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 cellular space near the anal area predisposes to this.
For what reasons does this disease occur? What symptoms indicate its presence? And how is this disease treated? Well, this topic deserves special attention.
Classification
The first step is to refer 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 a 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.
- Ishiorectal - K61. Z.
- Intrasphincteric - 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.
Reasons
As a rule, acute purulent paraproctitis occurs as a result of human infection with microorganisms of pathogenic origin.
Most often it is E. coli. It penetrates almost unhindered into fatty tissue either from the rectal region or through ulcers and wounds. Also, the disease can occur due to infection with clostridium, 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 inflammation of the prostate gland of a bacterial nature.
If we talk about risk groups, then men suffering from diabetes mellitus, hemorrhoids or atherosclerotic vascular disease are most susceptible to this disease. In addition, predisposing factors include anal sex, resulting cracks, as well as weak immunity.
Subcutaneous paraproctitis
This form of the disease is characterized by the location of a purulent focus in fatty tissue directly under the skin.
When visually examined around the anal canal, a swelling of a characteristic red color is noticeable. Any touch, as well as an attempt to sit down or defecate, causes a sharp pain of a throbbing nature. In addition, the patient complains aboutsymptoms of general intoxication, namely:
- Temperature reaching 39°C.
- Chills.
- Feeling unwell.
- Deterioration of appetite.
- Pain in muscles, joints and bones.
Since this problem delivers the strongest discomfort and literally interferes with normal life, most men immediately go to the doctor. Diagnosis does not cause difficulties - a survey, visual examination and palpation are enough.
Ishiorectal paraproctitis
The disease of this form is diagnosed if the focus of inflammation is localized in the ischiorectal fossa.
The specificity of the disease lies in the fact that the pathological process in this case also affects the muscle that raises the anus. Therefore, the patient is overcome by pain in the small pelvis when trying to defecate, cough or sneeze.
If you do not immediately turn to a specialist, ischiorectal paraproctitis will begin to progress. After a few days, the anus will become swollen and hyperemic, and the following symptoms will also appear:
- Temperature 37.5-38°C, but sometimes higher.
- Easy breathing.
- Increased heart rate.
- Pain in the rectum.
- Swelling of one of the buttocks.
- 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 soreness of the wall and determine the exact location of the infiltrate.
Pelviorectal paraproctitis
This is a particularly hard 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 because it practically does not manifest itself in any way, since the focus is located deep.
Symptoms are also non-specific. Here is what usually worries a person:
- Headache.
- Fever and chills.
- Symptoms of pronounced intoxication.
- Constipation, dysuria.
- Pain in the lower abdomen of a dull nature. Over time, the sensations are localized, and the patient begins to clearly feel them in the rectum and in the pelvic area.
To diagnose pelviorectal acute purulent paraproctitis, a digital examination of the rectum is necessary. But to confirm the diagnosis, the doctor usually refers the patient to sigmoidoscopy and ultrasonography.
Submucosal paraproctitis
You can guess the specifics of this form 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 an area 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 intestinal lumen, and then it is excreted through the anus.
Retrorectal paraproctitis
This case is also difficult, because the focus of infection occurs behind the rectum. He does not appear infor 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.
From the specific signs, it can be noted that with this disease, pain radiates to the perineum and thighs. 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 suffering from acute purulent paraproctitis have a retrorectal form in their medical history. This is indeed a very rare case. But completely curable. After a digital examination and sigmoidoscopy, the doctor prescribes therapy that will help you heal quickly.
Drug therapy
Now you can briefly talk about how to treat paraproctitis. As a rule, the proctologist prescribes the following drugs:
Vishnevsky's ointment. A combined medicine that disinfects, eliminates inflammation, and also promotes the regeneration of damaged areas
- "Proctosedyl". Ointment with corticosteroid hormones. It blocks the inflammatory process, has an analgesic and anti-edematous effect.
- "Locacorten-N". An anti-inflammatory drug with glucocorticosteroids that quickly relieves inflammation, prevents the development of infection and saturates the skin with beneficial substances, restoring its elasticity.
- "Posterized". Highlyeffective suppositories that have an immunostimulating and anti-inflammatory effect. They reduce exudation during inflammation, itching, swelling and hyperemia, improve the tone of blood vessels, and also promote regeneration.
And of course, when talking about how to treat paraproctitis, one cannot fail to mention suppositories with propolis. It is a homeopathic remedy of natural origin, which has an antimicrobial and restorative 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 - the entry of pathogenic microbes into the body. Babies have very weak immunity, so they are ten times more likely to become infected than adults.
Paraproctitis in infants is difficult to notice. First, a small cyst forms, which then develops into an abscess. Often it comes out 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 have regular check-ups. Alarming symptoms are fever, restless capriciousness of the child, refusal of the baby to eat, lethargy and deterioration of reactions, as well as accompanying bowel movements with crying.
Operation
The operation is indicated only if the patient was found to have a fistulous tract during the examination. Surgicalintervention is aimed precisely at its elimination.
The fistula can be removed in various ways - incision, excision, ligature method, plastic surgery, laser obliteration or collagen thread.
Elimination of the 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 a person constantly.
After the operation, paraproctitis will recede. But it will take a long time to recover. The patient will need to take antibiotics and painkillers, perform dressings daily, and also follow a slag-free diet - eat rice and semolina porridge on the water, boiled fish, steam meatballs and omelettes. You will also need to hold stool for 2-3 days.
The wound heals in 3-4 weeks. But full rehabilitation takes 2-3 months.
