PROCTITIS.
Under the term proctitis are comprised acute inflammations of the rectal mucosa, which are characterized by discharge of mucus, mucopus, and perhaps blood, and accompanied by more or less tenesmus, pain, and sphincteric spasm. The conditions which produce proctitis are those which lead to ulceration. It may be the result of a downward extension of trouble from above, as in mucocolitis, dysenteric, tuberculous or other forms of colitis, or it may be the result of infection from below (e. g., gonorrheal). An inflamed rectum may be more or less easily exposed for study through some form of speculum (see above), and a more perfect picture of the actual condition thus presented to the eye than can be seen elsewhere, save in the mouth and pharynx, of the effects which serious and even ulcerative inflammation may produce in the way of congestion, swelling, bleeding, and actual breaking down.
Gonorrheal proctitis is not common, yet it may occur either by extension or by direct infection, and will be of an acute type. The other forms may vary in severity according to their cause and duration.
Symptoms.
—The symptoms differ only in degree, and include the features already mentioned. There are soreness, tenderness, and often pain, especially when the lower part of the rectum, with its numerous sensory nerves, is involved, while reflex pains are referred to the sacrum and the lower part of the back. Sensation of local heat and of soreness is generally noted, while the patient is more or less tortured by frequent desire to evacuate the bowel, but passes perhaps a little bloody mucus with the accompaniment of tenesmus and straining. In acute cases the condition is an exceedingly painful one.
Treatment.
—Treatment should be begun by a search for and removal of the cause. Relief is afforded by local anodynes, of which the hot sitz bath is one of the most comforting, and by hot rectal lavements of soothing antiseptic fluid, such as linseed tea, to which a little thiol or ichthyol has been added. These should be retained as long as possible, then ejected. Local anodynes may be furnished through the medium of suppositories containing opium, or preferably some of the milder local anesthetics, such as orthoform. Cases which do not quickly yield to this form of treatment should be anesthetized in order that complete exposure of ulcerated areas and vigorous local treatment may be accomplished. A brushing of the entire surface with a 2 or 3 per cent. solution of silver nitrate will frequently be followed by relief, which will be further furnished by sufficient stretching of the sphincter to overcome its painful spasm. The diet should be so regulated as to leave a minimum of undigested residue that may irritate the lower bowel, and laxatives should be so administered that there shall be no coprostasis in the colon, but that whatever enters it shall be speedily extruded. The specific forms of proctitis require specific treatment, for which there is perhaps nothing better than the silver preparations, either the mild, like argyrol, or the active, like solutions of silver nitrate.
ULCERATION OF THE RECTUM.
The causes of the formation of ulcer in the rectum nowise differ from those of ulcer elsewhere about the body. They may be summarized as catarrhal, i. e., more pronounced and local extensions of non-specific inflammation of the mucosa, which, in certain areas, assume more intense and later infective and degenerative form (in this way are formed the so-called catarrhal ulcers); specific, including primary chancre, which is rarely met with high up in the rectum, or the later expressions, varying from mere mucous patches which may abound both within the rectum and around the anus, to the deeper, more destructive, and usually tertiary ulcerations, with destruction of tissue, extensive involvement of surface and most pronounced tendency to subsequent cicatricial contraction when they begin to repair.
What has been said regarding syphilitic ulcer is true also of chancroid, which when found in this region involves most frequently the anus, but which may extend or even be seen as a primary lesion higher up.