of unaltered mucous membrane, and by their non-infiltrating growth. With the exception of the polypoid variety of adenoma, simple tumours are very rare. The finger in the rectum will readily detect masses of impacted feces, or foreign bodies that may have been swallowed or introduced through the anus, or an impacted gall-stone. If after an enema has been given and returned the finger finds the bowel empty and its lumen enlarged, and it does not contract upon the finger, it is said to be 'ballooned.' If the patient complains of severe burning, stinging, or shooting pain of a paroxysmal nature in the bowel or anus, and after a thorough examination of the bowel no local lesion can be found, and if there is no disease of the urinary organs, nor tumour in the pelvis, and particularly if the patient is subject to neuralgia elsewhere, the affection may be described as neuralgia of the rectum. The congenital deformities of the anus and rectum, with one exception, have been considered at p. 560. A congenital malformation which may be overlooked for some time is narrowing of the anus; in this case the meconium escapes, but after a time attention is drawn to the fact that the feces are passed with difficulty and that they are of very small diameter. The anus at birth should readily admit the surgeon's little finger.
<Callout type="important" title="Important">A narrow anus can be overlooked initially, as meconium passes easily but later leads to difficulties in passing stool.</Callout>
The polypoid variety of adenoma is a rare tumour that can be detected by rectal examination. It is important to differentiate between simple tumours and polyps due to their different growth patterns.
<Callout type="warning" title="Warning">Impacted gallstones in the rectum are rare but can cause severe pain; they should always be considered in cases of unexplained abdominal pain.</Callout>
Narrowing of the anus, a congenital condition, is significant as it may not be immediately apparent. It can lead to chronic issues with defecation.
<Callout type="tip" title="Tip">Always perform a thorough rectal examination when dealing with unexplained abdominal pain or difficulty in passing stool.</Callout>
Key Takeaways
- Perform rectal examinations to detect masses, impacted feces, and foreign bodies.
- Differentiate between simple tumours and polyps based on their growth patterns.
- Consider neuralgia of the rectum in cases with severe pain without local lesions.
Practical Tips
- Always use a thorough examination technique when dealing with unexplained abdominal pain or difficulty in passing stool.
- Be aware that congenital narrowing of the anus may not be immediately apparent but can lead to chronic issues.
- Look for signs of impacted gallstones, though rare, as they can cause severe pain.
Warnings & Risks
- Do not overlook a narrow anus; it can lead to chronic defecation difficulties.
- Be cautious with diagnosing neuralgia without considering other potential causes like urinary tract issues.
Modern Application
While the techniques described in this chapter are rooted in historical practices, they still provide valuable insights for modern survival preparedness. Understanding rectal examinations and common conditions can be crucial in emergency situations where immediate medical care may not be available. The knowledge of recognizing symptoms such as impacted feces or narrowing of the anus remains relevant, especially in remote areas.
Frequently Asked Questions
Q: How can one differentiate between simple tumours and polyps during a rectal examination?
Simple tumours are very rare and typically non-infiltrating, while polypoid adenomas have distinct growth patterns that can be detected by the finger. Polyps often protrude into the lumen of the bowel.
Q: What should one do if a patient complains of severe pain in the rectum but no local lesion is found?
If after a thorough examination, no local lesion can be found and there are no urinary tract issues or tumours in the pelvis, the condition may be described as neuralgia of the rectum. This type of pain should be considered.
Q: What is the significance of congenital narrowing of the anus?
Congenital narrowing of the anus can initially go unnoticed but may lead to chronic issues with defecation. It's important to recognize this condition early for proper management and prevention of complications.