Sphincteritis

Sphincteritis is an inflammation of the sphincter of any localization (hepatopancreatic ampulla (sphincter of Oddi), rectum. This article will discuss sphincteritis of the rectum, as this disease can cause the development of severe consequences.

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Epidemiology

Sphincteritis is diagnosed in almost 80% of all patients, which is why it is now considered the most common disease instead of hemorrhoids, which was previously considered as such.

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Causes sphincteritis

Pathology can develop due to a fairly large number of different reasons:

• an infectious process affecting the gastrointestinal tract;
• intestinal dysbacteriosis;
• hemorrhoids in acute or chronic form;
• damage to the rectum, anal fissures;
• poor nutrition, 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 dysfunction of the sphincter of Oddi, in which gastric juice and bile do not enter the duodenum;
• rectal cancer;
• autoimmune pathologies of hereditary nature.

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Risk factors

Factors that can also provoke the appearance of sphincteritis include inflammation of nearby organs, problems with defecation, and regular hypothermia.

The following situations are also considered risk factors:

• patients who have gastrointestinal diseases (colitis, hemorrhoids, pancreatitis, as well as chronic cholecystitis, etc.);
• patients who practice anal sex;
• elderly people;
• patients who have previously undergone surgery on the bile ducts;
• people with weak anal muscles.

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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 occurrence of catarrhal lesions, lasting only a few days, and in the absence of the necessary treatment, quickly passes into the next form - erosive. This form of the disease is protracted, and its development is due to the fact that the inflamed mucous membrane begins to be mechanically damaged by fecal masses passing through the intestine.

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Symptoms sphincteritis

Regardless of the reasons that caused the development of sphincteritis, its manifestations are almost the same. The main symptom is pain that increases during defecation. This pain can also radiate to the perineum, and also to neighboring organs. Over time, in addition to pain, a constant burning sensation occurs along with severe itching in the anus.

In addition, sphincteritis manifests itself in the form of false and very painful urges to defecate (tenesmus). In addition, foaming mucus or purulent plaque appears on the feces, and the urine becomes dark. Often, blood streaks are also observed in the feces.

The onset of inflammation is accompanied by a rise in temperature to 38 degrees, general severe malaise. Patients also note the occurrence of colic - these attacks are similar in intensity to hepatic colic. After eating, the pain intensifies, felt in the right hypochondrium. Vomiting with nausea is also possible.

If liver diseases are added to sphincteritis, jaundice may be observed periodically, accompanied by a bitter taste in the mouth, as well as severe itching.

Sphincteritis in children

Sphincteritis in children develops less frequently than in adults. Basically, the childhood form of the pathology is a consequence of microtrauma in the anus with cryptitis (an inflammatory process in the crypts of the anus) or chronic constipation. If cryptitis is not cured, inflammation of the tissues in the valve apparatus, as well as the mucous membrane of the entire distal part of the rectum, may begin.

It is quite easy to recognize the possible development of sphincteritis in a child - the child begins to complain of itching and discomfort in the anus, and later refuses to go to the toilet, as he is afraid of feeling pain when emptying the bowels.

Stages

All 3 types of the disease can flow from one to another or develop simultaneously in different areas of the sphincter, so such a division can be considered conventional. Basically, the first stage of the disease is its catarrhal form, then it turns into erosive, and then into erosive-ulcerative.

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Forms

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

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Catarrhal sphincteritis

In catarrhal sphincteritis, a characteristic enhanced vascular pattern is observed. The main symptoms of this type of pathology are redness, swelling, pain in the tissues of the muscles and mucous membrane of the rectum.

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Erosive sphincteritis

Erosive sphincteritis is a manifestation of ulcerative colitis (with the development of this pathology, bile enters the small intestine with difficulty, which disrupts the secretion of pancreatic enzymes - as a result, an increase in pressure in the bile ducts is observed).

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Erosive ulcerative sphincteritis

With this type of disease, erosions and ulcers are observed on the mucous membrane. In addition, the main symptoms of this pathology are the following manifestations: the occurrence of bleeding with varying degrees of severity, as well as the release of purulent secretions.

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Complications and consequences

Untreated sphincteritis can lead to the development of the following consequences:

• necrotic changes occur – areas of the sphincter begin to die off;
• the inflammatory process spreads to neighboring cells and tissues;
• the intoxication process intensifies;
• As a result of necrosis, sepsis may develop (it can become life-threatening for the patient).

Possible complications of the disease include the development of the following pathologies:

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

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Diagnostics sphincteritis

Diagnostics begin with collecting anamnesis, especially noting (if any) chronic pathologies of various organs of the gastrointestinal tract. During examination by a proctologist, a problem with sphincter contraction may be detected (as a result of rectoscopy or digital examination).

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Tests

It is necessary to undergo the following laboratory tests: give blood for a general analysis - with inflammation, the number of leukocytes increases. A coprogram is also carried out - feces are examined to determine the presence of a purulent fraction, blood streaks, and along with this, all other changes.

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Instrumental diagnostics

Instrumental diagnostic procedures are also performed - this is duodenoscopy, as well as duodenal sounding, which help to evaluate the functioning of the liver together with the bile ducts. Rectoscopy is performed to determine the condition of the rectal mucosa.

