What is the structure of the rectum in women and men? Rectal cancer. Symptoms and signs, stages, diagnosis, treatment and prognosis, prevention What is the size of the rectum in men

The rectum is the final part of the human digestive tract.

The anatomy and physiology of the rectum differs from those of the large intestine. The rectum has an average length of 13-15 cm, the diameter of the intestine ranges from 2.5 to 7.5 cm. The rectum is conventionally divided into two parts: the ampulla of the intestine and the anal canal (anus). The first part of the intestine is located in the pelvic cavity. Behind the ampulla is the sacrum and coccyx. The perineal part of the intestine has the form of a slot located longitudinally, which passes through the thickness of the perineum. In men, in front of the rectum is the prostate gland, seminal vesicles, bladder and ampulla of the vas deferens. In women, the vagina and uterus. In the clinic, it is convenient to use the conditional division of the rectum into the following parts:

nadampular or rectosigmoid;
upper ampullar;
medium ampullary;
lower ampullar part;
crotch part.

Clinical anatomy of the organ

The rectum has curves: frontal (not always present, changeable), sagittal (permanent). One of the sagittal folds (proximal) corresponds to the concave shape of the sacrum, which is called the sacral flexure of the intestine. The second sagittal bend is called perineal, it is projected at the level of the coccyx, in the thickness of the perineum (see photo). The rectum from the proximal side is completely covered by the peritoneum, i.e. is located intraperitoneally. The middle part of the intestine is located mesoperitoneally, i.e. covered with peritoneum on three sides. The final or distal part of the intestine is not covered by the peritoneum (located extraperitoneally).

Anatomy of the rectal sphincters

On the border between the sigmoid colon and the rectum is the sigmorerectal sphincter or according to the author O'Bern-Pirogov-Mutier. The basis of the sphincter is smooth muscle fibers arranged circularly, and an auxiliary element is the fold of the mucous membrane, which occupies the entire circumference of the intestine, located circularly. Three more muscle sphincter are located throughout the intestine.

The third or proximal sphincter (according to the author of Nelaton) has approximately the same structure as the first sphincter: it is based on circular smooth muscle fibers, and an additional element is a circular fold of the mucous membrane that occupies the entire circumference of the intestine.
Internal sphincter of the rectum, or involuntary. It is located in the area of the perineal flexure of the intestine, ends at the border where the surface layer of the external sphincter of the anus connects with its subcutaneous layer. The basis of the sphincter consists of thickened smooth muscle bundles that run in three directions (circular, longitudinal and transverse). The length of the sphincter is from 1.5 to 3.5 cm. The longitudinal fibers of the muscle layer are woven into the distal sphincter and into the external sphincter of the anus, connecting with the skin of the latter. The thickness of this sphincter is greater in men, it gradually increases with age or with certain diseases (accompanied by constipation).
Voluntary external sphincter. The basis of the sphincter is the striated muscle, which is a continuation of the puborectalis muscle. The sphincter itself is located in the pelvic floor. Its length ranges from 2.5 to 5 cm. The muscular part of the sphincter is represented by three layers of fibers: the subcutaneous part of the annular muscle fibers, the accumulation of superficial muscle fibers (combine and attach to the bones of the coccyx from behind), the layer of deep muscle fibers is associated with the fibers of the pubic-rectal muscle . The external arbitrary sphincter has auxiliary structures: cavernous tissue, arteriolo-venular formations, connective tissue layer.

All rectal sphincters provide the physiological process of defecation.

