Definition
The rectum is, as its name suggests, the last part of the 5-6 meter long intestine in the human body. The rectum is 20 to 30 cm long and connects to the large intestine in the lower right part of the abdomen and ends with the anus. By the time the digested food pulp reaches the rectum, all usable nutrients and almost all the water it contains have been removed, so that the pulp arriving here already has the solid consistency of stool.
The forward transport also takes place in the rectum as in the rest of the intestine by wave-like tension of the muscles around the intestine in the intestinal wall. Another name for the rectum is rectum or, in Latin, rectum. The task of the rectum is to collect the finished digested food pulp in the so-called ampoule, the dilated entrance piece of the rectum.
The lower part of the rectum is then responsible for the controlled excretion of stool by voluntary muscle relaxation of the anus. The anus consists of a very strong muscle ring which, when tensed, holds the solid or liquid stool and intestinal gases in the intestine. The muscle ring is supported by a network of veins surrounding it. If these veins fill up with blood, they can additionally support the sphincter muscle. If the ampoule fills and expands, nerve signals are transmitted, which then trigger the urge to defecate and one feels the need to go to the toilet.
Causes
The causes of inflammation in the rectum can be manifold. A gastrointestinal endoscopy can provide indications of the cause, which can indicate whether other parts of the gastrointestinal tract (lat. : gastrointestinal tract) are affected.
If only the rectum is affected, in medical terminology it is also called proctitis (the suffix “-itis” is always used in medicine to denote an inflammation). A pure inflammation of the rectum (=proctitis) is often confused with hemorrhoids. However, these are found on the anus and not inside the rectum.
The causes are far-reaching and can range from venereal diseases, injuries, cancer, allergies or even in the context of a chronic inflammatory bowel disease. Among the venereal diseases the so-called gonorrhea (lat: gonorrhea) or syphilis (lat: lues) caused by bacteria or genital herpes caused by herpes viruses as well as genital warts caused by papilloma viruses play a role. A permanent inflammation due to a chronic disease is called chronic inflammatory bowel disease.
The best-known representatives are Crohn’s disease and ulcerative colitis. Both can affect the rectum and are similar in their disease characteristics. They both lead to progressive inflammation of the intestinal wall, but differ in terms of how it spreads in different parts of the intestine.
The rectum can be affected in both diseases. The causes of these inflammations are not yet fully understood, but a combination of different triggers is suspected, among which hereditary predisposition, autoimmune disease, dietary habits or infection with viruses or bacteria as well as psychological influences are discussed. A conclusion on environmental influences can be drawn from the fact that the number of patients in the western world has been much higher in recent years than in other countries.
Both diseases have in common a relapsing course, which means that those affected will always have phases in which no signs of illness are visible, which are replaced by phases with a strong inflammation. A proctitis can cause very different signs in the affected person. In less pronounced cases, the anus is only very sensitive to the slightest touch and feels sore, and itching is not uncommon.
Pain during bowel movements is also common. In cases of severe inflammation, pus or even blood may be found on the toilet paper or in underwear. If blood is added, anemia can develop in the long term with fatigue, paleness, dizziness, shortness of breath and concentration problems.
If there is blood in the stool, a rectal tumor must always be clarified. The diagnosis of a chronic inflammatory bowel disease is often not so clear and easy to make, and not all signs of a chronic inflammatory bowel disease directly indicate involvement of the bowel, because in these diseases those affected suffer from so-called “general symptoms”. In the case of a chronic inflammatory bowel disease, these can be a drop in performance with fatigue, loss of appetite and in some cases fever.Very clear is often also a clearly progressive weight loss, since by the permanent inflammation of the mucous membrane nutrients can no longer be absorbed correctly into the body.
In patients with ucerative colitis, it is not uncommon for anemia to occur, as in the case of bloody proctitis, as a result of blood loss due to frequent bowel movements. Bloody stools are less common in Crohn’s disease than in ulcerative colitis. The first thing most people notice is the changes in the bowel movements.
Diarrhea is the most common form of diarrhea and it is not unusual for people to report having bowel movements more than twenty times a day! This diarrhoea is then accompanied by abdominal pain, which usually occurs before or after the bowel movement. These phases alternate with phases of almost complete freedom from symptoms due to the intermittent course of chronic inflammatory bowel diseases.
An affected person can go through this change several times a year. Depending on the cause of the proctitis, it must be treated differently. If a sexually transmitted disease is caused by bacteria, such as gonorrhea or syphilis, antibiotic therapy will provide relief by killing the pathogens and the rectum can heal.
Other causes, such as injuries, often heal by themselves. Local anaesthetics in the form of suppositories, ointments or gels can relieve the symptoms during this period of healing. Chronic inflammatory bowel diseases are more difficult to treat and can only be cured in the rarest of cases.
It is not uncommon for a chronic inflammatory bowel disease to require lifelong therapy with medication. In order to contain the inflammation, cortisone therapy or therapy with drugs that suppress the immune system is often used. These have considerable side effects and should be reduced again when the symptoms improve.
A close relationship between the person affected and the doctor can optimally adjust the treatment to the current level of inflammation. To prevent a relapse, however, a small dose of cortisone or another medication must often be taken permanently. For the attending physician, a protocol of bowel movements and symptoms can be helpful to determine the optimal therapy for the current condition. As a non-drug measure it is important to ensure a balanced diet and to avoid foods that cause intolerance. During a relapse, a light, low-fiber diet is recommended.
