To treat the rectum intelligently and thoroughly, requires special
knowledge on the part of the osteopath. A speculum should be used in
many cases when making an examination, and all abnormal conditions
carefully inspected with the eye; although much can usually be noted by
the examination with the finger alone. The best position in which to
give an examination and treatment is to have the patient on the side,
with thighs flexed upon the abdomen. In a few cases the patient may
lean over an operating table.
The =objects= of =rectal treatment= are many—to relieve hemorrhoids,
etc., of the mucous membrane; to correct a dislocated coccyx; to treat
an enlarged prostate gland; to replace a prolapsed rectum; to tone the
lower bowel in cases of constipation; to give reflex stimuli to the
heart and lungs, in cases of fainting, paroxysms, etc.; to relieve
severe pains in the rectum at the time of the menstrual period, and
to relieve congestion, inflammation, contracted tissues, etc., of
local sources; to relax spasms in croup, and to remove tension to the
nervous system in some forms of insomnia. In fact, so many diseases are
affected by reflex irritations from the rectum that its examination
is a necessity in many cases. The phrase “when in doubt treat the
rectum” was coined by a progressive student and there is an element of
truth in it. Surgical assistance to treatment will be considered under
hemorrhoids.
The principal need of osteopathic internal rectal treatment, is: (1)
To relax all contracted and constricted fibres about the walls of the
rectum and between the sacrum and coccyx. (2) To correct a dislocated
coccyx. (3) To dilate the sphincters thoroughly, in order to relieve
irritations about the sphincters, and to stimulate the sympathetic
nerves.
Work through the rectum to treat an enlarged prostate gland, to correct
a displaced uterus, and to make a more thorough examination of the
uterine tissues, the Fallopian tubes and the ovaries, is a frequent
occurrence.
In giving =local treatment=, cleanse the fingers and oil the index
finger; then, after introducing it into the rectum relax the contracted
tissues by an upward sweeping motion on all sides. This treatment
relieves all obstructions to vessels and nerves caused by contracted
fibres, and tones the rectal walls. In prolapsed sigmoid, causing
obstructive constipation, the finger can be used to separate the folds
of mucous membrane and open the lumen of the bowel. Frequently there
will be enough tone to the muscular coat so that the irritation
will set up slight peristalsis and cause the bowel to draw up to a
considerable degree. In children where there is much straining at the
stool, the sigmoid will often be found down and by using the little
finger the same results can be accomplished and much relief given.
To =dilate= and =stretch= the sphincters thoroughly a speculum or
dilator should be used under anesthesia; still, considerable can
be done by one or two fingers. The sphincter should be thoroughly
stretched in all directions, care being taken when an instrument is
used that too much force is not applied. Secure as much voluntary
relaxation of the sphincter as possible. Inhibition at 2d and 3d sacral
will aid. This treatment is of aid in cases of hemorrhoids and prolapse
of the rectum, in constipation due to the loss of tonicity of the lower
bowels, in tightness of the sphincters, in pain of the rectum, and in
stimulating the heart and lungs. In cases of a prolapsed rectum, due
to irritation about the sphincters, causing tenesmus, this treatment
is of special value, as it gives the sphincter a physiological rest.
Frequency of treatment per rectum must depend entirely on the patient
and disease. It can be given daily in many cases and is frequently so
indicated in acute hemorrhoids, prostatic troubles, etc.
According to Quain, the sensory nerves to the rectum are from the
second, third and fourth sacrals. Some of the motor fibres of the
circular muscles of the rectum are from the lower dorsal and upper
two lumbar nerves; these pass by the aortic plexus to the inferior
mesenteric ganglion. Associated with these fibres, are the inhibitory
fibres of the longitudinal muscles of the rectum. The sacral nerves
contain motor fibres to the longitudinal muscles, and inhibitory fibres
to the circular muscles of the rectum. In all cases of rectal trouble,
the lower dorsal and upper lumbar vertebræ may be found deranged, and
thus interfere with the rectal nerves. Relaxation of the sacral muscles
over the sacral foramina has a marked effect in relieving =tenesmus=.
In dysentery, where there is a constant desire to defecate, a thorough
upward relaxation of the sacral muscles will give great relief.
=Proctitis= or inflammation of the rectum is not an uncommon disorder.
The disease has been divided into acute, chronic, gonorrheal,
dysenteric, and diphtheritic. Foreign bodies, impacted feces, cold,
purgatives, prolapse of the sigmoid, and lumbar, coccygeal and
innominate lesions are the most important causative factors. The
=acute= form is more frequently found in older people. The =symptoms=
are tenesmus, frequent evacuations of blood and mucus (possibly pus),
prolapse of the mucous membrane, feeling of fullness, and radiating
pains. The gonorrheal, diphtheritic and dysenteric forms are of rare
occurrence, with the exception that the dysenteric may be somewhat
frequent. The =treatment= is to remove all local irritations, cleanse
the bowels, and put the patient in bed. All irritating foods are to be
prohibited. Use milk, soups, beef juice, soft boiled eggs and similar
foods. Correct all osteopathic lesions; especially will inhibition over
the sacral foramina relieve the tenesmus. Cold water in the rectum and
applied to the anus will be beneficial. If abscesses occur, employ
surgical measures.
=Prolapse= of the =rectum= is another common rectal disorder. Acute
cases are especially found in children, due to straining at stool. The
sacrum is more straight, and thus violent straining, coughing, etc.,
the more readily produces prolapse. Prolapse of the mucous membrane
is the most common, although all of the rectal coats may be involved.
Prolapse of the upper part of the rectum into the lower or invagination
is frequently met with by osteopaths. The sigmoid may prolapse and
also affect the rectum. The =treatment= is to return the mass, using
an anesthetic if necessary. If it is not retained, place straps across
the buttocks. Then with attention to lesions that may be disturbing
and weakening the rectal walls, and thorough local toning treatment,
the prognosis should be favorable. In high rectal prolapse local
attention is necessary as well as deep treatment through the abdominal
walls to the sigmoid and upper rectum. The use of Cole’s irrigator for
high enema will replace and elevate both the upper rectum and sigmoid
and greatly aid in a cure. Regularity of habits and proper food are
essentials.