Wall structure

The walls of the rectum consist of three layers: serous, muscular and mucous (see photo). The upper part of the intestine is covered with a serous membrane in front and on the sides. In the uppermost part of the intestine, the serosa covers the back of the intestine, passes into the mesenteric mesorectum. The mucous membrane of the human rectum forms multiple longitudinal folds that are easily straightened. From 8 to 10 longitudinal mucous folds of the anal canal are permanent. They have the form of columns, and between them there are recesses called anal sinuses and ending with semilunar valves. The flaps, in turn, form a slightly protruding zigzag line (called the anorectal, dentate, or comb line), which is a conditional boundary between the squamous epithelium of the rectal anal canal and the glandular epithelium of the ampullar part of the intestine. Between the anus and the anal sinuses is an annular zone called the hemorrhoidal. The submucosa provides easy movement and stretching of the mucosa due to its loose connective tissue structure. The muscle layer is formed by two types of muscle fibers: the outer layer has a longitudinal direction, the inner one is circular. Circular fibers thicken up to 6 mm in the upper half of the perineum, thereby forming the internal sphincter. Muscle fibers of the longitudinal direction are partially woven into the outer pulp. They are also connected to the muscle that lifts the anus. The external sphincter, up to 2 cm high and up to 8 mm thick, incorporates arbitrary muscles, covers the perineal region, it also ends with the intestine. The mucous layer of the wall of the rectum is covered with epithelium: the anal columns are lined with squamous non-keratinized epithelium, the sinuses are lined with stratified epithelium. The epithelium contains intestinal crypts extending only to the intestinal columns. There are no villi in the rectum. A small number of lymphatic follicles are located in the submucosa. Below the sinuses of the intestine is the border between the skin and the mucous membrane of the anus, which is called the anal-skin line. The skin of the anus has a flat, non-keratinizing stratified pigmented epithelium, papillae are expressed in it, and anal glands are located in the thickness.

blood supply

Arterial blood enters the rectum through the unpaired superior rectal and rectal arteries (middle and lower). The superior rectal artery is the last and largest branch of the inferior mesenteric artery. The superior rectal artery provides the main blood supply to the rectum to its anus. The middle rectal arteries depart from the branches of the internal iliac artery. Sometimes they are absent or not developed equally. Branches of the inferior rectal arteries depart from the internal pudendal arteries. They provide nutrition to the external sphincter and the skin of the anal region. In the layers of the wall of the rectum there are venous plexuses, bearing the names: subfascial, subcutaneous and submucosal. The submucosal, or internal, plexus is connected with the rest and is located in the form of a ring in the submucosa. It consists of dilated venous trunks and cavities. Venous blood flows through the superior rectal vein into the portal vein system, through the middle and inferior rectal veins into the inferior vena cava system. Between these vessels there is a large network of anastomoses. The superior rectal vein lacks valves, so the veins in the distal rectum often dilate and develop symptoms of venous congestion.

lymphatic system

Lymphatic vessels and nodes play an important role in the spread of infections and tumor metastases. In the thickness of the mucous membrane of the rectum lies a network of lymphatic capillaries, consisting of a single layer. In the submucosal layer there are plexuses of lymphatic vessels of three orders. Networks of lymphatic capillaries lie in the circular and longitudinal layers of the rectum. The serous membrane is also rich in lymphatic formations: it has a superficial small-looped and deep wide-looped networks of lymphatic capillaries and vessels. The lymphatic vessels of the organ are divided into three types: extramural upper, middle and lower. From the walls of the rectum, lymph is collected by the upper lymphatic vessels, they run parallel to the branches of the superior rectal artery and flow into the lymph nodes of Gerota. Lymph from the side walls of the organ is collected in the middle lymphatic vessels of the rectum. They are directed under the fascia of the levator ani muscle. From them, lymph enters the lymph nodes located on the walls of the pelvis. From the lower rectal lymphatic vessels, lymph goes to the inguinal lymph nodes. Vessels start from the skin of the anus. They are associated with lymphatic vessels from the ampulla of the intestine and from the mucous membrane of the anal canal.

innervation

Different parts of the intestine have separate branches of innervation. The rectosigmoid and ampullar parts of the rectum are innervated mainly by the parasympathetic and sympathetic nervous systems. The perineal part of the intestine is due to the branches of the spinal nerves. This can explain the low pain sensitivity of the ampulla of the rectum and the low pain threshold of the anal canal. Sympathetic fibers provide innervation of the internal sphincter, branches of the pudendal nerves - the external sphincter. Branches depart from the 3rd and 4th sacral nerves, providing innervation to the levator ani muscle.

