According to statistics, among all proctological pathologies, paraproctitis takes 4 places in terms of prevalence. Often the disease is diagnosed in men.
Paraproctitis (ICD-10 code - K61) refers to an acute or chronic inflammatory process that occurs in the adipose tissue surrounding the rectum. Often, pathology is accompanied by hemorrhoids and occurs when pathogens penetrate through the affected skin of the anal area. If there are signs of the disease, you should definitely consult a doctor for diagnosis and subsequent treatment.
Classification
According to the classification, paraproctitis is divided into several types according to the form of the course, the cause of occurrence, as well as the localization of the lesion. Depending on the course of the disease, it can be acute or chronic. Regardless of the classification of acute paraproctitis, it is an inflammation of a purulent nature, which was formed in the patient for the first time. In turn, doctors distinguish several different forms of this disease. According to the classification of paraproctitis by localization, doctors distinguish such species as:
- rectorectal;
- submucosa;
- subcutaneous
- ischiorectal;
- necrotic;
- pelviorectal.
All these forms have their own specific manifestations, which must be taken into account when making a diagnosis. For subcutaneous paraproctitis, a photo of which demonstrates the peculiarity of the pathology, the presence of purulent inflammation of the subcutaneous tissue of the perianal region is characteristic, which, when timely treatment is performed, has a favorable prognosis.
With ischiorectal paraproctitis, a purulent-inflammatory process in the rectal fossa proceeds. The submucosal form is characterized by the fact that inflammation occurs in the submucosal layer of the rectal canal. With the pelvic rectal type of the disease, the area of purulent lesion is localized inside the pelvis.
The acute necrotic form is considered one of the most severe, as it provokes a significant necrotic tissue lesion and is characterized by lightning fast flow. According to the classification of paraproctitis by etiology, such species are distinguished as:
- specific;
- non-specific;
- anaerobic;
- traumatic.
The chronic type of pathology is characterized by the fact that inflammation affects almost the entire pararectal space and surrounding tissues. The disease is characterized by a prolonged course with periods of exacerbation and remission, as a result of which fistulas form. The chronic form always develops against the background of the course of an acute lesion with incorrect or defective treatment.
As a result of this, fistulas are formed that do not heal for a very long time and combine the cavity of the pararectal abscess with other organs or open outward. According to the classification of chronic paraproctitis, complete and incomplete species, as well as internal or external fistulas, are distinguished. In addition, they can vary in localization. In addition, there are various types of paraproctitis, which are divided according to how they are located in relation to the sphincter. That is why, fistulas are distinguished, such as:
- extrasphincteric;
- intrasphincter;
- transsphincter.
According to doctors, the most common cause of the chronic form of the disease is improper treatment and a later visit to a doctor. That is why, if there are symptoms of the disease, you should immediately consult a doctor for treatment.
Causes of occurrence
The main cause of the disease are pathogens that penetrate from the rectum. Any domestic injuries, wounds, as well as mucosal surgery can trigger an infection. In addition, bacteria can penetrate through sinusitis, caries. With the flow of lymph and blood, pathogens from the area of inflammation spread to other tissues and organs.
Another way for bacteria to enter is to block the duct of the anal gland. Regardless of the type of paraproctitis, the formation of the disease is facilitated by such factors as malnutrition, the presence of inflammatory processes, as well as a sedentary lifestyle. Among the additional provoking factors, it is necessary to highlight such as:
- diabetes;
- weakened immunity;
- anal intercourse;
- atherosclerosis of blood vessels;
- cracks in the anus.
In especially severe cases, inflammation immediately covers several areas located near the intestine.
The main symptoms
The acute form of the disease is characterized by a sudden onset and intensity of manifestation. External symptoms of paraproctitis (a photo on this topic are presented in the article) largely depends on the localization of the pathology, the area of damage, the characteristics of the pathogen, as well as the body's ability to resist. Some common clinical manifestations are observed in all types of this disease. These include such as:
- symptoms of poisoning;
- hyperemia and fever;
- problems with bowel movements;
- soreness in the anus.
Each of the forms of damage is characterized by certain signs. With subcutaneous paraproctitis, symptoms, the photo of which allows to determine the peculiarity of inflammation, are expressed in the form of severe redness of the skin, tissue tightening, swelling, pain on palpation, and the inability to sit normally. The area of damage immediately changes, which makes the patient immediately consult a doctor.
