Sphincteritis

Sphincteritis is an inflammation of the sphincter of any localization (hepatic pancreatic ampulla (sphincter of Oddi), rectum.) This article is devoted to the sphincteritis of the rectum, as this disease can cause severe consequences.

[1], [2], [3]

Epidemiology

Sphincteritis is diagnosed in almost 80% of all patients, as a result of which it is now considered the most common disease in place of previously considered hemorrhoids.

[4], [5], [6]

Causes of the sphincteritis

Pathology can develop due to a rather large number of various causes:

• infectious process, affecting the organs of the digestive tract;
• intestinal dysbiosis;
• hemorrhoids in acute or chronic form;
• damage to the rectum, anal fissures;
• malnutrition, abuse of alcohol, smoked and fatty foods;
• chronic diseases of the digestive system: cholecystitis or pancreatitis (including acute), and in addition cholangitis with duodenitis and impaired function of the sphincter of Oddi, in which the gastric secretion and bile do not enter the 12-colon;
• rectal cancer;
• autoimmune pathologies of a hereditary nature.

[7], [8]

Risk factors

Among the factors that can also provoke the appearance of sphincteritis - inflammation of nearby organs, problems with defecation, regular hypothermia.

The following situations are also considered risk factors:

• patients who have gastrointestinal diseases (colitis, hemorrhoids, pancreatitis, as well as cholecystitis in chronic form, etc.);
• patients who practice anal sex;
• people of advanced age;
• patients who had previously undergone bile duct surgery;
• people who have weak anus musculature.

[9], [10], [11], [12], [13]

Pathogenesis

There are several forms of inflammation that develop in the sphincter. Each of them is a stage of disease progression. It begins with the onset of catarrhal lesions lasting only a few days, and in the absence of the necessary treatment, rapidly passing into the next form - erosive. This form of the disease is protracted, and its development is due to the fact that the inflamed mucosa begins to be mechanically damaged by the gulping masses passing through the gut.

[14], [15], [16]

Symptoms of the sphincteritis

Regardless of the causes that caused the development of sphincteritis, its manifestations are almost identical. The main symptom is pain, accruing during the process of defecation. This pain is also capable of radiating into the perineum, but also to neighboring organs. Over time, in addition to pain, there is a constant burning along with a strong itching in the anus.

In addition, the sphincteritis manifests itself in the form of false and very painful urge to emptying (tenesmus). In addition, the feces appear foaming mucus or purulent plaque, and urine becomes dark. Often in the feces are observed and bloody veins.

The onset of inflammation is accompanied by an increase in temperature to 38 degrees, a general severe malaise. Also, patients notice the occurrence of colic - these attacks are similar in intensity to hepatic colic. After eating, the pain intensifies, sensing in the area of the right hypochondrium. Perhaps the emergence of vomiting with nausea.

In case of adherence with sphincteritis of liver diseases, jaundice can occur periodically, accompanied by a bitter taste in the mouth, as well as a sharp itch.

Sphincteritis in children

Sphincteritis in children develops less frequently than in adults. In general, the pediatric form of the pathology is a consequence of microtraumas in the anus in cryptites (inflammatory process in the crypts of the anus) or chronic constipation. If the cryptite is not cured, inflammation of the tissues in the valve apparatus and also the mucosa of the entire distal part of the rectum can begin.

Recognize the possible development of the sphincteritis in the baby is quite simple - the child begins to complain of the itching and uncomfortable sensations in the anus, and later refuses to go to the toilet, because he is afraid to feel pain when emptying.

Stages

All 3 types of disease are able to flow from one to another or to develop simultaneously at different sites of the sphincter, so that this division can be considered arbitrary. Basically, the first stage of the disease becomes its catarrhal form, after it passes into the erosive, and then into the erosive-ulcerative.

[17], [18], [19], [20], [21], [22], [23]

Forms

The main types of sphincteritis are: catarrhal, erosive-ulcerative, erosive, ulcerative.

[24], [25], [26]

Catarrhal sphincteritis

With catarrhal sphincteritis, a characteristic intensified pattern of vessels is observed. The main symptoms of this type of pathology are redness, swelling, soreness in the tissues of the muscles and the rectal mucosa.