Functions

The main function of this section of the intestine is to evacuate feces. This function is largely controlled by the consciousness and will of a person. New studies have established that there is a neuroreflex connection between the rectum and the internal organs and systems of the body, carried out through the cerebral cortex and the lower floors of the nervous system. From the stomach, food begins to be evacuated a few minutes after eating. On average, the contents of the stomach are released after 2 hours. By this time, the first portions of chyme reach the Bauhinian valve. Up to 4 liters of fluid passes through it per day. The human large intestine per day provides absorption of about 3.7 liters of the liquid part of chyme. In the form of feces, up to 250-300 grams are evacuated from the body. The mucous membrane of the human rectum ensures the absorption of such substances: sodium chloride, water, glucose, dextrose, alcohol, and many drugs. About 40% of the total mass of feces are undigested food residues, microorganisms, waste products of the digestive tract. The ampullar part of the intestine acts as a reservoir. In it, feces and gases accumulate, stretch it, irritate the interoceptive apparatus of the intestine. The impulse from the higher parts of the central nervous system reaches the striated muscles of the pelvic floor, the smooth muscles of the intestine and the striated fibers of the abdominal press. The rectum contracts, the anus rises, the muscles of the anterior abdominal wall, the pelvic floor diaphragm contract, and the sphincters relax. These are physiological mechanisms that ensure the act of defecation.

Measurement of temperature in the rectum

The rectum is a closed cavity, so the temperature in it is relatively constant and stable. Therefore, the results of thermometry in the rectum are the most reliable. The temperature of the rectum is almost equal to the temperature of human organs. This method of thermometry is used in a certain category of patients:

patients with severe emaciation and weakness;
children under the age of 4-5 years;
patients with thermoneuroses.

Contraindications are diseases of the rectum (hemorrhoids, proctitis), stool retention, when the ampullar part of the intestine is filled with feces, diarrhea. Before you start measuring the temperature, you need to lubricate the end of the thermometer with vaseline oil. An adult patient can lie on his side, it is more convenient for children to lay on his stomach. The thermometer is inserted no more than 2-3 cm. An adult patient himself can do this. During the measurement, the patient continues to lie down, the thermometer is held by the fingers of the hand, which lies on the buttocks. The sharp insertion of the thermometer, its rigid fixation or the movement of the patient during the measurement is excluded. The measurement time will be 1-2 minutes if you use a mercury thermometer.

The normal temperature in the rectum is 37.3 - 37.7 degrees.

After measurement, place the thermometer in a disinfectant solution and store in a separate place. The following symptoms may indicate diseases of the rectum.

Constipation. To determine the cause of constipation, you should consult a specialist and undergo the necessary studies. Constipation can be a sign of serious diseases: intestinal obstruction, tumor diseases, intestinal diverticulosis.
Symptoms indicating the presence of a chronic anal fissure: spotting with scarlet blood after the act of defecation, pain before and after defecation. The proctologist will detect this disease during a routine visual examination.
Sharp intense pain in the rectal area, impaired general well-being and fever with signs of intoxication are indications for calling ambulance specialists. These symptoms may indicate an inflammatory process of subcutaneous adipose tissue - paraproctitis.
The reason for contacting a specialist is non-specific symptoms that are characteristic of many diseases of the rectum (cancer, polyps, hemorrhoids): a sharp loss in weight, there is an admixture of blood, mucus in the feces, the patient is worried about severe pain before and after the act of defecation.

The anus is the final part of the intestine through which the body throws out feces (that is, the remnants of waste food).

