Ulcer proktit – the severe form of an inflammation of a rectum which is characterized by formation of ulcers on a mucous membrane. After healing of ulcers the hems capable to become the reason of development of a stenosis of a rectum are formed. It is shown by a hyperthermia, violation of the general state, tenezmama, pain, an itch, burning, release of blood, pus and slime with a kalovy masses. Ulcer proktit it is diagnosed taking into account the clinical manifestations given survey, a rectal research, endoscopy, a biopsy and other diagnostic methods. Treatment is conservative, includes a diet, enemas, trays, the general and local medicamentous therapy.
Ulcer proktit – one of forms of a sharp proktit resulting from infections, parasitic diseases, injuries and other influences and which is followed by formation of deep defects on mucous body. Unlike an erosive form of a disease at which after recovery the complete recovery of a mucous membrane is observed the scarring of an intestinal wall capable to cause a rectum stenosis becomes an outcome of an ulcer proktit. Because of distinctions in clinical symptomatology, a current and the forecast sharp ulcer proktita are considered separately from proktit at nonspecific ulcer colitis to which separate article of this medical reference book is devoted. Treatment is carried out by experts in the sphere of a proktologiya.
Reasons of an ulcer proktit
Ulcer proktit is the polietiologichesky disease arising owing to violations of a diet, mechanical injuries of a rectum, damage mucous at contact with the irritating substances, influences of parasites and infectious agents, radiation therapy, diseases of area of an anus and the top departments of a gastrointestinal tract. Among the factors promoting development of an ulcer proktit, experts specify immune violations, overcooling and inflammatory diseases of bodies of a small pelvis. Ulcer proktit is a severe form of a sharp proktit and usually arises at high intensity of the damaging influence or at a combination of several listed above reasons and the contributing factors.
Ulcer defeats of a gut can be a consequence of excessively intensive radiation of area of a small pelvis at patients with oncological pathology. Most often heavy ulcer proktita are diagnosed for patients with cancer of a body and neck of a uterus. At malignant tumors of other bodies of a small pelvis of an ulcer on a mucous membrane are formed less often. Ulcer proktit also can develop after enemas with use of the substances irritating and damaging a gut wall including – with potassium chloride, boric acid, iodine, hypertensive solution of the Karlovy Vary or table salt. Abuse of enemas, use of too hot or too cold solutions become the additional injuring factors in similar cases.
Sometimes ulcer proktit arises after a mechanical trauma (anal sexual intercourse, introduction to an anus of firm or rough objects, damages mucous incidentally swallowed foreign matters), and also after operations for a crack of back pass, hemorrhoids and a paraproktit. Sometimes ulcer proktit is diagnosed against the background of dysentery or parasitic infections. It is especially dangerous in this regard (the activator of a trikhotsefalez), taking root into a gut wall. Besides, ulcer proktit it can be found at some specific infections, for example – at gonorrheal damage of a rectum.
Ulcer proktit, arisen owing to violations of the food mode, is called alimentary. This form of an inflammation can develop at abuse of hard alcoholic beverages, greasy food, smoked products, sharp, spicy and salty products. The chronic lock provokes stagnant ulcer proktita. Constant damages of the lower departments of a large intestine by too dense fecal masses become an immediate cause of development of an inflammation in similar cases. Violations of food and stagnation a calla are often combined among themselves or become the aggravating factors provoking development of an ulcer proktit at other damaging influences.
Symptoms of an ulcer proktit
The clinical symptomatology of an ulcer proktit corresponds to other forms of a disease. The sudden beginning with a hyperthermia, weakness, weakness, tenezma, pains, an itch and burning in the field of an anus is characteristic. In process of development of an ulcer proktit intervals between acts of defecation are reduced. The chair becomes liquid. At some patients continuous desires with an otkhozhdeniye of a small amount liquid bloody a calla or blood and slime without impurity of fecal masses are observed.
Distinctive features of an ulcer proktit are heavier current and a significant amount of blood in Calais. Blood usually red, settles down on a surface issued a calla or contains in liquid fecal masses in the form of well distinguishable inclusions. At large deep ulcers and an ulcer and necrotic proktit perforation of a wall of a gut with development of kalovy peritonitis is possible. In case of safe healing of ulcers on a wall of a gut hems are formed. The rectum stenosis can become the result of extensive scarring.
Diagnostics of an ulcer proktit
For diagnosis data of poll, survey of back pass, a rectal research, a rektoromanoskopiya, biopsy and analyses a calla are used. At poll pay attention to the factors capable to provoke development of an ulcer proktit (beam treatment, rectum injuries, chronic locks and so forth), prescription of emergence of symptoms and feature of a course of a disease. At survey of area of an anus at initial stages find a spasm, and in the subsequent – excessive relaxation of a sphincter.
In the absence of diseases of back pass the perianalny zone in the first days of a disease is not changed. In the subsequent because of a sphincter gaping at patients with an ulcer proktit pollution of skin a stake, blood, pus and slime with maceration development can come to light. The rectal research confirms existence of hypostasis of a rectum. The most informative technique at an ulcer proktit is the rektoromanoskopiya allowing to estimate visually expressiveness and prevalence of an inflammation, quantity, the sizes and depth of ulcers. When carrying out an endoscopic research carry out a biopsy. For definition of the reasons of development of an ulcer proktit appoint a koprogramma, analyses a calla on and to eggs a worm. At suspicion of a specific infection (gonorrhea, syphilis) of the patient direct to consultation to the venereologist.
Treatment of an ulcer proktit
Treatment is carried out in stationary conditions. The patient suffering from an ulcer proktit is hospitalized in office of a proktologiya or gastroenterology. Appoint a bed rest. Exclude the products rendering irritant action on a gut wall from the menu. Recommend boiled meat and fish, broth, rice and semolina porridge on water, kissels and broths with the enveloping action (from a plantain or seeds of flax). Perform etiotropny therapy. At a beam ulcer proktit stop beam treatment. At intestinal infections appoint antibacterial medicines, at helminthoses – antigelmintny means.
Use warm enemas with camomile infusion, cod-liver oil, sea-buckthorn oil, protargoly or kollargoly. Apply local means with anesthetic, the anti-inflammatory and regenerating action: candles with propolis, candles with methyluracil. In the course of treatment of an ulcer proktit appoint repeated endoscopic researches for control of a condition of a mucous membrane. In the sharp period surgical intervention is shown only at perforation of a gut. At emergence cicatricial in the remote period perform the corresponding therapy (physiotherapeutic procedures, introduction of hormones, expansion of a buzhama of Gegar), at inefficiency of conservative actions excise cicatricial fabric. The forecast at an ulcer proktit depends on prevalence of pathological process, quantity, the size and depth of ulcers.