturbances in intestinal activity and pelvic functions. Only after this study is an anoscopy and sigmoidoscopy prescribed and performed.

Digital examination of the rectal lumen allows the doctor to:

assess the condition of various tissues of the anal canal, the closing function of the sphincter and organs surrounding the rectum;
determine the degree of preparation of the rectum for endoscopic examinations;
check the rectal mucosa;
identify the presence of pathological processes in the intestines;
assess the nature of discharge from the anus;
select the optimal position of the patient for the main diagnostic examinations.

The anal canal is examined by sequential palpation of its walls, as a result of which the mobility, elasticity and folding of the mucous membrane, as well as possible changes in the walls of the anus, are determined. The process of examining the rectum can be carried out (depending on the medical history) in various positions of the patient: in the knee-elbow position, lying on the side with bent legs; on your back in a gynecological chair.

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Technique: the doctor, wearing a rubber glove, gently and carefully introduces forefinger into the anus and carries out step-by-step sequential palpation of all walls of the rectum. In this case, the patient needs to push, as if he has a bowel movement, and relax his stomach during the examination. A digital examination is carried out using an anesthetic spray or ointment, without increasing pain or causing discomfort. There are practically no contraindications for this study.

Anoscopy is an instrumental method for examining the lower rectum and anus and is included in the list of mandatory methods of primary diagnosis for organic lesions of the final area of the gastrointestinal tract. Anoscopy is performed before subsequent endoscopic examinations - sigmoidoscopy and colonoscopy. The examination is carried out after the procedure of digital rectal examination and is carried out using a device - an anoscope, which is inserted through the anus. Anoscopy allows the proctologist to examine the anal canal and rectum with internal hemorrhoids 8–10 cm deep.

Indications for anoscopy: chronic or acute pain in the anus; regular discharge of blood or mucus; regular constipation or diarrhea; suspicion of rectal disease. Using this procedure, the proctologist can clarify the course of hemorrhoids, identify small neoplasms and inflammatory diseases of the rectum, and also take a biopsy and smear if necessary.

Technique: anoscopy is usually performed with the patient in the supine position. The anoscope is inserted into the anus effortlessly in a circular motion. After insertion, the anoscope flaps expand, opening the lumen for inspection. The anoscopy procedure is absolutely safe for the patient, and relative contraindications for its implementation are: acute inflammation in the perianal area; severe narrowing of the lumen of the anal canal; fresh thermal and chemical burns; stenosing tumors.

Sigmoidoscopy

Sigmoidoscopy (rectoscopy), is a popular endoscopic method examination of the rectum, as well as the lower part sigmoid colon. This procedure is the most informative and accurate, therefore it is often an integral element of a full proctological examination. Sigmoidoscopy allows you to assess the condition of the rectum to a depth of 20 to 35 cm. The procedure, although not very comfortable, is quite painless, and therefore requires anesthesia only in special cases. Before the study, you need to thoroughly cleanse the intestines with an enema. Sigmoidoscopy can be performed only after a digital rectal examination of the rectum.

Indications for rectoscopy: pain in the anus; discharge of blood, mucus and pus; regular bowel movements; suspicion of sigmoid colon disease. Besides, this type diagnostics is used for preventive examination people of the older age group for exclusion malignant neoplasms at least once a year.

Technique: The patient takes off his underwear and stands on the couch on all fours in a knee-elbow position. In this position, the abdominal wall moves down slightly, which facilitates the transition of the rigid tube of the proctoscope from the rectum to the sigmoid colon. After lubricating the tube with Vaseline, the rectoscope is inserted along the longitudinal axis of the anal canal into the anus by 4–5 cm. Afterwards, the tube is inserted into the depth so that its edges do not rest against the walls, and the device moves only along the lumen of the intestine (using a special pear into the intestine air is constantly pumped in). From this moment on, all further examination takes place only under the visual supervision of a doctor.

Sigmoidoscopy has virtually no contraindications, but its implementation can be postponed for some time in such cases as profuse bleeding, acute inflammatory disease of the abdominal cavity and anal canal, acute anal fissure.

Irrigoscopy

Irrigoscopy is x-ray method examination of the colon when filling it with a barium suspension administered through the anus. It is carried out by a proctologist in the radiology room. Pictures are taken in direct and lateral proportions. Irrigoscopy is used to clarify or diagnose diseases such as diverticulosis, fistulas, neoplasms, chronic colitis, scar tissue narrowing and others.

When x-raying the colon, the following is used: tight filling of the intestine with a barium suspension, studying the relief of the mucous membrane after the intestines are freed from contrast, as well as double contrast. Dense filling of the intestine with contrast allows you to obtain information about the shape and location of the organ, the length of the intestine and its parts, the distensibility and elasticity of the intestinal walls, as well as detect rough pathological changes. The degree of emptying determines the nature of the functionality of various parts of the intestine. The most informative method for identifying colon polyps and tumors is double contrast. A contraindication for irrigoscopy is perforation of the wall of any part of the intestine, as well as a complicated condition of the patient.

Colonoscopy

Colonoscopy is diagnostic test, which is carried out using a special endoscopic device - a colonoscope, and allows you to examine the large intestine along its entire length - from the cecum to the rectum. During the procedure, the endoscopist visually assesses the condition of the intestinal mucosa. In addition, during colonoscopy it is possible to perform therapeutic measures such as deleting benign tumors, extraction foreign bodies, stopping bleeding, etc. This method is considered one of the most informative for the primary diagnosis of benign and malignant neoplasms in the intestine, as well as diseases such as UC, Crohn's disease and others. Colonoscopy in mandatory performed in patients who have previously had polyps removed, as well as after conservative treatment ulcerative colitis or surgery for bowel cancer.

Indications for colonoscopy are: suspicion of a tumor; inflammatory diseases colon; intestinal obstruction; intestinal bleeding. Contraindications: violation of the blood coagulation system; cardiac and pulmonary failure; spicy infectious diseases; severe forms colitis, both ischemic and ulcerative.

