Stenosis of the rectum is a narrowing of its lumen, which is accompanied by impaired patency of the colon.
The main consequence of such pathological conditions is the deterioration of the evacuation function of the rectum (elimination of feces). In addition to the occurrence of physiological discomfort, this violation leads to poor social adaptation. With the progression of the disease, the consequences can be much worse – in the form of development of intoxication by the waste products of the body, of which, indeed, formed stool.
In most cases, stenosis of the rectum occurs as a complication of diseases and pathological conditions of the rectum and its surrounding tissue.
Causes and development of disease
Depending on factors provoking the development of stenosis of the rectum, the pathology may be:
Congenital stenosis of the rectum is defects, which are formed as a result of failure of fetal development of rectal tissue. They manifest themselves almost immediately after birth.
Acquired stenoses are formed as a result of various diseases and pathological conditions affecting the rectum after birth.
Causes of acquired stenosis of the rectum can be divided into the following groups:
Traumatic stenosis can occur with trauma:
- iatrogenic – resulting from medical intervention;
- external – coming in rough external factors.
Iatrogenic factors that may lead to stenosis, are observed during medical procedures:
Diagnostic factors iatrogenic trauma of the rectum, can lead to stenosis are:
- digital rectal exam – rectal tissue walls are quite durable, but the trauma to the finger may occur with sufficient coarse the research.
- proctoscopy inspection of the rectum with a rectal mirror;
- various types of endoscopic examinations of the rectum inside (sigmoidoscopy, colonoscopy) and external (laparoscopy – during this study the rectum can hurt if you study it with an endoscope, inserted into the abdominal cavity);
- the biopsy (taking of tissue for further study)
and so on.
Therapeutic measures that can lead to trauma to the rectal wall, is:
- setting cleaning or siphon enemas with damaged equipment (chipped bits, etc.);
- surgical procedures on or in the rectum, surrounding tissue, perineum or perianal area – endoscopic removal of rectal polyps electrocoagulation lesions of rectal bleeding (“burning” electric shock bleeding vessels), remove internal hemorrhoids, the opening of the purulent abscess, surgical treatment of rectal fistulas (abnormal passages) and so on;
- introduction into the rectum with the purpose of treatment chemicals that were corrosive to tissues (often occurs if you attempt self-treatment);
- improper childbirth, which leads to rupture of the perineum and rectum during childbirth
and the like.
Most often, postoperative stenosis in children result of surgical intervention about:
- atresia (overgrowth of the lumen) of the anus;
- rectal fistulas arising from paratrechina.
External causes that can lead to trauma:
- the impact of traumatic subjects, resulting in torn, bitten, cut, puncture wound of the rectum;
- intentional introduction into the rectum of aggressive substances in order to self-harm (for example, if you attempt suicide, or to avoid service in the army), and in situations with a criminal tinge (torture);
- rough anal sex;
- traumatic methods of anal Masturbation (by using improper means, is able to injure the wall of the rectum).
Tumors that trigger the development of stenosis of the rectum, can grow inside the lumen of the intestine and out, squeezing it from the outside. This:
- benign tumors – they are in most cases grow in the direction of the rectal lumen. Is polyps, fibroids, fibroids and so on;
- malignant neoplasm – primary, formed from the rectal lumen, and metastatic tumors formed from cells contracted from malignant tumors of other sites.
Inflammatory lesion of the rectal wall can lead to its stenosis occurs due to infectious lesions, which can be:
- non-specific nature – caused by infectious agent that could cause various infectious diseases. This is mainly staphylococci, streptococci, Proteus, Escherichia coli;
- specific nature – caused by infection, which leads to a single pathology.
Nonspecific diseases of the rectum, which often lead to stenosis is:
- proctitis – inflammation of the mucous membrane of the rectum;
- proctosigmoiditis – inflammation of mucosa of rectum and sigmoid;
- paraproctitis – inflammation of the perianal tissues;
- ulcerative colitis – inflammation of the mucous membrane of the large intestine, including the rectum, with the formation of ulcerations;
- somewhat less pectins is a chronic inflammation of the scallop (anatomical structures located in the zone of the rectal folds). Pectins may occur when fissure of the anus, proctitis with lesions of the perineal part of the rectum and chronic paraproctitis.
A vivid example of specific inflammatory lesions of the rectum, which quite often ends her stenosis are intestinal tuberculosis caused by tubercle Bacillus (Mycobacterium tuberculosis).
Non-inflammatory causes, often provoking stenosis of the rectum is:
- some rectal disease, in particular Crohn’s disease (education in the rectal wall multiple granulomas);
- radiation injury due to radiation therapy, which was appointed for tumors of the pelvis, when working with radioactive elements, to unauthorized access to radioactive substances;
- secondary lesion with sexually transmitted diseases.
