Hemorrhoids EXTERNAL

HAEMORRHOIDS

These are pouches of lower rectal and anal mucosa enclosing  dilated

and tortous veins.  They are visable when enlarged and present at

the anal margins.

8.2.1 EXTERNAL HAEMORRHOIDS

External  haemorrhoids involve haemorrhoidal veins distal to  the

anorectal line and are covered by skin.

*  Severe  pain generally results from thrombosis and  oedema  of

   external haemorrhoids.

*  Anal skin tags may be readily distinguished from  haemorrhoids

   by their appearance as redundant skin at the anal margin.

Thrombosed  external piles occur as an acute, transitory  episode

in an otherwise normal anus, it may subside spontaenously.

Simple  puncture  of the skin and evacuation of the clot  may  be

adequate to relieve sphincter spasm and pain.  Hot sitz baths are

started.

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Imperforate Anus

IMPERFORATE ANUS

The  majority (90%) of them have cognitive & other defects have a  fistula

tract  from  the  rectum in the male.  This  tract  ends  in  the

perenium or the urethera.

In the females the fistula leads to vestibale or vagina Fig.

The infant can also present with anal stenous.  These anal   need  

to  be  recognised  at  birth  and   surgically corrected.

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ANAL CANAL

ANAL CANAL

The  anal canal is an ectodermal tube 4 cm in  length  continuous

with the rectam.

The distal end is marked by the anal verge, beyond which lies the

perianal  skin.   Proximally,  the  anal  canal  starts  at   the

anorectal  mucoutaneous junction and shows the pectinate line  or

dentate  margin at the junction with the rectum and is formed  at

the  end  of  five to eight longitudinal folds,  the  columns  of

Morgagni (Fig. 19.5).

Defecation

This act of evacuation occurs in the rectum and anal canal.

The rectum and anal canal are empty because of a week sphincter at the rectosigmoid junction there is also a sharp angle at this point preventing entry of colonic contents.

The leak form anus is prevented by the

internal anal sphincter a several centimeter thickening of circular muscle of that anal canal

external and sphincter voluntary muscle around the anus controlled by the pududat nerve.

Mass movement forces feces into the rectum cause a sensation of the need to empty the rectum the reflex can be initiated by sitting or squatting in a convenience holding you breath contraction of diaphragms and abdominal muscles.

EXAMINATION

Complete examination includes:

*  Visual  inspection  through  a  proctoscope  and  a   digitial

   palpation of the anal canal and rectum

*  Visualisation of the anal canal and distal rectum can also  be

   obtained by sigmoidoscopy, and should be an integral part of a

   routine  complete  physical examination in all  patients  over

   forty.

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RECTAL PROLAPSE

RECTAL PROLAPSE

Some  or  all the layer of the rectum may  prolapse  through  the

anus. 

The  prolapse  slides through a defect in the  pelvic  diaphragm,

invaginates  the anterior wall of the rectum,  intussuscepts  the

rectum and rectosigmoid.

A  congenital mesorectum is present, extending forward  from  the

posterior wall, allowing the prolapse to occur.

It is an acquired condition in elderly multiparous women in  whom

the  defect is created by stretching and atrophy of  the  levator

ani muscle.

TREATMENT

Objectives  of surgical treatment of massive rectal prolapse  are

correct of the defect in the pelvic floor.

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