BALLOONING OF THE RECTUM--Continued.
In the last chapter a description was given of the anatomy of the anus
and rectum; and it was shown how a chronic inflammatory process
involving these organs develops stricture in the parts invaded; and it
was shown how a partial stricture of the anal canal results in
ballooning or dilatation of the lower part of the rectum. The primary
cause of all the symptoms of rectal disease is chronic inflammation
(proctitis) involving the whole structure of the anal tubes and in a
few cases the sigmoid flexure as well.
Perhaps the first marked symptom of disease of the rectum is
constipation, semi-constipation or of chronic character. The function
of the anus and rectum being disturbed by the inflammation, the fecal
mass is unduly retained and its moisture is absorbed by the system.
This accounts for the condensed and hardened fecal mass in isolated
lumps of various proportions. A hard-formed stool is abnormal, and is
evidence of auto-infection. When three-fourths of the normal fecal mass
has been re-absorbed by the system, does it not stand to reason that
the blood and tissues have been poisoned by their own waste products
(auto-intoxication) and that anemia, emaciation and local disturbances
of other organs of the body are symptoms of such intoxication?
The loading and blocking of the sigmoid flexure come from _too much
activity or irritability, due to inflammation, of the upper half of the
rectal tube_. A consequence of this excessive sensitiveness is a
diminished or perverted normal stimulus, notice or desire, that the act
of defecation should take place.
The victim of proctitis simply forms a habit of daily soliciting an
evacuation, though the normal invitation or desire to stool may be
entirely absent, and the evacuation in such cases is attended with more
or less delay and straining effort to accomplish partially or wholly
the expulsion of the more or less inspissated feces.
As the extreme sensitiveness of the inflamed upper half of the rectum
offers resistance to the passage of the fecal contents of the sigmoid
flexure; so, in a somewhat similar manner, the inflamed anal tube, in
its more or less constricted state, prevents the passage of feces and
gases as they approach the terminal part of the rectum. As a
consequence, the feces and gas deposit and lodge at this latter
location, producing in so doing the abnormal cavity called ballooning
of the rectum, so often found just above the anal tube.
The greatest depth of the dilated pouch is on the posterior wall of the
rectum, or just in front of the tip of the coccyx. In some cases the
pouch measures two and a half inches in depth at the back and gradually
diminishes in depth on each side as you near the anterior wall of the
rectum. Often the upper end of the anal canal is higher than the
depressed circumference of the spacious cavity that almost surrounds
it. The irritable orifice of the cavity will invariably compel a
quantity of liquids and feces to lodge in the cavity as a permanent
cesspool, allowing the absorbent vessels to absorb as much as they can
by incessant work. The height or length of this abnormal cone-shaped
rectal cavity is from two to three inches, involving usually the lower
half of the rectum. The anal canal frequently becomes shortened by the
dilating process to a quarter of an inch, leaving two frail, irritable
muscles at the vent, to guard the rectal cavity. And fortunate are
these two thin, sore, contracted muscles, and the possessor of them, if
they escape the surgeon's barbarous notion of operating on them.
If the medical butcher has operated on them, you will find an anal
canal open to such an extent that two fingers can be inserted without
distending the tissues in the least. And when the victim of ballooning
of the rectum and ignorant operation makes further complaint to the
surgeon of the aches and pains, he is consoled by being informed that
the end of the spine will have to be removed. Irreparable damage done
and no aid at all received! It is a pity such ignorance on the subject
should exist in the medical profession in this city.
The abnormal cavity, so difficult to empty properly owing to its depth
and diseased outlet, is seldom free from gases, feces and liquids.
Daily evacuations will not empty this cavity, nor will cathartics or
diarrhea. A permanent cesspool of poisons is this, where all forms of
poisonous germs are propagated, and infect the system by absorption. No
use to take medicines for your _poor blood, bad complexion and horrid
feelings_, as they will not cleanse the augean stable so long
neglected. No use to journey to other localities for health so long as
you carry so formidable a foe to health with you.
The mucous membrane in the chronic state of the disease presents a
rather dry, indolent and bluish appearance, except that here and there
the tissues show more activity of the disease, more especially so over
the anal region, due to harsher disturbance during the act of stooling.
In the subacute or acute stage of the inflammatory process there is
more general redness and puffiness of the mucous membrane, or a swollen
condition with increased discharge of mucus and perhaps some blood.
There is a heavy, uncomfortable feeling, with more or less soreness and
pain, especially after evacuation of the feces. If a fissure or anal
ulcer is present the pain is in proportion to its size and the general
aggravation of all the diseased parts. Itching or pruritus about the
anus may accompany the trouble to a very annoying extent, being an
evidence that the anal pockets are becoming much diseased. The
partially constricted and irritable sphincter muscles become excited
during the act of stooling and react on the anal grip or contraction,
making it more intense. This latter condition may shut off the flow of
blood in a local vein; and the blood becoming coagulated forms a
painful bluish grape-like tumor at the external opening of the anus.
Abscesses may form at some portion of the diseased gut and result in an
external fistula.
Piles may co-exist in some cases of ballooning, but are usually not
annoying.
It is the local anal or external annoyances that compel the sufferer to
seek medical advice and aid, and he learns that the troubles complained
of are only symptoms of a chronic disease, therefore easily removed
without harsh treatment while the cause is being properly cured.
It is very fortunate for the sufferer from ballooning of the rectum to
have in or near the anal canal those painful hints or symptoms of a
very grave and long existing disease whose constitutional symptoms were
well marked but attributed to other causes, especially to disease of the
liver--an organ of _so much solicitude_ that the poor liver-worshipping
patient ought to receive more gracious response from it.
In every case of chronic proctitis, or inflammation of the anus and
rectum, the sigmoid flexure must be more or less dilated, as the upper
part of the rectum is very irritable and contracted and inhibits the
feces from passing beyond the sigmoid; but this irritability and
contraction of the rectum, as a rule, is not nearly so severe as that
of the anal canal, whose orifice is closed by very strong sphincter
muscles.
Such being the pathological change in the sigmoid flexure and
especially in the lower portion of the rectum, as described in these
two chapters, who, with ordinary intelligence and an idea of
cleanliness, would take or prescribe remedies to move the bowels, if it
were possible to cleanse the foul capacious cavities with water? We
know that they can be thus cleansed, and that it can be easily
accomplished with benefit to the diseased canals.
After the system has absorbed 75 per cent of the fecal mass, a "remedy"
is taken to excite a flow of watery excretions into the bowels, of
which a portion will be retained in the colon, and especially the
ballooned cavities, and reabsorbed; and every day the objectionable
practice is repeated without any thought of the harm being done.
The flushing of the rectum, sigmoid flexure and colon with water is not
a _cure-all_, but it is one of the means of treating a grave chronic
disease, a disease insidious and far-reaching in its poisonous effects
on the human organism.