Chapter 23

BALLOONING OF THE RECTUM--Continued.

In the last chapter a description was given of the anatomy of the anus and rectum; and it was shown how a chronic inflammatory process involving these organs develops stricture in the parts invaded; and it was shown how a partial stricture of the anal canal results in ballooning or dilatation of the lower part of the rectum. The primary cause of all the symptoms of rectal disease is chronic inflammation (proctitis) involving the whole structure of the anal tubes and in a few cases the sigmoid flexure as well.

Perhaps the first marked symptom of disease of the rectum is constipation, semi-constipation or of chronic character. The function of the anus and rectum being disturbed by the inflammation, the fecal mass is unduly retained and its moisture is absorbed by the system. This accounts for the condensed and hardened fecal mass in isolated lumps of various proportions. A hard-formed stool is abnormal, and is evidence of auto-infection. When three-fourths of the normal fecal mass has been re-absorbed by the system, does it not stand to reason that the blood and tissues have been poisoned by their own waste products (auto-intoxication) and that anemia, emaciation and local disturbances of other organs of the body are symptoms of such intoxication?

The loading and blocking of the sigmoid flexure come from _too much activity or irritability, due to inflammation, of the upper half of the rectal tube_. A consequence of this excessive sensitiveness is a diminished or perverted normal stimulus, notice or desire, that the act of defecation should take place.

The victim of proctitis simply forms a habit of daily soliciting an evacuation, though the normal invitation or desire to stool may be entirely absent, and the evacuation in such cases is attended with more or less delay and straining effort to accomplish partially or wholly the expulsion of the more or less inspissated feces.

As the extreme sensitiveness of the inflamed upper half of the rectum offers resistance to the passage of the fecal contents of the sigmoid flexure; so, in a somewhat similar manner, the inflamed anal tube, in its more or less constricted state, prevents the passage of feces and gases as they approach the terminal part of the rectum. As a consequence, the feces and gas deposit and lodge at this latter location, producing in so doing the abnormal cavity called ballooning of the rectum, so often found just above the anal tube.

The greatest depth of the dilated pouch is on the posterior wall of the rectum, or just in front of the tip of the coccyx. In some cases the pouch measures two and a half inches in depth at the back and gradually diminishes in depth on each side as you near the anterior wall of the rectum. Often the upper end of the anal canal is higher than the depressed circumference of the spacious cavity that almost surrounds it. The irritable orifice of the cavity will invariably compel a quantity of liquids and feces to lodge in the cavity as a permanent cesspool, allowing the absorbent vessels to absorb as much as they can by incessant work. The height or length of this abnormal cone-shaped rectal cavity is from two to three inches, involving usually the lower half of the rectum. The anal canal frequently becomes shortened by the dilating process to a quarter of an inch, leaving two frail, irritable muscles at the vent, to guard the rectal cavity. And fortunate are these two thin, sore, contracted muscles, and the possessor of them, if they escape the surgeon's barbarous notion of operating on them.

If the medical butcher has operated on them, you will find an anal canal open to such an extent that two fingers can be inserted without distending the tissues in the least. And when the victim of ballooning of the rectum and ignorant operation makes further complaint to the surgeon of the aches and pains, he is consoled by being informed that the end of the spine will have to be removed. Irreparable damage done and no aid at all received! It is a pity such ignorance on the subject should exist in the medical profession in this city.

The abnormal cavity, so difficult to empty properly owing to its depth and diseased outlet, is seldom free from gases, feces and liquids. Daily evacuations will not empty this cavity, nor will cathartics or diarrhea. A permanent cesspool of poisons is this, where all forms of poisonous germs are propagated, and infect the system by absorption. No use to take medicines for your _poor blood, bad complexion and horrid feelings_, as they will not cleanse the augean stable so long neglected. No use to journey to other localities for health so long as you carry so formidable a foe to health with you.

The mucous membrane in the chronic state of the disease presents a rather dry, indolent and bluish appearance, except that here and there the tissues show more activity of the disease, more especially so over the anal region, due to harsher disturbance during the act of stooling. In the subacute or acute stage of the inflammatory process there is more general redness and puffiness of the mucous membrane, or a swollen condition with increased discharge of mucus and perhaps some blood.

There is a heavy, uncomfortable feeling, with more or less soreness and pain, especially after evacuation of the feces. If a fissure or anal ulcer is present the pain is in proportion to its size and the general aggravation of all the diseased parts. Itching or pruritus about the anus may accompany the trouble to a very annoying extent, being an evidence that the anal pockets are becoming much diseased. The partially constricted and irritable sphincter muscles become excited during the act of stooling and react on the anal grip or contraction, making it more intense. This latter condition may shut off the flow of blood in a local vein; and the blood becoming coagulated forms a painful bluish grape-like tumor at the external opening of the anus.

Abscesses may form at some portion of the diseased gut and result in an external fistula.

Piles may co-exist in some cases of ballooning, but are usually not annoying.

It is the local anal or external annoyances that compel the sufferer to seek medical advice and aid, and he learns that the troubles complained of are only symptoms of a chronic disease, therefore easily removed without harsh treatment while the cause is being properly cured.

It is very fortunate for the sufferer from ballooning of the rectum to have in or near the anal canal those painful hints or symptoms of a very grave and long existing disease whose constitutional symptoms were well marked but attributed to other causes, especially to disease of the liver--an organ of _so much solicitude_ that the poor liver-worshipping patient ought to receive more gracious response from it.

In every case of chronic proctitis, or inflammation of the anus and rectum, the sigmoid flexure must be more or less dilated, as the upper part of the rectum is very irritable and contracted and inhibits the feces from passing beyond the sigmoid; but this irritability and contraction of the rectum, as a rule, is not nearly so severe as that of the anal canal, whose orifice is closed by very strong sphincter muscles.

Such being the pathological change in the sigmoid flexure and especially in the lower portion of the rectum, as described in these two chapters, who, with ordinary intelligence and an idea of cleanliness, would take or prescribe remedies to move the bowels, if it were possible to cleanse the foul capacious cavities with water? We know that they can be thus cleansed, and that it can be easily accomplished with benefit to the diseased canals.

After the system has absorbed 75 per cent of the fecal mass, a "remedy" is taken to excite a flow of watery excretions into the bowels, of which a portion will be retained in the colon, and especially the ballooned cavities, and reabsorbed; and every day the objectionable practice is repeated without any thought of the harm being done.

The flushing of the rectum, sigmoid flexure and colon with water is not a _cure-all_, but it is one of the means of treating a grave chronic disease, a disease insidious and far-reaching in its poisonous effects on the human organism.