Congenital stenosis of the rectum are most often placed in the area of the anal ring, at least – a few inches taller. In other parts of the rectum are diagnosed they are extremely rare. A segment of rectal wall exposed to the stricture, in most cases small.
Reduction of the lumen of the rectum with acquired stenosis may develop in a different way from a local stricture in a limited area of rectal wall to the contraction of most or all of the rectum. Narrowing can form on any part of the rectal wall – from the point of transition into the sigmoid colon to the anus.
Acquired stenosis develop slowly from the time of exposure to a provoking factor (trauma, radiation exposure, and so on) to the development of the clinic may take from several months to several years. Some develop faster inflammatory stenosis, in some cases, the tumor (depending on the growth rate of tumors).
Symptoms of stenosis of the rectum
Congenital stenosis of the rectum manifests itself clinical symptoms in the first days of life the newborn baby. Signs that are observed is:
- a violation of the discharge of meconium;
- the selection of the rear fluid passage;
- an increase in the abdomen of the child;
- the change in behavioral responses of the newborn.
Violation of the discharge of meconium is shown as follows:
- the first discharge of meconium is extremely difficult;
- subsequent feces, which began to emerge in the intestine of the child, out of the anus in the form of a narrow tape (mom characterize the phenomenon this way: “Cal is squeezed out like toothpaste from a tube”);
- in severe stenosis the stool is not allocated, this condition requires immediate medical solutions.
The allocation of turbid fluid from the anus it is noted in the absence of the discharge of feces, which may occur due to the critical severity of stenosis. Because of pathogene Cala the volume of the stomach of the child is increased in the first days after birth.
The behavior of a newborn with stenosis of the rectum is a typical, but not specific: he refuses to eat, sleeps badly, is restless, crying because of discomfort in the abdomen. If the stenosis is slight, it is difficult to diagnose – often correctly diagnosed only a few months or even years after birth.
Typical signs of acquired stenosis of the rectum are:
- discomfort in the abdomen;
- difficulty emptying the rectum;
- false urge to defecation;
- itching in the anus
- impurities in the stool.
A feeling of discomfort in the stomach caused by the pressure of feces that had accumulated above the stenosis, intestinal wall, but a full-fledged pain syndrome are not typical.
Difficulty emptying does not depend on the type of food eaten the day before. Patients should make an extra effort (push) to empty your rectum. In this case the stool away in the form of thin strips, the width of which can be pre-estimate the degree of narrowing of the rectum.
False urge to defecation provoked by irritation of the mucous membrane of the rectum of the accumulated fecal masses.
The true cause of itching in the anus stenosis of the rectum is unknown.
As impurities in the stool can be:
- mucus – when stenosis begins to be produced in larger quantities to facilitate the passage of fecal masses in the rectum is compromised. Another reason for the enhanced production of mucus may be adhering secondary inflammation of the rectal mucosa;
- blood – appears in the place of ulceration, which may occur in the area of occurrence of the stenosis;
- pus is secreted in the presence of purulent complications of stenosis of the rectum.
Depending on the degree of development of clinical symptoms there are three degrees of stenosis of the rectum:
- offset – difficulty in defecation occur periodically, but overall evacuation function of the rectum is not broken;
- subcompensated – the symptoms are frequent, but not permanent violations of the evacuation function of the moderates, the rectum is emptied with difficulty, but almost completely;
- asthma – symptoms of intestinal obstruction, with complications such as inflammatory processes, the formation of hemorrhoids, enlargement of the rectum above the level of the stenosis, in severe cases of fecal incontinence, as well as intoxication, which occurs due to the ingestion of toxic substances from the stagnant stool in the blood.
Diagnosis of stenosis of the rectum
In violation of the act of defecation in the first days of birth, should be suspected of congenital stenosis of the rectum. The diagnosis of acquired narrowing of the rectum to put it is not always easy, as the symptomatology is not specific. The most informative in the diagnosis are the clinical history (in particular, the presence in the vulgar operations, injuries, and other inflammatory lesions of the rectum), and instrumental methods of examination, but physical examination and laboratory examination will help to complete the picture of the disease.
The results of the physical examination the following:
- during the inspection – in the case of congenital stenosis in children is rendered not typical the anus is formed, and a cone-shaped depression with a hole in the center. With acquired stenosis of the anus is dilated or in the yawning condition. Also stenosis of the rectum can be detected scars and areas of maceration (corrosion of tissues in the presence of secretions);
- rectal examination – in case of low location of the stenosis, it can be felt with your finger, and to detect ulcers and infiltration of the rectal wall, which could be complicated for the described pathology.