Technique: The patient lies on the couch on his left side and pulls his knees to his chest. After local anesthesia of the anus, a colonoscope is inserted into the rectum and slowly moved forward through the intestine with a small supply of air to expand the lumen of the intestine. To avoid discomfort In this rather complex procedure, the patient must strictly follow all the endoscopist's instructions. During a colonoscopy, the patient may be bothered by a false urge to defecate, arising from the overcrowding of the intestine with air. In addition, when the endoscope negotiates the bends of the intestinal loops, the patient may experience short-term pain. Sometimes, to clarify the diagnosis, a biopsy of the affected areas of the mucous membrane is performed, which leads to an increase in the duration of the study by a couple of minutes. At the end of the diagnosis, air from the intestine is sucked out through the endoscope tube. After a colonoscopy, the patient is advised to lie on his stomach for several hours.

Conclusion

Today in proctology there is an extensive arsenal of research techniques, thanks to which it is possible to carry out accurate diagnosis any pathologies of the colon and rectum, anal canal and perineum. The main thing is to consult a doctor in a timely manner, who will select the most appropriate studies based on the patient’s complaints and medical history.

stomach ache;
constipation;
diarrhea;
blood, pus, or mucus in the stool;
haemorrhoids;
bloating;
a sharp decrease in weight or, conversely, weight gain;
constant belching and heartburn;
bad smell from the mouth, not related to dental health;
the appearance of plaque on the tongue.

Often patients consult a doctor too late, when the discomfort can no longer be tolerated. Some people are afraid that the procedure will be painful, others think that it is difficult to get to a specialist. One way or another, a late visit to the doctor leads to the fact that the disease is already well developed and requires more serious and expensive treatment. In the case of cancerous tumors, any delay may be the last.

Important! Modern diagnostic methods are developed well enough to detect pathology at the earliest stage of development and eliminate it in time.

Laboratory tests help detect pathology, but an accurate diagnosis requires more reliable instrumental diagnostics.

Colonoscopy allows you to obtain more information; with its help you can detect inflammation, polyps, tumors, and also check the condition of the mucous membrane. A colonoscopy is relatively painless, but may be unpleasant for some. In rare cases, the procedure is performed with local anesthesia. A flexible tube with a camera is inserted into the anus, with its help you can not only examine the intestines, but also take tests if necessary. Most often, the examination is performed while lying on the stomach, but if necessary, the doctor may ask the patient to turn on his side or lie on his back.

More modern method examination is capsule diagnostics. Compared to a colonoscopy, it is completely painless and does not cause any discomfort. The patient just needs to swallow a small capsule with a camera, it passes through the stomach and intestines and is eliminated from the body naturally. While moving through the gastrointestinal tract, the camera takes about 50 thousand pictures, which are transmitted to a special device attached to the patient’s waist. The capsule allows you to examine the thin and colon, stomach and rectum.

Important! Colonoscopy and capsule diagnostics are performed on an empty stomach. The day before the procedure you should not eat anything.

If necessary, in addition to tests and colonoscopy or capsule diagnostics, an ultrasound, CT scan or x-ray of the intestine may be prescribed.

Increased body temperature, fatigue, sudden weight loss - all this may indicate the presence of the disease.
When palpating the abdomen, there are compactions.
Constant pain in the intestinal area.
The appearance of spots on the skin, changes in color, rash.
Abnormal bowel movements, blood from the anus.
Fluctuations in body weight.
Hunger.
Nervousness, insomnia.

If you have any of the listed symptoms, you should definitely consult a doctor. The earlier treatment of the disease is started, the more successful it is.

Which doctor is best to see?

First of all, you need to contact a gastroenterologist. To exclude gynecological reasons If abdominal pain occurs, women will also need to visit a gynecologist. If pain and others unpleasant symptoms localized in the rectal area, you need to be examined by a proctologist. The diagnostic methods of a gastroenterologist and a proctologist are identical:

palpation;
laboratory research;
instrumental examination.

Important! Acute attack appendicitis requires urgent surgical intervention. In such cases, you must immediately call ambulance or contact a surgeon yourself, if possible.

One of the new ways to examine the gastrointestinal tract without colonoscopy on video:

Approximately the same for women and men. But since the intestines are located somewhere in the same area as the genitals, they have their own characteristics and differences.

This article discusses the structure of the organ in men and women, its functions and possible diseases.

More about the rectum

This organ descends to the pelvis, forming curves. One of them is convex forward, and the other protrudes backward, repeating the curve of the sacrum.

The length of the intestine is from 10 to 15 cm. The organ consists of muscle tissue, mucous membrane and submucosal part, located in the connective tissue membrane - in male body it also covers the prostate gland, and in the female it envelops the cervix.

The mucous membrane is covered epithelial tissue, which contains a large number of Lieberkühn crypts (glands).

These glands, in turn, consist of cells that produce mucus, which explains why mucus is secreted from the intestines in various diseases.

Just above the anus are the rectal columns of Morgagni, formed by a fold of mucous tissue. They resemble columns, their number varies from 6 to 14.

Between the columns there are niches called pockets. Quite often they retain fecal residues, which can cause inflammation.

Intestinal diseases and disorders motor function irritate the intestinal mucosa, which is why papillae may appear on it, the size of which depends on how severely the mucosa is irritated. Sometimes the irritation is mistaken for a polyp.

Blood enters the rectum from several hemorrhoidal arteries - from the lower, middle and upper. The first two are paired, but the top one is not.

Blood moves through the veins through the hollow and portal veins; in the lower part of the rectum there are many large venous plexuses.

In women, the structure of the intestine is different from the male body. This is influenced by the characteristics of the female reproductive system.

In women, the rectum is adjacent to the vagina in front - between the organs, of course, there is a separating layer, but it is very thin.

