What happens in the anus
Along the circumference of the anal canal there are depressions - the crypts of Morgagni, into which the ducts of the anal glands open, moisturizing the canal. Between the crypts are the anal papillae. With frequent straining, hard stools or, conversely, loose and frequent stools, the contents of the intestine flow into the crypt and linger there. If the gland duct becomes clogged, microbes multiply and inflammation develops. The mucous membrane swells, the crypt stops emptying, and the process closes in a circle. That is why, without normalizing stool, treatment is often ineffective.
- Acute cryptitis - vivid complaints for several days
- Chronic cryptitis with periods of exacerbation
- Papillitis - inflammation and enlargement of the anal papillae
- Hypertrophied papilla, which is sometimes mistaken for a polyp
- Transition of inflammation to paraproctitis
Causes and risk factors
The main factor is bowel movement in any direction. Hard feces injure the mucous membrane and compress the crypts, frequent loose stools irritate the anal canal and carry the contents inside. Concomitant proctological problems contribute to inflammation: hemorrhoids, anal fissure, mucosal prolapse. Sedentary work, lack of fiber and fluid, and the habit of sitting in the toilet for a long time with the phone play a role. Diabetes mellitus and reduced immunity worsen the course. In some patients, persistent cryptitis turns out to be a manifestation of Crohn's disease.
- Chronic constipation and straining
- Frequent loose stools, intestinal infections
- Hemorrhoids and anal fissures
- Sedentary lifestyle, prolonged use of the toilet
- Lack of fiber and water in the diet
- Spicy food and alcohol
- Diabetes mellitus and reduced immunity
- Crohn's disease
Symptoms
Unpleasant sensations are typical in the anus, and not in the depths of the abdomen: burning, tingling, foreign body sensation, wetness and itching due to mucus secretion. The pain intensifies during defecation and can persist after it, radiating to the tailbone or perineum. Traces of blood or mucus are sometimes visible on toilet paper. With papillitis, a person can feel the dense, painful papilla himself. Signs indicating a complication are increasing throbbing pain, temperature and tightness near the anus.
- Burning and itching in the anus
- Pain during and after defecation
- Foreign body sensation
- Humidity, mucus, marks on laundry
- Small traces of blood on paper
- Referral of pain to the tailbone and perineum
- Sphincter spasm and fear of defecation
Survey
The diagnosis is made during examination: the proctologist evaluates the skin of the perineum, performs a digital examination and anoscopy, during which an edematous crypt with purulent discharge or an enlarged papilla is visible. To exclude more serious causes, sigmoidoscopy is performed, and colonoscopy is recommended for people over 45 years of age or with alarming signs. If a hidden abscess or fistulous tract is suspected, an ultrasound of the rectum and pararectal area is prescribed. A persistent course requires the exclusion of Crohn's disease and sexually transmitted infections.
- Examination of the perineum and digital examination of the rectum
- Anoscopy with assessment of crypts and papillae
- Sigmoidoscopy
- Ultrasound of the rectum and pararectal area
- Colonoscopy for warning signs and after 45 years
- Stool tests for chronic diarrhea
- Screening for persistent Crohn's disease
Treatment and prevention
Treatment begins with the main thing - regular soft stools: enough fiber and water, if necessary, the doctor selects a mild laxative. Sitz baths with warm water, careful hygiene with cool water instead of hard paper, avoidance of spicy foods and alcohol during treatment are helpful. The doctor prescribes local remedies with anti-inflammatory and healing components, and, if necessary, antibacterial drugs. If an abscess has formed, an autopsy is required: you cannot wait for an independent breakthrough. If there are persistent complaints, the hypertrophied papilla is removed on an outpatient basis.
- Normalization of stool: fiber, water, diet
- Avoiding straining and sitting on the toilet for long periods of time
- Warm sitz baths
- Washing instead of dry paper
- Local anti-inflammatory drugs as prescribed by a doctor
- Antibacterial therapy for purulent inflammation
- Opening and drainage for paraproctitis
- Removal of hypertrophied papilla for persistent complaints
