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BOTTOM END PROBLEMS - THE LITTLE DETAILS
The Normal structure of the rectum and anus:
Nornal structure


The picture on the left shows a stylised and simplified picture of the rectum and anus as they would appear if they were sliced across the middle and seen from the side. The end of the intestine that stores stool (feces) temprarily is called the rectum. The narrow passage that allows the stool to pass outside is called the anus. The opening of the anus is normally controlled by a ring shaped muscle around it. The ring muscle is called the sphincter, and it is essential to prevent gas or stool from being passed accidentally or inadvertently. The red line inside the rectum and anus is the lining or "skin" which is a moist pink layer called the "mucosa" which is richly endowed with blood vessels.

The mucosa plays an important part in the causation of piles, which you can read about below. The sphincter muscle becomes a major player in fissures and in the treatment of fistulas, which are also described below.



PILES

Piles


Piles are thought to be caused by the pushing out, and out-pouching of the lining mucosa of the rectum. Pressure caused by execssive straining at stool or even  normal straining during the delivery of a baby can push the mucosa out. The mucosal lining takes with it a network of its own blood vessels, and the part that bulges out is called a "pile" or a "hemorrhoid"

If those blood vessels burst there is visible bleeding that appears like drops or even a small jet of blood while pasing stool. Sometimes the burst blood vessel bleeds under the skin and mucosa to cause a hugely enlared and painful clot of blood called a "thrombosed hemorrhoid"






ANAL FISSURE

fISSURE

An anal fissure is merely a wound, or a crack in the skin of the bottom. The crack is usually just at the entrance of the anus and can just be seen from the outside. Unfortunately nature does not provide eyes near one's bottom for fissures to be seen by the sufferer - they have to be seen by someone else - usually a surgeon.

The wound often causes great pain while passing stool. The wound itself is often caused either by a very large and hard motion, or by several bouts of diarrhea. It can also cause visible bleeding.

A fissure is accompanied by a spasm of a part of the sphincter muscle (that part is not shown in the picture on the left) . Curing the fissure involves helping to relieve this spasm, because the spasm ensures that stool continues to rub against the wound and keep it open.




ABSCESS

Abscess





An abscess is a collection of pus - a large boil inside or near the anus. The picture on the left shows (in Red)  the usual areas where pus can collect. This can be within the anus, just outside or further to the side near the buttock.

Abscesses cause a great deal of pain and fever and need to be treated by surgery. Anything less can lead to serious complications.









FISTULA IN ANO

Fistula
A fistula is strange problem. It is an abnormal passage - a "bypass tube" if you like that extends between the inside of the anus or rectum and the outside skin - usually on the buttock.

The sufferer may only feel a wet spot near the bottom and notice a pus stain on the underwear. Or else he may feel gas from inside his rectum pass out of the side channel.

Fistulas can be "low" or "high" depending in whether they pass mainly below the ring muscle that controls continence of the anus (low fistula) or above (or through) the ring muscle for a high fistula. (The fistula is marked by the blue line in the picture on the left, the ring muscle in brown)  The significance of this is that low fistulas are relatively easy to cure by surgery, but high fistulas are difficult to cure because the ring muscle through which the fistula passes cannot be damaged.

Various options are available to cure high fistulas, none of them simple or straighforward and more than one operation is often necessary.

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