Among the annoyances incident to the rectum, is an occasional preternatural contraction of the sphincter muscle. It is generally the consequence of local irritation set up by purgatives, by which the orifice becomes sore and excoriated, which, if not timely relieved, ulcerates, constituting cracks also, and in process of time a portion sloughs away, and the adjacent edges unite, and thereby diminish the calibre of the opening. This disease may be congenital, that is, the individual may be born with a contracted or narrow sphincter. The treatment, naturally enough, is to dilate the orifice, which is to be attempted by the introduction of bougies, after the mode advised for the cure of stricture, of which this in reality is a form. The cracks of the sphincter are occasionally obstinate to heal; and the ulceration will spread within the rectum. When that is the case, the application of any stimulative ointment will promote a healthy action.
In inveterate cases division of the sphincter is necessary, which is to be done with a scalpel, and the incision should be made from within laterally, by which injury to the perineum is avoided. The operation is very simple, and by no means painful or dangerous: the cure is perfect. Appropriate medical treatment must not be neglected.
PROLAPSUS OF THE RECTUM.
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This disease is often confounded with piles; and as patients are generally diffident in submitting to an examination, any extraordinary protrusion of piles they denominate a falling of the gut. Prolapsus Ani is distinguished from piles by the muscular coats of the intestine descending with the mucous membrane, and forming a bag, like a pendulum, to the length of many inches; the rectum, in fact, becomes everted, as we see the finger part of gloves when turned inside out; and the inner membrane being highly vascular, and the vessels in a congested state, it assumes a blood-red appearance. The case is here well portrayed. Of course the disease occasions much inconvenience and if not abated by appropriate treatment, serious consequences ensue. Piles are most commonly the cause of prolapsus, when, from the frequent and hard straining, the gut at last descends, bringing the piles with it, which will be seen winding around the upper part. When that is the case, the best treatment is first to apply a ligature round the hœmorrhoids, and then return them and the rectum together. Where the gut protrudes from relaxation of the sphincter, the treatment depends upon local support, for which there are many contrivances.[16] Astringent injections should also be used to give tone to the parts, and medicines given to render the alvine evacuations less hurtful. Children are very liable to prolapsus, but with them a return of the fallen gut, and a brisk purgative is all that is needed to prevent a repetition, provided proper attention be paid to the bowels afterward—a disturbance of the latter being, in most instances, the cause. Where a rectum has been for a long time the seat of disease, excrescences are apt to arise, resembling warts: they may be removed without much pain, and with perfect safety.
STRICTURE OF THE RECTUM.
The rectum, it is presumed, is known to be the lower portion of the intestines that leads to the outlet called, in domestic language, the fundament. Now some writers assert that the rectum answers the same purpose to the bowels generally, as the urethra does to the bladder, while others contend that it is a receptacle for the fæces previous to their expulsion. We are all sensible, I think, that it must answer both purposes; but it is also evident that it is employed more for the former than the latter purpose. The moment the rectum is full, there is a desire to empty it, which is the best proof of its office; but circumstances oftentimes forbid us, for even hours, obeying the summons, which establishes its capability as a recipient. Well, the rectum, consisting of muscular and membranous coats, similar to the urethra, is alike subject to irritation, inflammation, and ulceration, and imitatively gives forth morbid and other secretions. The rectum, from its situation and office, is very obnoxious to disease; and in addition to those already enumerated, it is extremely liable to become strictured.