Symptoms of the ileo-rectal form are also non-specific and only after a week of the course of the disease can you notice such signs as:
- swelling;
- redness of the skin;
- asymmetry of the buttocks.
Chronic paraproctitis (photos we can not provide for aesthetic reasons) is characterized by the formation of a fistula. It is a kind of formation with a channel going out. Purulent contents are secreted through the abscess located at the anus . With a complicated course of pathology, additional formations are formed.
The disease in children and pregnant women
In children, paraproctitis is also periodically diagnosed, however, it is not always possible to timely recognize the pathology. It is worth noting that this disease occurs mainly due to microtraumas, stagnation of feces, as well as clogging with a viscous secret. Since the classification of paraproctitis is quite extensive, it is imperative to carry out a diagnosis to exclude the presence of a perineal abscess.
Among the main signs, it is necessary to highlight anxiety and causeless crying, fever, the presence of compaction and redness near the anus. In the case of a fistula, purulent discharge is possible.
In some cases, the formation of paraproctitis in pregnant women is possible, which can very badly affect the condition of the fetus, especially in the case of a purulent formation in the first trimester of pregnancy. When the very first signs appear, you need to see a doctor who will determine the tactics of pregnancy and treatment.
Diagnostics
It is imperative to understand exactly what classification, clinic, diagnosis and treatment of paraproctitis exists, so that the development of dangerous complications can be prevented. Diagnosis of the disease implies:
- collection of complaints;
- examination of the rectal area and perineum;
- palpation of the abscess;
- examination of the anus;
- laboratory research;
- sounding of the fistula;
- tomography;
- fistulography;
- ultrasonography.
For an experienced specialist to accurately establish the correct diagnosis, it will be enough to collect an anamnesis and existing complaints. However, in complex cases, additional diagnostic techniques are required. Often it is necessary to differentiate paraproctitis from other diseases, since at the beginning of the course, it does not have any characteristic signs.
Treatment features
Regardless of the classification of paraproctitis, treatment basically implies an operation. For this, the doctor performs an autopsy of the purulent formation, its drainage and removal. Only this will achieve a complete cure.
The chronic form is mainly treated conservatively if there is an exacerbation of the inflammatory process. This is done in order to eliminate the abscess. The patient is also prescribed antibiotics and physiotherapy. Full recovery occurs after about 5 weeks, subject to strict adherence to all doctor's recommendations.
Drug treatment
A mandatory step in the treatment of paraproctitis is the use of antibiotics. They can be used systemically and locally. In the acute course of the disease, antibacterial treatment after paraproctitis can be prescribed, as this will prevent the development of complications after surgery. In the chronic course of the disease, antibiotics can be prescribed during the preoperative preparation and in the postoperative period.
Among the main drugs that are used for treatment, one can distinguish "Gentamicin", "Cefotaxime", "Metronidazole". It is worth noting that systemic antibacterial drugs are not used to treat all patients. Similar products can also be used as powders, ointments and creams. Local use of antibacterial agents helps to speed up the healing process and prevent the occurrence of infectious complications. Often prescribed drugs such as Levomekol or Levosin. These drugs are applied directly to the wound, pre-treated with an antiseptic 2 times a day. Top you need to cover the wound with a gauze bandage.
Surgery
When treating paraproctitis, surgery is considered the main method. During surgery under epidural anesthesia or general anesthesia, the doctor performs an autopsy of the abscess, carries out subsequent drainage of this area, and then reveals the fistulous course and the affected crypt, as well as their elimination.
The operation is carried out in a specialized medical institution, and this procedure requires a highly qualified surgeon, extensive experience and good knowledge of anatomy.
Physiotherapy
Physiotherapeutic methods are widely used in the acute form of the disease in the postoperative period, as well as in the chronic course of the disease. Physiotherapeutic techniques can be used in preparation for surgical intervention to reduce the inflammatory process, the destruction of pathogens. The most effective methods of physiotherapy are such as:
- ultraviolet radiation in the affected area;
- electrophoresis;
- magnetotherapy;
- electrophoresis;
- irradiation with infrared rays.