If inflammation occurs in one of these organs, it is likely that it will spread to the neighboring organ.

Because of this internal structure Women quite often develop fistulas that affect both the intestines and the organs of the reproductive system.

This disease is a consequence of problematic childbirth or any trauma.

The rectum is the last part of the intestine that ends with the sphincter. Surprisingly, the anus in men and women has a different structure.

The sphincter or anus is a depression that goes into the rectum. Depending on the structure of the body, it may be located quite deep or not very deep.

In men, for example, the sphincter may be funnel-shaped, while in women it is flatter and protrudes slightly forward.

In women, such a structure of the sphincter may be due to the fact that its muscles are stretched too much.

How does defecation occur?

The rectum is part of the large intestine, which also includes the sigmoid, ascending, descending and transverse. You need to understand how everything works in general in order to look at the rectum individually.

In men and women, approximately 4 liters of digested food (chyme), which comes from the stomach, enters the large intestine per day from the small intestine.

The large intestine mixes this pulp, resulting in the formation of feces in a person.

This happens due to the fact that the organ performs wave-like contractions, which causes the chyme to thicken. Ultimately, out of 4 liters of digested food, about 200 g of feces remain.

Usually feces consist not only of chyme residues, but also of mucus, cholesterol, bacteria, cholic acid, etc.

The organ absorbs food, and all the toxic and harmful substances of the chyme penetrate into the blood, which enters the liver. In the liver, “harmful” blood is retained and then released along with bile.

After all this, bowel movement occurs, which is ensured by the actions of certain intestinal mechanisms.

With the help of peristalsis, feces enter the sigmoid colon, where they accumulate and are temporarily retained.

Stopping further movement of feces in this part of the intestine occurs due to contractions of the muscles that are located in the intestine.

Not only the intestinal muscle layer, but also the abdominal muscles help push out the contents of the intestines.

Additional help from another muscle group helps push feces into the anal canal for constipation and various cramps. After defecation, the organ is free for some time and does not fill.

This part of the intestine has a strong influence on the functioning of the stomach. If any problems arise, this affects the digestive process, the secretion of saliva and bile.

The brain also affects defecation: if a person is worried or tired, it delays bowel movements.

Possible diseases

Since the structure of the intestine in the female and male body is different, there are also quite a lot of diseases that can be found in this organ.

One of the most common diseases of the rectum is proctitis. Simply put, inflammation of the mucous membrane.

This disease may be caused excessive consumption spicy foods and spices, as well as constipation, during which there is stagnation of feces.

Feces can remain in the “pockets” between the columns of Morgagni, gradually poisoning the body, which can also lead to congestive proctitis.

Inflammation of the rectal mucosa can begin after unsuccessful laser therapy.

For example, if a person has a tumor in the pelvic region, then as a result radiation therapy Proctitis may well develop.

Inflammation of the mucous membrane can also occur from hypothermia, hemorrhoids, cystitis, prostatitis, etc.

Proctitis can be chronic or acute. The first type of pathology occurs almost unnoticed, accompanied by slight itching and burning in the anal canal.

Acute proctitis occurs suddenly and is characterized by high temperature, heaviness in the intestines, chills, burning in the intestines.

This type of proctitis occurs infrequently, with timely treatment a fairly rapid recovery of the patient is possible.

But the prognosis for chronic proctitis is more disappointing, because with this type of disease exacerbations periodically occur.

Rectal prolapse is a pathology in which the wall of the organ falls out through the sphincter.

This is most often observed in women who have undergone difficult childbirth, since after it the woman’s anus muscles can be significantly stretched and injured, and ruptures are possible.

However, bowel prolapse also occurs in men. Typically, this can occur due to changes in the muscles of the anus during the aging process, from bowel surgery. Constipation can lead to pathology if a person regularly strains for a long time in the toilet.

Usually the disease begins with constipation and other difficulties during bowel movements in childhood, but the first signs of the disease in adulthood are also possible.

With this pathology, a person begins to experience itching in the anus, fecal incontinence, and blood and mucus are released.

Diagnosis of rectal prolapse is made by palpation. The doctor may also ask the patient to push - then part of the intestine becomes visible. If polyps are suspected, a colonoscopy may be performed.

For adults in such cases it is only indicated surgical intervention. During the operation, the patient's intestinal ligaments are strengthened.

If a person also complains of incontinence, then the muscles of the anus are additionally strengthened.

Although the operation is rather large, it can be performed by almost anyone – even the elderly.

Quite often, intestinal prolapse occurs along with uterine prolapse in women. If a woman is elderly or does not intend to have children, then the uterus is removed.

If bowel prolapse occurs in young man without other health problems, they may prescribe conservative treatment, which includes special physical exercise, strengthening the muscles of the anus, and a diet rich in essential vitamins.

Patients with pathologies are diagnosed upper regions Gastrointestinal tract, and cases with predisposition.

Modern medicine provides diagnostic rooms with innovative equipment for conducting examinations to identify pathologies of the rectum.

There are many ways to diagnose rectal diseases, among which you can choose the most convenient and affordable one.

General rules for preparation

Examination of the rectum is carried out using several methods, differing in the method of execution, the equipment used, diagnostic material. But they all require execution general rules preparation for the procedure. On the eve of the rectal examination, the patient must completely cleanse the intestines. Preparation is done in several reliable ways:

Water enemas. To increase the effectiveness of preparatory measures, it is recommended to eat liquid meals the day before the study, avoid high-calorie and nutritious cereals, baked goods, as well as vegetables and fruits, foods that cause gas in the intestines. Over 8-10 hours, 2-3 enemas are done with 1.5-2 liters of warm water. Breaks between stages of intestinal processing are 30-60 minutes. A couple of hours before the examination, an additional 2-3 enemas are given.
Microclysters, such as “Norgalax”, “Normacol”, “Adulax”, are introduced into the rectum to irritate the receptors that cause the urge to defecate. Twice at intervals of 15 minutes is enough. The method does not require a diet and is fast and comfortable. But allergies are possible as a response to inflammation in the rectum, so microenemas are not recommended for internal ulcers, Crohn's disease.
Medicines with polyethylene glycol, for example, Fortrans, Flit-phosphosod, Endofalk. The selected substance is dissolved in 1-4 liters of water, according to the instructions. Part of the drug is drunk a couple of hours before the examination. A complete cleansing of the intestines is carried out in 12 hours. Suitable for fibrocolonoscopy, irrigoscopy.