Treatment sphincteritis

In order for the treatment of the disease to be effective, it is necessary to eliminate the causes that provoked its development. The main goals that the attending physician must adhere to are:

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

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

Medicines

Medication usually consists of antibacterial drugs and antispasmodics. First, it is necessary to eliminate spasms, as well as inflammation in the sphincter area. In addition, if necessary, the process of bile discharge is stimulated. For this, analgesic and choleretic drugs are used in the form of suppositories or ointments (such as posterisan, as well as relief ultra, procto-glivenol and suppositories with belladonna, and in addition to this, ultraproct).

Posterisan in the form of an ointment is prescribed 2 times a day (in the morning and in the evening); in the form of suppositories - 1 piece, also 2 times a day. The course lasts on average about 5-7 days.

Among the side effects of the drug - in patients with increased sensitivity to its elements, an allergy may occur (in the form of skin itching, urticaria, and eczematous rash). Local irritation can also be caused by the substance phenol, which is contained in both the ointment and suppositories. The drug is contraindicated in patients who have an intolerance to the active components, as well as in children.

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

Side effects - in some cases, an allergy appears in the form of itching, as well as a burning sensation in the anus. Among the contraindications are individual intolerance to medicinal components, 1 trimester of pregnancy, and in addition, it is not recommended to prescribe to children, since there is no reliable information on the safety and effectiveness of Procto-Glivenol in pediatrics.

Ultraproct in the form of an ointment is applied twice a day, but on the first day of treatment the number of applications can be increased to 4 to quickly alleviate the symptoms of the disease. In the form of suppositories, 1 time per day is enough, but on the 1st day you can also administer 2-3 suppositories to eliminate unpleasant manifestations.

It does not have the side effects that are typical for GCS drugs, since it contains a small dose of fluocortolone (but in case of prolonged (more than 1 month) use, local side effects are possible - such as skin atrophy). In very rare cases, an allergy develops - urticaria, itching, skin rash. Contraindicated in tuberculosis or syphilitic process at the site of application, and in addition to this, in viral pathologies (chickenpox). Also, it cannot be used if the pregnancy period is less than 14 weeks.

Physiotherapy treatment

The method of physiotherapy treatment is electrical stimulation, which helps improve muscle trophism and tone. In addition, therapeutic physical training exercises are also used, which help increase the speed of muscle contraction, as well as their performance.

Performing exercises causes muscle fatigue, which results in an increase in the number of motor units recruited.

Folk remedies

Sphincteritis can also be treated using folk methods (but this should be done at an early stage of the disease). There are several quite effective recipes:

Manganese baths, which must be taken for 15 minutes. After the procedure, the anus must be treated with an octeniderm solution. Such baths must be taken for 2 weeks.

Using tampons soaked in ointment from medicinal herbs. First, you need to prepare the ointment itself - melt a small slice of pork fat on the fire and mix its fat with toadflax flowers, oak bark, and water pepper. Apply this ointment to a gauze tampon, then insert it into the anus for 3-4 hours. Repeat this procedure 2 times a day for 2 weeks. Then take a break for 10 days and repeat the treatment course.

Enema with chamomile tincture. You need to brew simple pharmacy chamomile, and then use it together with an enema that cleanses the intestines. For a full course of treatment, you need to do about 10 such enemas.

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Herbal treatment

An important stage of treatment is thorough regular hygiene. It is necessary to wash every day, in the morning and evening, with smooth movements. In this case, it is better to use not soap for washing, but decoctions of medicinal herbs - chamomile with calendula, which have an anti-inflammatory and disinfectant effect, as well as oak, which has an astringent effect.

Surgical treatment

There are several types of surgical treatment for this pathology:

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

During choledochotomy, the walls of the common bile duct are cut to remove stones. Often, the suture after the operation is made using an atraumatic needle.

Application of a choledochoduodenoanastomosis, which unites the common bile duct with the duodenum. During such an operation, it is necessary to closely monitor the progress of the fusion of the walls of the gallbladder, as well as the duodenum. Xymedon is used to strengthen the cellular structure of the sutured tissues. This agent accelerates the healing process of postoperative sutures, as well as the walls of the gastrointestinal tract.

Transpapillary drainage procedure - in this case the duodenal papilla is led to the lumen of the duodenum, starting from the choledochotomy opening. Then a drain is placed in this lumen, after which the papilla, which serves as a conductor, is removed.

Diet for sphincteritis

Another important part of sphincteritis therapy is proper nutrition. The patient needs a diet - it is necessary to eat food that will not irritate the mucous membrane of the intestine, stomach and other organs of the gastrointestinal tract.

Therefore, the patient's diet should include eggs with cottage cheese, river fish, and lean meat. Berries and fruits are allowed only in the form of jelly or compote. It is forbidden to eat spicy, fried, and fatty foods, alcohol, strong tea and coffee, certain raw fruits and vegetables (especially carrots and potatoes, and also strawberries, apples and plums).

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Prevention

To avoid the development of sphincteritis, it is necessary to observe the following preventive measures: promptly treat anal fissures and hemorrhoids, as well as cholecystitis with pancreatitis.

It is also necessary to eat food that will not irritate the intestinal mucosa - reduce the consumption of overly spicy foods or give them up altogether.

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Forecast

Sphincteritis responds well to treatment, so it has a favorable prognosis - timely competent therapy will quickly alleviate the patient's condition. Self-medication is not recommended - when the first symptoms of the disease appear, you need to contact a proctologist.

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