During the physiotherapeutic treatment of paraproctitis, the patient reviews are very good, since such techniques help to quickly eliminate existing violations.
Folk remedies
You can treat paraproctitis at home with the help of folk remedies. However, it is worth remembering that an operation is required beforehand, since this is a surgical pathology. Folk remedies can be used as a supplement to the main treatment. In addition, you must first consult with your doctor.
You can stop inflammation using such means as:
- juice or infusion of red rowan berries;
- infusion of yarrow, sage and chamomile;
- herbal teas;
- tincture of calendula;
- baths with sea salt.
Juice or infusion of red mountain ash should be taken daily 3 times a day before eating. Red mountain ash has pronounced anti-inflammatory properties, and also has a pronounced, antimicrobial and anti-inflammatory effect.
On the external exit of the fistula, you can apply tincture of calendula for disinfection. Mummy baths also have a good effect. To prepare them, you need to dissolve the mummy tablets in hot water, and when the solution is at room temperature, pour into a wide basin and sit in it. In addition, rectal suppositories made from raw potatoes can be used for treatment. From the vegetable, you need to cut the cylinder with a thickness of the little finger, grease with petroleum jelly and enter into the anus for the night. This remedy helps reduce pain and inflammation.
Dieting
There is no special diet for patients with paraproctitis. When the disease progresses, experts recommend adhering to fractional nutrition. You need to eat in small portions 4-5 times a day. Soups must be present in the diet. Dinner should be light and must consist of any dairy products or fresh vegetables.
Fatty varieties of fish, poultry and meat, as well as spicy and fried foods, as well as limit the consumption of alcohol, white bread, as well as muffins, should be excluded from the usual diet. Cooking should be done using gentle heat treatment. It is also important to maintain a full water balance in the body, that is, consume at least 1.5 liters of water per day.
Recovery period
After the operation to remove paraproctitis, patients should follow the regimen. For 3 days you need to consume a lot of fluids, after which a strict diet is prescribed. From the usual diet, it is necessary to exclude fatty, fried, salty, sour.
The postoperative period, which lasts for at least 3 weeks, is very important. During all this time, it is imperative to carefully monitor the perineum and postoperative wounds. Antibacterial agents for systemic use are necessarily prescribed. Wound dressing is also indicated using antiseptic solutions, ointments. Help in treatment is also a means to improve healing.
Possible complications
Acute paraproctitis can be very dangerous for its complications, among which it is necessary to highlight such as:
- melting of the urethra, vagina and other organs with pus;
- necrotic lesion of the walls of the rectum;
- leakage of feces into pararectal fiber;
- purulent inflammation of the peritoneum;
- formation of retroperitoneal abscess.
All these complications can lead to the fact that the disease can go into sepsis, when pathogens penetrate the bloodstream and can even lead to the death of the patient. In addition, there are a number of pathological conditions that form against the background of a chronic form of paraproctitis, in particular, such as:
- scar tissue formation;
- rectal canal deformity;
- leakage of feces from the anus;
- weakness of the anal sphincter;
- rectal stricture.
Chronic fistulas from the inside are covered with epithelium, the cells of which with a prolonged course of pathological processes can degenerate into a malignant form. The risk of cancer is another significant reason that, when the first signs of the disease occur, immediately seek medical help.
Prevention and prognosis
Doctors distinguish primary and secondary disease prevention. Primary implies strengthening the immune system, saturating the body with vitamins, following nutritional rules. In addition, it is very important to lead an active lifestyle, normalize weight and timely treat diseases that can trigger the development of paraproctitis.
Secondary prevention implies a set of measures that will help prevent the recurrence of the disease after surgery. For this, it is shown:
- prevention of constipation and their quick elimination;
- weight control;
- dieting;
- personal hygiene;
- treatment of foci of chronic infection.
Timely contacting a doctor and strict implementation of all his prescriptions is the only prevention of the onset of a chronic form of the disease.
With timely access to a doctor, the prognosis after treatment of paraproctitis is quite favorable. However, patients who went to the doctor too late or were self-medicating are threatened not only with the transition of the disease into a chronic form, but also provoke the death of the patient. The chronic form of the disease in the absence of timely treatment can lead to the formation of fistulas, as well as go to the malignant stage.