Rectal-digital examination

Used first when making a diagnosis. The procedure is performed when the patient complains of pain and intestinal dysfunction. Rectal digital examination of the rectum is used:

to determine the condition of the anal muscle tissue;
assessing the severity of damage to all parts of the rectum;
classification of the pathological process.

The rectum is examined with the patient in different positions: lying on his back or on his side, in the knee-elbow position. The method is contraindicated for sphincter spasms, severe narrowing of the anal canal, cutting pain in the anus.

Before rectal palpation, the doctor examines in detail the condition of the anal area. An external check of the condition allows you to identify fistulas, external hemorrhoids and thrombosis, determine the degree of damage to the skin around the anus and the force of closure of its edges. But a more accurate assessment of the condition is provided by fistulography or profilometry.

Palpation is carried out with the index finger in a medical glove. To reduce the feeling of discomfort, the finger is lubricated with Vaseline, and the anus is treated with an anesthetic gel. The examination is carried out in two stages: with tense and relaxed sphincter muscles. No special preparatory steps are needed. Natural bowel movements are sufficient.

Anoscopy

The examination is carried out by a proctologist using an anoscope. The device is inserted into the anus to conduct additional research the degree of damage caused by the disease. The technique is used if there is:

pain in the anal canal;
traces of blood, mucus, pus;
alternating constipation with diarrhea;
suspicion of inflammation.

During anoscopy, the doctor examines the anus, anus, rectum with hemorrhoids located inside. A section of the intestine with a depth of 80-100 mm is subject to inspection. Profilometry is carried out similarly.

The procedure is performed after palpating the rectum, but before using sigmoidoscopy and colonoscopy. The technique is based on the gradual introduction of an anoscope in a circular motion in a supine position. After reaching the required depth, the instrument flaps expand the intestinal lumen before examination.

This type of endoscopy is painless, safe and effective, unlike gastroscopy. Anoscopy should not be used for acute inflammation of the anus, severe narrowing of the lumen of the anal canal, fresh burns and stenotic tumors.

Sigmoidoscopy

This common method allows for an informative rectal examination to obtain reliable data on the condition of the intestine. For this purpose, a sigmoidoscope is used, which is inserted to a depth of 35 cm from the anus. The method is a separate species endoscopy.

In addition to pain in the anus, discharge of pus, mucus with blood, and irregular bowel movements, the procedure determines the nature of the pathology of the sigmoid colon. Effectively used to detect the early stages of cancer in the rectum.

The essence of the technique: insertion of the device to a given depth in a knee-elbow position. To increase the lumen of the intestine, air is introduced while pushing the sigmoidoscope. If sudden pain occurs, you should report it to your doctor to make sure there is no damage. On the eve of the examination, you need to prepare thoroughly.

Irrigoscopy

The method refers to x-ray examinations using barium sulfate contrast, which is injected into the rectum. During the examination you can:

determine the size, location, shape of the intestinal lumen;
carry out an examination of the walls of the organ to determine the extensibility and elasticity of their tissues;
determine the condition of all parts of the intestine.

Irrigoscopy checks the functionality of the intestinal valve between the ileum and colon. With stable operation, the intestinal contents move from the thin to the thick sections. With dysfunction, the process is reversed, which can be seen by the movement of contrast. The relief of the mucous epithelium is also assessed, the condition of which makes it possible to check the presence or absence of ulcers, diverticulosis, fistulas, cancer or other formations, congenital pathologies development, healed narrowings. The method is most effective when combined with fistulography.

Irrigoscopy is safe, painless, and non-traumatic. The double contrast method is endowed with maximum information content, which reveals polyps and other tumor formations. Contraindications to the method are wall perforation and serious condition of the patient.

Colonoscopy

Refers to highly informative methods for identifying benign and malignant formations. Indications:

suspicion of tumor formation;
severe bleeding;
obstruction;
feeling of a foreign body.

Colonoscopy uses a colonoscope inserted through the anus into the rectum to the required depth. The patient lies on his left side. The device is gradually pushed forward with periodic pumping of air. To increase visibility, the rectum is first pumped with air, which, after the diagnosis is completed, is pumped out through an endoscope. The patient may feel discomfort and a false urge to defecate due to the rectum being filled with air. During the passage of intestinal loops, short-term painful sensations, which are less pronounced if you follow your doctor's instructions.

Other examination methods

general stool tests for dysbacteriosis;
clinical tests and blood biochemistry used to determine the inflammatory process and the degree of its progression;
capprogram and analysis on occult blood in stool, when checking for impurities and unwanted inclusions in stool, to identify inflammation;
biopsy, which allows diagnosing diffuse pathologies in the intestine, Crohn's disease, tuberculosis, the nature and type of tumors;
Ultrasound, which helps to identify a large number of diseases of the rectum;
fibrocolonoscopy, which allows assessing the condition of the mucous epithelium with the possibility of collecting biopsy material;
MRI and CT used to identify rectal cancer, its form, prevalence, determine treatment tactics and surgery, evaluate the effectiveness of the chosen course of therapy;
profilometry, which allows you to assess the degree of damage to the rectum by hemorrhoids;
fistulography, how X-ray examination, used to assess the condition, structure, length, connection of the fistula with other organs by introducing contrast into the intestine, followed by fluoroscopy.

