Rectal Case: History

                                                                Rectal Case: History

SYMPTOMS OF ANO-RECTAL DISEASE

1. Bleeding

·         fresh or altered

·         When blood is degraded by intestinal enzymes and bacteria, it becomes black and acquires a characteristic smell. Such a black, tarry stool is called a melaena.

·         Recognizable blood may appear in four ways:

■ mixed with the faeces

Ø  come from bowel higher than the sigmoid colon (softness of the stool and the time left for transit are still sufficient for mixing)

■ on the surface of the faeces

Ø  usually come from the lower sigmoid colon, rectum or anal canal

■ Separate from the faeces, either after or unrelated to defaecation

Ø  If bleeding follows defaecation( probably anal condition) -haemorrhoids

Ø  If the blood is passed by itself, it has accumulated in the rectum rapidly so as to give a desire to defaecate(Blood acts as a purgative) and the patient passes blood and clots. Causes include diverticular disease, a rapidly bleeding carcinoma, or inflammatory bowel disease

■ On the toilet paper/hand after cleaning

Ø  caused by minor bleeding from conditions in the anal margin- fissure or haemorrhoids

2. Pain

·         Pain from the anal canal is felt principally on defaecation, and is protracted, cramp-like and distressing

·         Excessive stretching of the anal canal may cause a sharp, splitting pain (fissure)

·         Internal haemorrhoids and rectal cancer are not usually painful.

·         An annular lesion at the rectosigmoid junctionmay obstruct the àlower abdominal colic

3. Pruritus

·         Result in leakage of mucus on to the peri-anal skin

·         In children, the commonest cause is a worm infestation

·         worse at night (perhaps because there are no other sensory distractions)

4. Incontinence and soiling

·         caused by sphincter failure, impaction with overflow, extreme urgency or neurological impairment

5. Tenesmus

·         Constant intense desire to defaecate

·         When the patient tries to evacuate the rectum, nothing appears, or just a small amount of mucus and loose faeces

·         Caused by a space-occupying lesion in the lumen or wall of the rectum, which mimics the presence of faeces

6. Bowel habit

·         Any recent alteration in bowel habit