BALLOONING OF THE RECTUM.
To make plainer what has been said of the rectal and anal tubes or
canals, consider the sleeve of an infant's gown. This sleeve well
represents the rectal tube, the wrist-band the anal orifice and
tube--an inch or more long. Think of the sleeve or rectal tube as being
made up of four layers of material or membranes; and counting from the
inside of the sleeve or rectum there are (1) the mucous layer; (2) the
areolar layer; (3) the muscular layer; (4) the serous layer.
The muscular membrane is itself composed of two layers, and may be said
to form the framework of the rectum. One layer is composed of circular
muscular fibres, and the other of longitudinal muscular fibres. In a
similar manner you could make a sleeve out of fine circular rubber
bands; then bind them together by rubber strings extending lengthwise
of the sleeve. With the circular bands the bore of the sleeve may be
contracted or widened; and with the longitudinal bands the length may
be shortened or extended. Just so with the corresponding muscular
membranes of the rectum, in their normal and abnormal conditions.
Outside of the longitudinal muscular bands are the serous and areolar
layers, the latter covering the lower half of the rectum.
As you look inside the incomplete model of the rectum, or rather
sleeve, you observe circular muscular bands or fibres which it is
necessary to cover with soft spongy or fatty substance in whose meshes
are nerves, blood-vessels, etc. This is called the areolar layer or
coat. One more layer or coat upon this--the mucous coat--completes the
structure. This latter possesses the power of accommodating itself to
the distention and contraction of the muscular tube. The mucous
membrane is thrown into folds and columns which serve as valves to
inhibit the undue descent of the feces, thus assisting the mucous
membrane in performing its office.
The length of the rectum varies in different persons, six inches is the
average length. It is divided into two parts. The upper part is a
little more than three inches long; beginning in front of the third
sacral vertebra and extending down to the end or tip of the coccyx. In
shape this part conforms to the curve of the sacrum and the coccyx, to
which it is attached behind. The lower part of the rectum is a little
shorter than the upper part, and begins at the tip of the coccyx and
extends down with the same curve as the upper part, terminating at the
upper portion of the anal canal.
Returning to the sleeve again; the portion of it from the shoulder to
the elbow illustrates the upper part of the rectum when partially
covered with a serous coat on the side opposite the bore (the outside).
From the elbow to the wrist-band illustrates the lower part of the
rectum, when covered on the outside with an areolar coat.
The wrist-band of the sleeve will represent the anal tube if drawn into
a pucker and turned slightly backward from the direction of the sleeve
of which it is a continuation.
The muscular fibres described above likewise enter into the formation
of the anal canal or orifice. This orifice is closed by two strong
muscles that lie close together and are called internal and external
sphincters, which are abundantly supplied with nerves and blood-vessels
whose branches extend to the neighboring organs.
Nine persons in every ten have more or less chronic inflammation of the
mucous membrane of the anus and rectum. In time the areolar and
muscular coats become invaded by the morbid process, and this increases
the irritability of the tissues of the organ.
The change from the normal functions of the anal membranes is slow, and
the symptoms are not well marked and are consequently ignored for years
owing to inexpertness in detecting an invading serious disease, until
the time comes when the suffering can no longer be tolerated by the
victim of the neglect.
The result of disease to muscular tissue is contraction of its fibres,
and the contractions become more painful as the disease increases.
Accompanying the inflammation, there is a more or less inflammatory
product secreted between muscular fibres that "glues" them together in
their contracted state. And as the anal and rectal tubes are made up of
round muscular fibres, it is not hard to see how the bore of the canal
can be lessened by the slow binding together of its fibres in the
contracted state. The fact is that when the anal structure is invaded
by inflammation, there is more or less stricture of the canal and of
the orifice.
Recalling the sleeve illustration, and how the wrist-band was puckered
and bent back a trifle so that the contents of the sleeve would not
pass out so easily, suppose you now pucker the wrist-band rather
tightly, and suppose there is a forcible descent of sand in the sleeve,
the natural result would be a bulging out of the lower portion of the
sleeve just above the wrist-band, or place of undue constriction. If
the abnormally constricted condition of the anal orifice has been
growing from bad to worse for years, the locality immediately above the
anal canal will become dilated or cavernous (caused by retained feces
or gases), which cavity is called ballooning of the rectum. When a
speculum is introduced into the rectum (as shown on page 14 of pamphlet
_How to Become Strong_), and through it a bent probe is inserted to
determine the depth of the dilatation or abnormal cavity, it is as if
one were poking inside of an inflated balloon: hence the name.
Anatomists describe the rectum as terminating in a forward pouch, which
is close to the prostate gland in the male and the lower part of the
vagina in the female. In some cases there may be such a slight pouch,
due to the anal canal not following the direction of the rectum, and
slightly turning backward; but in most cases such a normal pouch is not
perceptible or observed through the speculum. The small pouch sometimes
found on the anterior wall of the rectum I have thought due to a very
acute inflammation on the verge of forming abscess, which often occurs
in the triangular space. (See 4 in diagram in pamphlet cited above.)
Immediately above the sphincter muscles on the posterior wall of the
rectum the greatest dilatation is found (as shown by the bent probe),
and extends on each side with less depth about the anterior wall of the
rectum.
The greater portion of the lower part of the rectum, which part is
about three inches long, is usually involved in the dilatation or
ballooning. Often the upper half or more of the anal canal is also
dilated with the rectum, leaving the sphincter muscles quite bare of
fatty tissue, with anal length of a quarter of an inch or less.
Your attention was called to a sleeve containing sand, and the bulging
or dilatation above the puckered wrist-band that was an inch or more
broad. Now suppose there were two strong rubber rings at the lower end
of the wrist-band, whose power of resistance to pressure is much
greater than the tissues above them forming the wrist-band. Naturally,
the tissues which form the upper part of the wrist-band would dilate
the same as the terminal portion of the sleeve just above the
wrist-band.
Similar changes in structure or formation take place in diseases of the
anal and rectal canals which result in ballooning of the rectum; and
two frail constricted sphincter muscles are left to guard this balloon,
filled, as it so often is, with feces and gas.
Chronic inflammation, that results in contraction of the circular
muscular fibres, will sooner or later constrict the gut so that it will
lose its normal power to expand without causing pain. The anal canal
may be said to be strictured to the degree in which it is unable to
dilate normally, and this strictured condition usually grows from bad
to worse.
The first symptom of rectal disease is usually an affection of the
anus, which affection occasions an inhibition, that is, a reluctant
permission for the passage of the feces; and this inhibition results,
consequently, in some degree of constipation. And this constipation
reacts more or less on the peristaltic action of the bowels and in time
defeats the function of peristalsis. All this will react on the
inflammatory processes at the anus, which originally engendered the
constipation. The narrow and contracted strait or canal through which
the feces must pass, gives a tape-like shape to the stools.
The anal and rectal mucous membrane is of a firm and tough structure,
similar to the integument at the bottom of a boy's heel. After many
years' observation of diseases of the anus and rectum I am forced to
conclude that as a rule inflammation exists in the tissues twenty or
more years before the severe symptoms, such as piles, fissure, anal
pockets, pruritus, hypertrophy, atrophy, tabs, abscesses, and fistula,
are sufficiently annoying to compel the sufferer to seek medical aid. I
believe it to be of as much importance to give early attention to
disease of the anus and rectum as to teeth and eyes, or even more.