Other types of endoscopic examinations, one of which is called FGDS or gastroscopy, are used to determine the disease, take a biopsy from the affected tissue, and evaluate the effectiveness of the applied therapy using a flexible fiberscope. FGDS allows you to simultaneously evaluate the esophagus, stomach, and duodenum. FGDS is used for diagnosis and treatment. FGDS is not used for fever, vomiting, black diarrhea, pain in the abdominal area. With the help of FGDS or gastroscopy, diseases are not only diagnosed, but also polyps and foreign bodies are removed, bleeding is stopped, and a biopsy is taken.

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How will the doctor check the rectum and intestines?

Treatment intestinal diseases V running forms- a very long process. Very often, a favorable outcome is overshadowed by numerous complications. Therefore, it is very important to know when you need to seek help from a proctologist and how you can check the rectum for the presence of certain diseases.

When should you contact a proctologist?

Most rectal diseases have similar symptoms. Timely health care will help to avoid very serious complications. Consultation with a doctor and examination of the intestines is necessary if the following symptoms occur:

discomfort in the anus: itching, burning, irritation;
pain in the rectum or anus, occurring during bowel movements or not associated with it. At the same time, the intensity pain syndrome doesn't matter. Frequent It's a dull pain may also be a sign of serious intestinal pathology;
feces with clots of blood or mucus, as well as discharge of mucus, blood or pus from the anus, regardless of the act of defecation;
nodes, seals in the perineum or anus;
disturbances in the usual bowel movement, including increased constipation or diarrhea or their alternation;
flatulence, especially in combination with heartburn or belching;
changes in general physiological condition (weight loss, poor appetite, fast fatiguability), combined with difficulty defecating, pain in the rectum or uncharacteristic discharge from the anus.

People whose relatives have suffered serious intestinal diseases, as well as elderly patients, are at particular risk. They are recommended to undergo preventive examinations every 6 months, even if characteristic features There are no bowel or rectal diseases.

How to prepare for a proctological examination?

During the first visit to the doctor, he carefully collects anamnesis (records the patient’s symptoms and complaints), and also conducts a visual, and in some cases, digital examination of the rectum. Therefore, before visiting a proctologist, you must prepare very carefully for the examination.

For the initial visit, it is enough to clean only the final section of the large intestine (rectum) from feces. This is easy to do with microenemas. If an endoscopic examination of the intestines is planned (anoscopy, sigmoidoscopy, colonoscopy, etc.), a more thorough cleansing of the organ from accumulated gases and feces is required. There are several ways:

Water cleansing enemas - they are done the day before the examination, in the evening (the first one is done at 18:00). 1.5-2 liters of warm water are injected into the rectum (it is advisable to use an Esmarch mug). The second enema is done an hour later, using the same amount of water. If necessary, do a third enema 1.5-2 hours after the second. In the morning, two more enemas are given, timing the time so that the last one is done no later than 2 hours before the examination.
Microclysters Norgalax, Microlax, Normacol, etc. Contained in preparations active substances help to quickly cleanse the intestines before endoscopic examination. Microclysters irritate intestinal receptors and cause defecation. Before the examination, it is recommended to do two enemas with a minute interval between them. It should be taken into account that the substances contained in the preparations may have a number of contraindications.
Laxative medications for bowel cleansing - Fortrans, Endofalk, Fleet Phospho-Soda. The drugs are dissolved in water and started to be taken a day before the scheduled examination. This method of bowel cleansing is advisable to use before complex instrumental diagnostics - colonoscopy, irrigoscopy.

The choice of method for cleansing the intestines is best agreed with a proctologist, since with very severe pain in the rectum, with internal bleeding, if partial or complete obstruction is suspected, cleaning procedures are prohibited.

General inspection

A general examination of the patient is necessary because it allows us to identify any deviations in the general physiological condition of the patient. It is known what it is dangerous disease how intestinal cancer causes changes in the general condition of the patient (pallor and dry skin, exhaustion).

Next, the proctologist must palpate the abdomen. This method of examination allows us to identify the intensity of contraction of the intestinal walls, compactions (tumors, fistulas), displacement of organs, location of intestinal loops, etc.

After palpation, the doctor proceeds to a visual examination of the anorectal area: assesses the condition of the anus and the skin around it. During the examination by a specialist, various anomalies may be detected: swelling of the skin, redness, pigmentation, the presence of polyps or anal fimbriae, hemorrhoids, etc.

A rectal digital examination is a mandatory stage of any proctological examination. For some diseases, a diagnosis can be made by a doctor immediately after diagnosis. During a rectal examination, the proctologist may:

assess the closing function of the sphincter muscles and the condition of the tissues of the anal area;
checks the rectal mucosa for scars, polyps or tumors;
evaluates the possibility of performing an endoscopic examination.

Anoscopy

Anoscopy is a method of instrumental diagnosis of the anus and lower part of the rectum. Carried out when there is suspicion of organic lesions intestines. Anoscopy is also often prescribed as a preliminary diagnostic procedure before sigmoidoscopy or colonoscopy.

For the examination, an anoscope is used, with which the condition of the anal canal and lower part of the rectum is examined and assessed to a depth of about 10 cm from the anus.

Indications for anoscopy:

constant or acute pain localized in the rectum;
frequent discharge of blood or mucus from the anus;
frequent constipation or diarrhea;
suspicion of internal hemorrhoids.

If necessary, during anoscopy, the doctor can take biological material for a biopsy.

Anoscopy is not performed in cases of severe inflammation in the perianal area in the acute stage, metastatic tumors and rectal stenosis.

Sigmoidoscopy

Sigmoidoscopy is a common diagnostic method that allows you to check the mucous membrane of the rectum and the lower segment of the sigmoid colon.

Indications for the examination:

bloody or mucous discharge;
stool disorder;
difficulty defecating;
pain of varying nature and intensity, localized in the perianal or anorectal area;
as a differential diagnosis for suspected formation of malignant tumors in the intestine.

