Acute purulent paraproctitis is a disease characterized by inflammation of the adipose tissue that surrounds the rectum. Men usually suffer from it - the structure of their cell space near the anal region predisposes to this.
For what reasons does this ailment arise? What symptoms indicate its presence? And how is such a disease treated? Well, this topic deserves special attention.
Classification
The first step is to turn to the information indicated in the ICD-10. Paraproctitis, according to the international classification of diseases, belongs to the list of diseases under the code K61. This class is "Abscess of the anus and rectum."
The word abscessus is translated from Latin as "abscess". An abscess is purulent inflammation of the tissues. And according to ICD-10, paraproctitis is of the following types:
- Anal (anal) - K61.0.
- Rectal - K61.1.
- Anorectal - K61.2.
- Ischiorectal - K61.Z.
- Intrasphincter - K61.4.
The classification notes that an abscess can be both with a fistula (a hollow channel between the passage and the rectum), and without it.
Causes
As a rule, acute purulent paraproctitis occurs due to infection of a person with microorganisms of pathogenic origin.
Most often it is E. coli. It penetrates adipose tissue almost unhindered either from the rectal region, or through ulcers and wounds. Also, the disease can occur as a result of infection with clostridia, enterococci, anaerobic bacteria and staphylococci.
It should be noted that microorganisms can penetrate almost any part of the subcutaneous fat. But as a rule, they affect the layer or the pelvic-rectal region.
In rare cases, the cause of acute purulent paraproctitis is bacterial inflammation of the prostate gland.
If we talk about risk groups, then men who suffer from diabetes mellitus, hemorrhoids or atherosclerotic vascular lesions are most susceptible to this disease. In addition, anal sex, cracks resulting from it, and weak immunity are attributed to predisposing factors.
Subcutaneous paraproctitis
This form of the disease is characterized by the location of the purulent focus in the fatty tissue under the skin directly.
Visual inspection around the anal canal shows a swelling of a characteristic red color. Any touch, as well as an attempt to sit down or have a bowel movement, causes a sharp, throbbing pain. In addition, the patient complains of symptoms of general intoxication, namely:
- Temperature reaching 39 ° C.
- Chills.
- Bad feeling.
- Decreased appetite.
- Pain in muscles, joints and bones.
Since this problem causes great discomfort and literally interferes with a normal life, most men immediately consult a doctor. The diagnosis is not difficult - just a survey, visual inspection and palpation.
Ischiorectal paraproctitis
A disease of this form is diagnosed if the focus of inflammation is localized in the sciatic-rectal fossa.
The specificity of the disease is that the pathological process in this case also affects the muscle that raises the anus. Therefore, the patient is overcome with pain in the pelvis when trying to defecate, cough or sneeze.
If you do not immediately contact a specialist, ischiorectal paraproctitis will begin to progress. After a few days, the anus will become swollen and hyperemic, and the following symptoms will appear:
- The temperature is 37.5-38 ° C, but sometimes higher.
- Rapid breathing.
- Increased heart rate.
- Pain in the rectum.
- Swelling of one of the buttocks.
- The smoothness of the anal folds on the affected side.
In this case, you may need a digital examination of the rectum, which will help determine the pain of the wall and determine the exact location of the infiltrate.
Pelviorectal paraproctitis
This is a particularly difficult case, since the pathological process does not just extend to the pelvic-rectal space - it affects the border of the abdominal cavity. Acute purulent paraproctitis of this form is dangerous in that it does not manifest itself in any way, since the focus is deep.
Symptoms are also nonspecific. Here is what usually bothers a person:
- Headache.
- Fever and chills.
- Symptoms of pronounced intoxication.
- Constipation, dysuria.
- Pain in the lower abdomen of a dull nature. Over time, sensations are localized, and the patient begins to distinctly feel them in the rectum and in the pelvic area.
To diagnose acute pelvic rectal purulent paraproctitis, a digital examination of the rectum is necessary . But to confirm the diagnosis, the doctor usually directs the patient for sigmoidoscopy and ultrasonography.
Submucosal Paraproctitis
The specifics of this form can be guessed by the name. In this case, the purulent process is localized under the mucous membrane of the distal intestine. Therefore, patients complain of pain in the rectal area.
In the process of palpation, the doctor finds a site with a seal. The slightest touch not only causes excruciating pain, but also often provokes a breakthrough of the focus. If this happens, then its contents enter the lumen of the intestine, and after that it is secreted through the anus.
Retrorectal paraproctitis
This case is also complex, because the focus of infection occurs behind the rectum. It does not manifest itself for a long time. There may be only symptoms of intoxication. Some patients complain of pain along the sciatic nerve. In such cases, the clinical picture has neurological symptoms.
Of the specific signs, it can be noted that with this disease, pain radiates to the perineum and hips. Still sometimes there is slight bleeding of the mucous membrane in the area of the ampoule and hyperemia.
It should be noted that only 1.5-2.5% of patients with acute purulent paraproctitis have a retrorectal form in the history of the disease. This is indeed a very rare case. But quite curable. After conducting a digital examination and sigmoidoscopy, the doctor prescribes therapy that will help to quickly recover.
Drug therapy
Now you can briefly talk about how to treat paraproctitis. As a rule, a proctologist prescribes the following drugs:
- Vishnevsky ointment. A combination medicine that disinfects, eliminates inflammation, and also promotes the regeneration of damaged areas.
- "Proctosed." Ointment with corticosteroid hormones. It blocks the inflammatory process, has an analgesic and decongestant effect.
- Lokacorten-N. An anti-inflammatory drug with glucocorticosteroids, which quickly relieves inflammation, prevents the development of infection and saturates the skin with useful substances, restoring its elasticity.
- "Posterized." Very effective suppositories that have an immunostimulating and anti-inflammatory effect. Reduce exudation with inflammation, itching, swelling and hyperemia, improve the tone of blood vessels, and also contribute to regeneration.
And of course, talking about how to treat paraproctitis, one can not help but mention propolis suppositories. This is a homeopathic remedy of natural origin, which has an antimicrobial and regenerative effect.
Disease in children
It should be noted that paraproctitis is very common in infants (under the age of 6 months). The reason is the same - pathogenic microbes entering the body. In infants, immunity is very weak, so they have a ten-fold higher risk of infection than in adults.
Paraproctitis in infants is difficult to notice. First, a small cyst forms, which then develops into an abscess. Often he goes outside and breaks through. If it remains inside, the process of fistula formation begins (not in all cases, but in most). This is dangerous - if pus enters the abdominal cavity, peritonitis is possible.
Therefore, it is very important to conduct regular examinations. Alarming symptoms are fever, restless moodiness of the child, the baby's refusal to eat, lethargy and worsening reactions, as well as accompanying defecation with crying.
Operation
The operation is shown only if the patient during the examination revealed a fistulous course. Surgical intervention is aimed precisely at its elimination.
Fistula can be removed in various ways - dissection, excision, ligature method, by means of plastic surgery, laser obliteration or collagen thread.
The elimination of a hollow channel is necessary. If there is a fistula, then infections will constantly get into it. And this is fraught with regular relapses of inflammation. In simple terms, paraproctitis will become chronic. And discomfort will accompany the person constantly.
After the operation, paraproctitis will recede. But a long rehabilitation is required. The patient will need to take antibiotics and painkillers, perform daily dressings, and also follow a non-slag diet - there are rice and semolina porridges on the water, boiled fish, steam meatballs and omelets. A stool delay of 2-3 days is also required.
The wound heals in 3-4 weeks. But full rehabilitation takes 2-3 months.