[27], [28], [29]

Erosive sphincteritis

Erosive sphincteritis is a manifestation of ulcerative colitis (with the development of this pathology, bile is difficult to enter the small intestine, which is why the secretion of pancreatic enzymes is disrupted - as a result, there is an increase in pressure in the biliary tract).

[30]

Erosive-ulcerative sphincteritis

With this type of disease on the mucous there are erosions and ulcers. In addition, the main symptoms of this pathology are such manifestations: the occurrence of bleeding with varying degrees of severity, as well as the secretion of a purulent secretion.

[31], [32]

Complications and consequences

The triggered sphincteritis can lead to the development of such consequences:

• necrotic changes occur - the parts of the sphincter begin to die;
• inflammatory process passes to neighboring cells and tissues;
• the process of intoxication is intensifying;
• due to necrosis, sepsis can develop (it can become a threat to the life of the patient).

Among possible complications of the disease is the development of such pathologies:

• subhepatic jaundice;
• cholestatic form of hepatitis;
• pancreatitis in chronic form;
• malignant tumor.

[33], [34], [35], [36], [37], [38]

Diagnostics of the sphincteritis

Diagnosis begins with the fact that they collect an anamnesis, especially noticing (if any) the chronic pathologies of various GIT organs. When examined by a proctologist, there may be a problem with a sphincter contraction (as a result of rectoscopy or finger examination).

[39], [40], [41], [42]

Analyzes

It is necessary to undergo the following laboratory tests: donate blood to a common analysis - the inflammation increases the number of white blood cells. A coprogram is also conducted - the fecal masses are examined to determine in them the presence of a purulent fraction, veins of blood, and with it all other changes.

[43], [44], [45], [46], [47], [48]

Instrumental diagnostics

There are also procedures for instrumental diagnosis - duodenoscopy, as well as duodenal sounding, which help to assess the functioning of the liver along with the bile ducts. A rectoscopy is performed to determine the condition of the rectal mucosa.

Treatment of the sphincteritis

To treat the disease was effective, you need to eliminate the causes that provoked its development. The main goals that must be followed by the doctor who is treating:

• normalization of the balance of enzymes and microflora in the intestine;
• suppression of the development of acute forms of pancreatitis or cholecystitis;
• symptomatic therapy to improve the patient's condition;
• elimination of intoxication and restoration of defecation function.

Methods of therapy can be divided into 3 separate categories: conservative, folk, and also surgical treatment. The latter method is used if there is a threat to the life of the patient - with sphincter necrosis, extensive abscesses with pus, sepsis.

Medications

Medication usually consists of antibacterial drugs and antispasmodics. First you need to eliminate spasms, as well as inflammation in the sphincter area. In addition, if necessary, the process of bile is stimulated. To do this, analgesic and choleretic medicines are used in the form of suppositories or ointments (such as posterizan, as well as the ultra ultra, procto-gliwenol and suppository with belladonna, and in addition ultraproject).

Posterizan in the form of an ointment is prescribed 2 r. / Day. (in the morning and in the evenings); in the form of suppositories - 1 pc., also 2 p. / day. The average course lasts about 5-7 days.

Among the side effects of the drug - in patients with increased sensitivity to its elements, allergies may occur (in the form of pruritus, hives, and eczematous rash). Local irritation can also cause the substance phenol, which is contained in both ointments and candles. The drug is contraindicated in patients who have intolerance to the active ingredients, as well as children.

The dosage of Procto-Glivenola, as well as the duration of the treatment course are determined by the doctor, each patient individually.

Adverse reactions - in some cases there is an allergy under the guise of itching, as well as a burning sensation in the anus. Among the contraindications - individual intolerance of medicinal components, 1 trimester of pregnancy, and in addition it is not recommended to prescribe to children, as there is no reliable information about the safety and efficacy of Procto-gliwenol in pediatrics.

Ultraprotect in the form of an ointment is used twice a day, but on the first day of treatment it is allowed to increase the number of applications to 4, in order to alleviate the symptoms of the disease more quickly. In the form of suppositories it is enough once a day, but on the first day 2-3 candles can also be introduced to eliminate unpleasant manifestations.