Sigmoidoscopy is painless and safe procedure, which does not cause complications. Relative contraindications may include profuse bleeding, acute inflammation, and chronic anal fissures.

Irrigoscopy

Irrigoscopy is a method for diagnosing the large intestine, which involves filling the intestinal ducts with a contrast agent (barium suspension) and X-ray radiation.

Indications for irrigoscopy:

clarifying the diagnosis of diverticulosis or fistulas;
suspicion of chronic colitis;
adhesive process in the intestines.

During diagnosis, tight filling of the colon with a contrast agent is used to obtain data on the shape of the intestine, the location of its loops in the abdominal cavity, the length of the intestine and its sections, as well as the compliance with the norm of distensibility and elasticity of the intestinal walls.

The next stage of the study is the removal of the contrast solution from the intestine. In this case, the doctor evaluates the functionality of various parts of the colon, and after complete removal of the substance, evaluates its relief.

Double contrast (the intestine is filled with contrast, then air is supplied into it under pressure) is used to identify tumors and polyps.

Irrigoscopy is contraindicated in case of perforation of any part of the intestine.

Colonoscopy

Colonoscopy is a diagnostic method in which the large intestine is examined. With its help, you can check the intestines for the presence of neoplasms, take biomaterial to determine the nature of these formations (malignant or benign). Of all possible methods For diagnostic purposes, colonoscopy is the most informative.

If polyps are detected, the specialist can remove small-diameter, single formations directly during the procedure. Subsequently, the removed lesions are sent to the laboratory for histological examination to identify cancer cells.

After removal of polyps or tumors, colonoscopy is performed several more times to monitor the appearance of new formations, as well as to assess the condition of the mucous tissue after their excision.

In other cases, colonoscopy is indicated for:

intestinal obstruction or if it is suspected;
intestinal bleeding of unknown etiology.

Diagnosis with a colonoscope is not possible in cases of poor blood clotting, cardiac or pulmonary insufficiency, as well as in infectious diseases in the acute stage, including severe forms of colitis.

IN modern medicine There are a lot of possibilities and innovative equipment that allow you to accurately diagnose any proctological diseases. Early detection intestinal pathologies allows you to achieve positive dynamics of treatment in a short time, prevent possible complications and increase the chances of full recovery with such serious illnesses like bowel cancer.

How to check the rectum?

Good afternoon, my name is Tatyana, 27 years old. I've been having pain in my lower abdomen for a couple of weeks now. And yesterday there was something similar to an attack: a sharp pain in the abdomen and an incessant urge to defecate. I sat in the toilet until the morning, the diarrhea seemed to have ended, but my stomach hurt. According to gynecology, everything is fine, I saw the doctor a month ago. I understand that I need to go to a proctologist, but how can I imagine this horror... Please tell me what methods the doctor uses to check the rectum?

Reasons for visiting a proctologist

Intestinal diseases have a variety of clinical manifestations. At the initial stage, some diseases, as a rule, do not have pronounced symptoms. They are often difficult to notice and almost impossible to associate with a specific illness. In addition, many people suffering from intestinal diseases consider visiting a proctologist something “inconvenient” and “shameful” and ignore bothersome symptoms, turning to a doctor at a time when the disease is already causing a lot of problems and is actively progressing. Unfortunately, this approach is fraught with serious problems for the patient: treatment of intestinal diseases in advanced stages is a very long, unpleasant and financially expensive process. Moreover, long-standing intestinal problems can lead to cancer. So, a consultation with a proctologist and a thorough examination of the rectum are necessary if at least one of the following symptoms is present:

discomfort or pain in the anus;
pain during or outside of bowel movements or anal itching;
bloody, mucous or purulent discharge from the anus;
prolapsed hemorrhoids;
change in the usual rhythm of bowel movements;
painful lumps (bumps) in the perianal area
pulling sensations in the perineum;
bloating and abdominal pain;
constipation, diarrhea, difficulty defecating, flatulence;
unmotivated weight loss, increased general weakness, lack or decreased appetite.

People with a negative hereditary and family history, as well as elderly patients, are at particular risk. Some of the most threatening symptoms, if present, you should visit a proctologist immediately, are acute pain, false urge to have a bowel movement, constipation alternating with diarrhea, daily discharge of blood or pus from the anus, rapid weight loss and general weakness. The most important thing in coloproctological diagnosis is not to miss a malignant tumor!

The main diagnostic methods include instrumental and non-instrumental rectal examination methods, as well as x-rays. Any examination of a patient begins with the doctor familiarizing himself with the patient’s complaints and a general examination. The choice of diagnostic methods required for a particular patient is determined by the doctor based on the results of a general clinical examination. The task of the proctologist is to obtain an accurate diagnosis, as well as information about the general condition of the large intestine, regardless of the location of the pathological area.

Preparing for a proctological examination

Water cleansing enemas. The day before the examination, you should eat liquid food, reduce the amount of vegetables, fruits, cereals, flour products, as well as any foods that provoke flatulence in your diet. If the appointment is scheduled for the morning, then the night before you need to do 2 to 3 enemas with water at room temperature with a volume of 1.5–2 liters with an interval between enemas of 30 minutes to 1 hour. In the morning you should give 2 or 3 more of these enemas. If the examination is carried out in the afternoon, then cleansing enemas should be given several hours before the consultation appointment. In this case, the last enema should be given no later than 2 hours before the doctor’s appointment. This method, although it requires a significant amount of time, is most effective for completely cleansing the intestines.
Special microenemas. The patient or doctor inserts a microenema (Norgalax, Normacol, Adulax, etc.) into the rectum. The solution included in the microenema irritates the receptors of the rectum and causes the urge to defecate. After administering such a microenema, the patient recovers on his own (about 2 times with a break of 10 to 20 minutes). This technique is quite comfortable for the patient: it is carried out quickly; does not require prior changes in diet. However, microenemas can cause allergic and inflammatory reactions in the rectum, therefore, if Crohn's disease or ulcerative colitis is suspected, such rectal cleansing with microenemas is undesirable.
Medicinal preparations for colon cleansing based on polyethylene glycol, such as fortrans, flit phosphosoda, endofalk, etc. The preparations must be dissolved in a large amount of water (1–4 l) according to the instructions and drunk a certain time before the examination. Usually, after taking such a solution, the rectum is completely cleansed within half a day. This method is often used for complex instrumental diagnostics, such as fibrocolonoscopy and irrigoscopy. For the initial examination of the rectum, these drugs are usually not used.