The structure of the human anus

The anus is limited by sphincters, which are formed by muscles. Such muscular rings are necessary to control the opening and closing of the anus. There are two anorectal sphincters in the human body:

Internal, consisting of thickenings of the smooth muscles of the rectum and not subject to consciousness. Its length is from one and a half to three and a half centimeters.
External, consisting of striated muscles and controlled by consciousness. Its length varies from two and a half to five centimeters.

It ends with an edge, which is a sharp transition of the scaly mucous lining of the distal anorectal canal into the skin of the perineum. The skin around the anus tends to be more pigmented (i.e. darker in color) and wrinkled due to the presence of the external sphincter.

In childhood, the anus is located more dorsally than in adults, about twenty millimeters from the coccyx. The diameter of the anal opening, as a rule, is three to six centimeters, and the length of the canal varies from three to five centimeters. In addition to sphincters, the rectal obturator apparatus includes muscles that lift the anus and muscles of the pelvic diaphragm.

In the structure of the anus, three sections can be distinguished:

The mucosa in this section is provided with longitudinal folds, between which crypts (anal sinuses) are found, where the openings of the anal glands go.
Area covered by stratified squamous epithelium.
This section is covered with stratified keratinized squamous epithelium and is supplied with numerous sebaceous and sweat glands, as well as hair.

The region of the anus and rectum has a developed circulatory network, as well as many nerve endings, which allows you to deliberately delay the act of defecation and is often the cause of neurogenic constipation.

Topography of the anus

The structures that interact directly with the anal canal are the rectal ampulla and the sigmoid colon. The anal canal is located in the perineum. In front, the rectum is adjacent to the seminal vesicles, ampullae of the vas deferens, the bladder and in men. In women, the vagina and uterus are located in front. The canal ends with an anus. Posteriorly, the external sphincter is attached to the coccyx by means of the anal-coccygeal ligament.

In the region of the perineum, behind and on the sides of the anus, there are paired sciatic-rectal fossae, which are shaped like a prism and filled with fatty tissue, in which nerves and blood vessels pass. In the frontal section, the pits have the shape of triangles. The lateral wall of the fossa is formed by the obturator muscle and ischial tuberosity (inner surface), the medial wall is formed by the external sphincter and the muscle that raises the anus. The posterior wall of the fossa is formed by the coccygeal muscle and its posterior bundles, which raises the anus, and the anterior wall is formed by the transverse muscles of the perineum. Adipose tissue, which is located in the cavity of the ischiorectal fossa, performs the function of an elastic elastic pillow.

The structure of the female anus

In the female body, the rectum is adjacent to the vagina in front and is separated from the latter by a thin layer of Denovillier-Salishchev. Due to this structural feature of the anus and rectum in women, both infectious and tumor agents easily penetrate from one cavity to another, which leads to the formation of rectovaginal fistulas as a result of various injuries or perineal ruptures during childbirth.

The structure of the anus in women determines its shape in the form of a flat or slightly protruding formation. This is due to the fact that in the process of delivery, the muscles of the perineum relax, and the muscles that raise the anus lose their ability to contract.

Features of the anus in men

The structure of the male anus has some differences. In men (especially muscular men) the anus looks like a funnel. The anterior wall of the anal canal is adjacent to the bulb and the top of the prostate gland. In addition, the internal sphincter of men is thicker than that of women.

Functions of the anus and rectum

The rectum is responsible for removing waste materials from the body. In addition, it absorbs liquid. So, with dehydration and pressing of feces, about four liters of fluid per day returns to the body. Together with the liquid, microelements are reabsorbed. The rectal ampulla is a reservoir for feces, the accumulation of which leads to overstretching of the intestinal walls, the formation of a nerve impulse and, as a result, the urge to defecate (defecation).

And now about the functions of the anus. Being in constant tension, its sphincters control the release of feces (defecation) and the release of gases from the intestines (flatulence).

Pathology of the anus

Tumors.
Haemorrhoids.
Hernias.
Various mucosal defects (cysts, anal fissures, ulcers).
Inflammatory processes (abscesses, paraproctitis, proctitis, fistulas).
Congenital conditions (anus atresia).