It has no side effects, which are characteristic for GCS preparations, as it contains a small dose of fluocortolone (but in case of prolonged (more than 1 month) use, local adverse reactions are possible - such as cutaneous atrophy). In very rare cases, an allergy develops - hives, itching, a rash on the skin. Contraindicated in tuberculosis or syphilitic process at the site of application, but in addition for viral pathologies (chickenpox). Also it is impossible to apply if the gestational age is less than 14 weeks.

Physiotherapeutic treatment

The method of physiotherapeutic treatment is electrostimulation, which helps to improve muscle trophism and tone. In addition, exercises of physiotherapy exercises, which help to increase the speed of muscle contraction, and also their work capacity, are also being applied.

Exercise leads to fatigue of the muscles, as a result of which the number of recruited motor units increases.

Alternative treatment

Sphincteritis can also be treated with alternative methods (but it should be done at an early stage of the disease). There are several fairly effective recipes:

Manganese baths, which must be taken for 15 minutes. At the end of the procedure, you need to treat the anus with an octeniderm solution. Take these baths need for 2 weeks.

Application of tampons moistened in ointments from medicinal herbs. First it is required to prepare the ointment itself - melt on the fire a small slice of lard and mix its fat with flax flowers, oak bark, and also water pepper. Apply this ointment on a tampon of gauze, and then enter the anal opening for 3-4 hours. Repeat this procedure 2 r. / Day. Within 2 weeks. Then take a break for 10 days. And repeat the treatment course.

Enema with chamomile tincture. It is required to brew a simple chemist's daisy, and then use it together with an enema that cleanses the intestines. For a full-fledged treatment course, about 10 such enemas are required.

[49], [50], [51], [52], [53], [54]

Herbal Treatment

An important stage of treatment is thorough regular hygiene. It is required to wash every day, in the mornings and evenings, with smooth movements. In this case, it is better to use soap instead of soap, and decoctions from medicinal herbs - camomiles with calendula, which have anti-inflammatory and disinfecting effect, as well as oak, which has an astringent effect.

Operative treatment

There are several types of surgical treatment of this pathology:

• papillosphincterotomy;
• choledochotomy (there are several types of procedure - suproduodenal, as well as retroduodenal and transduodenal);
• drainage of the biliary tract;
• sphincterotomy.

With choledochotomy, dissection of the walls of the common bile duct is performed - to remove the calculi. Often, the seam after surgery is done with an atraumatic needle.

The imposition of holedoduodenoanastomosis, in which the choledoch is combined with the 12-colon. In the course of performing such an operation, it is required to closely monitor the progress of the fusion of the walls of the ZHWP, as well as the DPC. To strengthen the cellular structure of cross-linked tissues, xymedon is used. This agent accelerates the healing process of postoperative sutures, as well as the walls of the digestive tract.

The procedure of transpapillary drainage - while the duodenal papilla is carried out to the lumen of the duodenum gut, starting from the choledochotomical hole. Further in this lumen, drainage is placed, after which the papilla serving as a conductor is removed.

Diet with sphincteritis

Another important part of therapy with sphincteritis is the correct diet. The patient needs a diet - you need to eat food that will not irritate the intestinal mucosa, stomach and other digestive organs.

Therefore, the patient's diet needs to include eggs with cottage cheese, river fish, and low-fat meat. Berries and fruits are allowed to use only in the form of jelly or compote. It is forbidden to eat sharp, fried, and fatty foods, alcohol, strong tea and coffee, some raw fruits with vegetables (especially carrots and potatoes, and in addition strawberries and apples with plums).

[55], [56], [57]

Prevention

To avoid the development of sphincteritis, it is necessary to comply with such preventive measures: timely treatment of anal fissures and hemorrhoids, and in addition cholecystitis with pancreatitis.

It is also required to eat food that does not irritate the intestinal mucosa - to reduce the use of excessively acute dishes or even to abandon them.

[58], [59], [60]

Forecast

The sphincteritis is well treatable, therefore it has a favorable prognosis - timely competent therapy will quickly ease the patient's condition. Self-medication is not recommended - when the first symptoms of the disease you need to turn to the coloproctologist.

[61], [62], [63]