The choice of bowel cleansing technique should be previously discussed with a proctologist, who will conduct a proctological examination.

If the reason for visiting a proctologist is severe pain in the rectal area or severe bleeding, then self-cleansing of the intestines cannot be carried out.

General examination of a proctological patient

Digital examination of the rectum

Digital examination of the rectal lumen allows the doctor to:

assess the condition of various tissues of the anal canal, the closing function of the sphincter and organs surrounding the rectum;
determine the degree of preparation of the rectum for endoscopic examinations;
check the rectal mucosa;
identify the presence of pathological processes in the intestines;
assess the nature of discharge from the anus;
select the optimal position of the patient for the main diagnostic examinations.

Technique: the doctor, wearing a rubber glove, gently and carefully inserts the index finger into the anus and carries out step-by-step sequential palpation of all walls of the rectum. In this case, the patient needs to push, as if he has a bowel movement, and relax his stomach during the examination. A digital examination is carried out using an anesthetic spray or ointment, without increasing pain or causing discomfort. There are practically no contraindications for this study.

Anoscopy

Sigmoidoscopy

Sigmoidoscopy (rectoscopy) is a popular endoscopic method for examining the rectum, as well as the lower part of the sigmoid colon. This procedure is the most informative and accurate, therefore it is often an integral element of a full proctological examination. Sigmoidoscopy allows you to assess the condition of the rectum to a depth of 20 to 35 cm. The procedure, although not very comfortable, is quite painless, and therefore requires anesthesia only in special cases. Before the study, you need to thoroughly cleanse the intestines with an enema. Sigmoidoscopy can be performed only after a digital rectal examination of the rectum.

Indications for rectoscopy: pain in the anus; discharge of blood, mucus and pus; regular bowel movements; suspicion of sigmoid colon disease. In addition, this type of diagnosis is used for preventive examinations of people in the older age group to exclude malignant neoplasms at least once a year.

Irrigoscopy

Irrigoscopy is an X-ray method for examining the colon while filling it with a barium suspension introduced through the anus. It is carried out by a proctologist in the radiology room. Pictures are taken in direct and lateral proportions. Irrigoscopy is used to clarify or diagnose diseases such as diverticulosis, fistulas, neoplasms, chronic colitis, scar tissue narrowing and others.

When x-raying the colon, the following is used: tight filling of the intestine with a barium suspension, studying the relief of the mucous membrane after the intestines are freed from contrast, as well as double contrast. Dense filling of the intestine with contrast allows you to obtain information about the shape and location of the organ, the length of the intestine and its parts, the distensibility and elasticity of the intestinal walls, as well as detect gross pathological changes. The degree of emptying determines the nature of the functionality of various parts of the intestine. The most informative method for identifying colon polyps and tumors is double contrast. A contraindication for irrigoscopy is perforation of the wall of any part of the intestine, as well as a complicated condition of the patient.

Colonoscopy

Colonoscopy is a diagnostic study carried out using a special endoscopic device - a colonoscope, and allows you to examine the large intestine along its entire length - from the cecum to the rectum. During the procedure, the endoscopist visually assesses the condition of the intestinal mucosa. In addition, with colonoscopy, it is possible to carry out therapeutic measures, such as removal of benign tumors, removal of foreign bodies, stopping bleeding, etc. This method is considered one of the most informative for the primary diagnosis of benign and malignant neoplasms in the intestine, as well as diseases such as UC, Crohn's disease and others. Colonoscopy is mandatory in patients who have previously had polyps removed, as well as after conservative treatment of ulcerative colitis or surgery for intestinal cancer.

Indications for colonoscopy are: suspicion of a tumor; inflammatory diseases of the colon; intestinal obstruction; intestinal bleeding. Contraindications: violation of the blood coagulation system; heart and pulmonary failure; acute infectious diseases; severe forms of colitis, both ischemic and ulcerative.

Technique: The patient lies on the couch on his left side and pulls his knees to his chest. After local anesthesia of the anus, a colonoscope is inserted into the rectum and slowly moved forward through the intestine with a small supply of air to expand the lumen of the intestine. To avoid discomfort during this rather complex procedure, the patient must strictly follow all the endoscopist's instructions. During a colonoscopy, the patient may be bothered by a false urge to defecate, arising from the overcrowding of the intestine with air. In addition, when the endoscope negotiates the bends of the intestinal loops, the patient may experience short-term pain. Sometimes, to clarify the diagnosis, a biopsy of the affected areas of the mucous membrane is performed, which leads to an increase in the duration of the study by a couple of minutes. At the end of the diagnosis, air from the intestine is sucked out through the endoscope tube. After a colonoscopy, the patient is advised to lie on his stomach for several hours.

Conclusion

Today, proctology has an extensive arsenal of research techniques, thanks to which it is possible to accurately diagnose any pathologies of the colon and rectum, anal canal and perineum. The main thing is to consult a doctor in a timely manner, who will select the most appropriate studies based on the patient’s complaints and medical history.

The rectum performs the function of defecation, the final function of the intestine. It is located in the posterior part of the small pelvis and ends in the perineum.