Instrumental methods used in the diagnosis of stenosis of the rectum, the following:
- rectoscopy using a rectal mirrors, introduced in the rectum, it is possible to detect the stenosis in its lower location;
- sigmoidoscopy – sigmoidoscopy (varieties of periodontal endoscope) it is possible to assess the condition of the rectum for longer and to reveal narrowing down to the border of the sigmoid colon and above, the extension of the large intestine;
- proctography in the rectum contrast medium injected, and then make x-ray images, which reveal stenosis, determine its localization, severity and condition of surrounding tissue;
- barium enema and -graphy – they are used if there is a suspicion that a pathological process is located above the rectum. Contrast medium fills the suspect portion of the colon at barium enema to examine the bowel using x-ray screen when irrigography make x-ray images, which analyze on the subject of the pathology causing the stenosis;
- biopsy – it is performed during endoscopic examination: make the fence of the tissue in the lesion, is then examined under a microscope.
Of laboratory methods for the study of stenosis of the rectum is the most valuable microscopic examination of biopsy material – first and foremost, find out whether the stenosis is the consequence of neoplastic lesions.
Other methods of laboratory diagnosis involved if necessary in case of complications stenosis.
Differential diagnosis of
Differential diagnosis of stenosis of the rectum is carried out diseases of the higher areas of the large intestine, which can cause similar clinical symptoms. This:
- inflammatory lesions of.
Stenosis of the rectum, developing as a consequence of many diseases and pathological conditions – so often a differential diagnosis should be performed among them. Actually, this is the diagnosis. In the first place, to exclude severe inflammatory disease and malignant tumors.
Complications stenosis of the rectum
Complications that often develop stenosis of the rectum is:
- persistent constipation;
- intestinal obstruction can develop in progressive total stenosis of the rectum;
- megacolon – an increase in the length and diameter of the individual segment of the large intestine which develops due to persistent stagnation in it the stool;
- proctitis – inflammation of the mucous membrane of the rectum. It provokes infectious agent that aktiviziruyutsya against the background of stagnation of stool formed in the rectum above the constriction;
- paraproctitis – inflammation of the tissues surrounding the rectum. Develops due to the increasing activation of infectious agent, where inflammation of the wall of the rectum spread to the surrounding tissue. In advanced cases, may develop purulent abscess;
- fistula – a pathological course that connects the rectum with the skin of the perineum or ending blindly in perianal tissues. Is formed at the extreme neglect of an infectious process that developed against the background of constipation because rectal stenosis.
The distinctive feature of rectal stenosis complications – often they are hard. The reason is the following: stenosis develops slowly, patients have time to adapt to new physiological conditions (in particular, defecation), which seek medical help later, when it is time to develop complications.
Treatment of stenosis of the rectum
Treatment of stenosis of the rectum may be:
Medical tactic depends on what disease provoked the stenosis, as expressed violations and are there any complications.
In the diagnosis of congenital stenosis of the practice of extension of the narrowed area with a finger or a hegar’s bougies – special metal rods. If there is no effect, then resort to surgery – the narrowed area of cut along the axis, and then sewn together in the transverse direction, due to this, the rectum increases.
If the stenosis is pronounced, then the affected portion of the rectum cut out, then spend its plasticity to restore integrity. You should be wary of such postoperative complications as rectal prolapse, so do its fixation.
If stenosis of the rectum is acquired, then treat the disease that provoked it. Conservative techniques that do apply are the following:
Such methods are effective for those pathologies, which has not come yet pronounced structural changes in the rectal wall (e.g., stenosis due to slight scarring).
Operative treatment in case of ineffectiveness of conservative treatment, the growing of the clinic or the appearance of complications.
The extent of surgery depends on the level and extent of the lesion. Can be performed:
- dissection of tissues at the site of stenosis;
- excision of the stenotic area;
- removal of the bowel segment with stenosis.
In advanced cases, which led to pronounced changes in the rectum (for example, the accession of the inflammatory process), an operation generally carried out in two stages, patients should be prepared for that. The first phase is the surgical formation of a colostomy – the colon is removed on the anterior abdominal wall, forming an artificial anus. The objective of the first stage discharge of the lower sections of the intestine. Then after some time (after the elimination of inflammatory lesions, and so forth) sections of the narrow cut and hold plastic rectum.
If the contraction occupies a large area or is quite high, may need removal of a large segment (partial resection) of the rectum or its complete removal.
Prevention of stenosis of the rectum
Specific methods of prevention of congenital stenosis does not exist. To prevent the development of defects in the unborn child, pregnant women should follow a healthy lifestyle and follow the doctor’s recommendations.
For the prevention of acquired stenosis of the rectum should be warned of pathology which lead to it, and if they have any – their time to identify and treat. Great importance is the detection and treatment of tumors, inflammatory processes and prevention of trauma to the rectum, which primarily lead to the formation of stenosis.
The prognosis of stenosis of the rectum
The prognosis of stenosis of the rectum generally favorable – with proper treatment, about 90% of patients recover or notes satisfactory job of the rectum.
Most often, the prognosis worsens with the development of complications in the first place, incontinence of feces. The treatment of such patients is long, with the involvement of conservative methods and surgical treatment in several stages.