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Thursday, September 23, 2010

7.8 Taking Care of Anus and Rectum

Physician's Notebooks 7  - http://physiciansnotebook.blogspot.com - See Homepage

Update 13 Feb. 2018

8. Rectum –    
starts 12 cm (c.5 inches) up from the anus. It is spacier than the colon, with thicker more elastic wall to serve its function – storage and expulsion of feces. The rectum descends into the hollow of the sacrum (lower end of backbone) until it becomes the anus, which is a 3.8 cm (c.1.5 inch)-long powerful muscle exit. In women, the anal sphincter muscle is continuous and intertwined with the vaginal sphincter. The anterior-posterior (front-back) curvature of the anal canal in vertical mid line of body is slightly convex forward, opposite to rectal curvature; together they form an S-shape curve. Entering the rectum with finger or penis can be in the person lying face up with thighs wide apart (missionary position in sex), or else in knee-chest position, on knees with buttocks humped high and shoulder flat to mat.
   A finger rectal exam is a must to understand the anatomy and curvatures of the anus and rectum. Best done on self by sitting on a WC commode. Use dominant-hand, 2nd finger and lubrication. First with fingertip, trace the anus opening then insert finger, noting direction is slightly forward at first but once the tip works way into anus, the rectum opens up and you may swivel finger around and feel the back curvature. There may be stool in rectum. If so, remove it. Note the rectum has a smooth, soft lining. (Above age 60 men may have a bump, the enlarged prostate gland or any age woman may have a bump felt from cervix of uterus, bulging out the front rectal wall) Examining with finger deep in rectum should reveal lowest rectal fold, or valve, where hard feces not infrequently gets stuck and needs finger removal. The rectal exam should be repeated until you are familiar with anus and rectum. If two people are learning together, one may do it on the other with better leverage. Couples that experiment with ano-rectal sex should precede it with digital examination, which can be part of the foreplay. But never forget when you touch rectum and anus, the risk of hepatitis, HIV and other germs.Therefore, better not to experiment with rectal sex.

   Use of finger digital removal of constipated
Over the years, I have gotten into the routine of digital removal of constipated feces. The main reason is to prevent undo straining at stool which not only is cause of hernia and internal organ dislocations but especially in an older age is a cause of brain stroke and myocardial infarction (coronary artery disease heart attack because of the backup of blood in the circulation due to the excess straining). First, the index finger is best and lubrication with most liquid soaps or ointments or Vaselines. Depending on the consistency of stool, you may use your finger to extract pieces or with softer stool, to simply direct the lengthy part of the stool in the direction where you can then expel it with mild to moderate effort. When you finish with the digital removal, use an alcohol cleaning tissue and dry the area. I've done this now for at least 5 years and find it very satisfactory.


   The common anus/rectum disease is hemorrhoid - a blood clot in anus-rectum vein - , hard to mistake because it calls attention by being pain in ass. Felt when you sit. If you reach down to feel it, you will encounter a sore bulge that comes out of edge of anus. Using mirror and flashlight to look at it, you will see blue-black swollen lump of flesh – external hemorrhoid. Sometime hemorrhoid is located inside anal canal and cannot be seen but it can be felt painfully.
   A hemorrhoid may be relieved without treatment if you remove the cause - stop straining at stool. The blood clot is relieved either by dissolving or by breaking vein and draining as bloody discharge. Give an acute hemorrhoid several days and it may go away. Use corticosteroid with antibiotic ointment on external hemorrhoid once a day. Warmed boric acid or epsom salts bath is soothing and draws out the blood. Acetaminophen helps the pain.
   An uncommon swelling around the anus is an abscess. Like hemorrhoid, it is felt as pain on sitting but is larger with pus and usually from a ‘sharp’ in BM that has cut the anus and got it infected. With abscess you  see pus and deep tender lump on side of anus extending to near buttock. Surgical drainage is required. Hot tub bath and antibiotic ointment are useful. 
   Cancer of rectum is easy to discover early by finger or anoscopy but surgery is a problem since it destroys the anus and results in colostomy opening on abdomen. Anus finger exam by doctor from earliest visit should prevent.

Rectal & Anus Bleeding: seeing blood on the toilet paper makes one worry about cancer. But usually it is due to straining at stool that tears blood vessel. Benign bleeding is irregular and happens in episodes that are connected with straining too hard at stool. The blood is red and not much. Bleeding that may signify cancer occurs repeatedly and is usually mixed with stool. Have doctor check it.
END OF CHAPTER. To read next now, click 7.9 Kidneys & GU Tract - Prevent Dialysis 1




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