In men, the prostate gland is located in front of the rectum, the posterior surface of the bladder, seminal vesicles and ampoules of the vas deferens. In women, the uterus and posterior arch vagina. At the back, the rectum lies next to the coccyx and sacrum.

The upper border of the intestine is located at the level of the upper edge of the third sacral vertebra.

The rectum is the final section. When it is not filled, longitudinal folds form in the mucous membrane. They disappear when the intestine is distended.

The length of the rectum does not exceed 15 cm. top part surrounded by three transverse folds. The rectum ends in the anorectal region.

The rectum forms two bends. The sacral flexure is curved towards the spine, and the perineal flexure - towards the abdominal wall. There are two sections of the rectum - pelvic and perineal. The border between them is the place of attachment of the levator ani muscle. The pelvic section, located in the pelvic cavity, consists of the supramullary and ampullary sections. The ampullary section has the shape of an ampulla with an expansion at the level of the sacrum. The perineal section of the rectum is also called the anal canal. It opens outward through the anus.

Muscularis

The muscular layer of the rectum is formed by outer longitudinal and inner circular layers. Transverse folds are formed by the circular muscles. The longitudinal layer contains fibers of the levator ani muscles. In the anal canal, 8-10 longitudinal folds are formed, the basis of which is smooth muscle and connective tissue.

The outlet of the rectum is ring-shaped by the muscular external sphincter of the anus (voluntary sphincter). At a distance of 3-4 cm from the anus, the thickening of the circular muscles forms another sphincter (involuntary). At a distance of 10 cm from the anus, the circular muscles form another involuntary sphincter.

Blood supply to the rectum

The blood supply to the rectum is provided by the superior and inferior rectal arteries. The superior rectal artery is a continuation of the inferior mesenteric artery, and the inferior rectal arteries are branches of the internal cava artery.

Thanks to this blood supply, the rectum is not involved in the pathological process during the development of ischemic colitis.

The outflow of blood occurs through the corresponding veins. These veins form plexuses in the wall of the rectum. In the submucosa of the anal canal, at the level of the anal valves, there is cavernous vascular tissue. Recent studies have convincingly proven that it is she who forms hemorrhoids.

In the mucous membrane there are single lymphoid nodules and sebaceous glands. At the border of the intestinal mucosa and skin there are sweat glands and hair follicles. The rectal mucosa has good absorption capacity. This quality is used to administer nutritional fluids and medicinal substances through the rectum through suppositories, enemas and irrigations.

Innervation

From the point of view of its functions, the most important part of the smooth muscles of the rectum and anal canal is the internal sphincter. It provides residual pressure in the rectal lumen. The motor activity of this sphincter is inhibited and excited by both the sympathetic and parasympathetic nervous systems.

Functions of the rectum

The rectum has two functions:

anal continence (accumulation of feces)
defecation (evacuation of feces).

Anal holding

Violation of the function of holding the intestinal contents of the rectum brings the greatest inconvenience to a person and creates problems of both a social and medical nature.

In its natural position, the internal anal sphincter is always contracted.
It relaxes only when the rectum is stretched. Immediately after stretching the rectum and relaxing the internal sphincter, the rectosphincteric relaxation reflex occurs.

Retention of intestinal contents is normal condition and is regulated unconsciously. However, volitional influence on this function is also possible. Retention depends on the interaction of many factors.
Chief among them is the consistency of feces in direct and colon. No less important is the coordination of the activity of smooth and transverse orbicularis muscles in the area of the anal canal. Of course, the anatomical integrity of all components of this process is necessary.

The smooth muscles of the anal canal, rectum and internal anal sphincter respond to local stimuli and to reflexes transmitted by the autonomic nervous system.

Transverse muscles voluntary sphincter controlled by centers of the spinal cord and brain. This is carried out by centrifugal and centripetal nerve fibers.

So what has the greatest impact on grip function? It was assumed that this role is shared between the internal and external anal sphincters. However, cutting the internal sphincter only affects gas incontinence. And dissection of the external sphincter also leads to gas incontinence and difficulty in holding large amounts of liquid feces.

It turned out that the holding function is determined mainly by the state of the puborectalis muscle, which maintains the required anorectal angle. When this muscle is damaged, severe fecal incontinence occurs.

Defecation

Defecation is difficult process, adjustable reflexively. It is divided into two interrelated phases:

afferent and
efferent.

In the afferent phase, an urge is formed, and in the efferent phase, feces are released.

The urge to defecate occurs when feces enter the rectum from the sigmoid colon. At the same time, they put pressure on the puborectalis muscle, in which numerous receptors are located. Afferent excitations are transmitted to the cerebral cortex. Here it influences the formation of the urge to defecate; it can be both inhibitory and intensifying the process.

When the urge occurs, feces continue to be retained in the rectum due to the internal and external sphincters. Emptying occurs reflexively and is controlled by an impulse from the central nervous system. If, when the urge occurs, the situation is unfavorable for defecation, then voluntary contraction of the external sphincter causes a rise pelvic floor, the anorectal angle increases and the stool is forced to rise upward.

Regular inhibition of the process of defecation when the urge occurs (volitional inhibition) can lead to disruption of the regulatory functions of the body, which in turn will lead to constipation.

The influence of the central nervous system on this process has not been fully studied. Thus, uncontrollable fecal incontinence may occur as an idiopathic phenomenon, but can occur with multiple sclerosis and other diseases of the nervous system.

In older people, constipation may occur due to weakening of the pelvic floor muscles and diaphragm.

Strong emotional stress can cause involuntary relaxation of the internal and external sphincters and lead to a violation of the act of defecation, known as “bear disease”.

An increased frequency of urges can also be caused by the effects of toxic substances on intestinal receptors. For various poisonings, this contributes to accelerated withdrawal harmful substances from the body.

Diseases of the rectum

Like any human organ, the rectum can have functional diseases and organic lesions. In addition, functional diseases of other parts of the intestine also disrupt the normal functioning of the rectum.