Spasm of the sphincters

In accordance with the structure of the anus, the manifestations of pathologies of this section of the intestine are also characteristic. Among the symptoms, the most common sphincter spasm (external or internal), which is pain and discomfort in the anus.

The reasons for this condition are:

mental problems;
prolonged constipation;
chronic inflammation in the area of \u200b\u200bthe internal or external sphincter;
excessive innervation.

Accordingly, the duration is distinguished:

Prolonged spasm, characterized by severe pain, which is not removed by taking ordinary analgesics.
Transient spasm - sharp short-term acute pain in the anus, radiating to the pelvic joints or coccyx.

Depending on the cause, spasm can be:

primary (due to neurological problems);
secondary (due to problems in the gut itself).

The manifestations of this symptom are:

the appearance of pain due to stress;
pain during defecation is stopped or with the help of warm water;
the pain is acute, localized in the anus and gives to the coccyx, pelvis (perineum) or abdomen.

Diagnosis of pathological processes

Computed tomography can detect polyps and other pathological formations.
A biopsy is used to determine malignancy
Anoscopy (rectomanoscopy) is used to assess the condition of the anus mucosa, as well as taking material for a biopsy.
anorectal manometry. In accordance with the structure of the anus (see photo above), the muscular apparatus (sphincters) of the anus is diagnosed. Most of the time, the anal muscles are at maximum tension to control defecation and flatulence. Up to eighty-five percent of the basal anal tone is carried out by the internal anal sphincter. With insufficient or no coordination between the muscles of the pelvic floor and the sphincters of the anus, dyschezia develops, which is manifested by difficult defecation and constipation.
This method allows you to identify hernias, prolapse of the intestines, uterus, hemorrhoids, fistulas, cracks and other pathologies of the anus and rectum.
Anus ultrasound. Based on this study, it is possible to assume the presence of neoplasms, determine their location and size, detect and so on.

Discomfort in the anorectal region

The anatomical structure of the anus is such that the skin in this area is especially sensitive, and pathogenic bacteria can settle in its folds if hygiene is not observed, frequent constipation or diarrhea, resulting in discomfort, irritation, itching, unpleasant odor and pain.

To reduce these manifestations and prevent them, you should:

Wash the anus and the skin around it with water without soap (the latter can dry out the skin and, as a result, lead to even more discomfort). It is necessary to give preference to the Kavilon spray or the use of alcohol-free wet wipes (since toilet paper irritates the skin).
The skin around the anus should be dry.
It is necessary to create a barrier to moisture penetration. For example, the use of Dimethicone cream is recommended, which creates a protective film on the skin around the anus.
The use of pharmaceutical powders (for example, talc or cornstarch). They should be applied to pre-cleansed and dried skin.
The use of disposable underwear or moisture-absorbing pads.
The use of "breathable" underwear and clothes made of natural materials of a free cut, which does not restrict movement.
In the event of fecal incontinence, underwear should be changed immediately.

Treatment

The purpose of this or that therapy depends on the nature of the disease. First of all, the causes that caused them are eliminated. In addition, laxatives, antibacterials, painkillers and antispasmodics in the form of ointments / suppositories are prescribed, as well as physiotherapy, electrosleep, applications, massage, microclysters. With the ineffectiveness of the ongoing conservative treatment, surgical operations are performed.

Hemorrhoids are treated with special suppositories and ointments, as well as surgical methods. Congenital pathologies (anus atresia) require immediate surgery. Tumors of the anus are treated with a combination of radiation and chemotherapy, as well as surgical removal of the tumor. Cracks in the anus are perfectly treatable with the use of special baths, diet, healing suppositories and creams, as well as surgery. Hernias are eliminated by surgical methods.

The rectum is the terminal (final) section of the digestive tract. It is a direct continuation of the large intestine, but differs from it both in its structure and in its functions.

The structure of the rectum

The rectum is located in the pelvic cavity. Its length in an adult is approximately 15 cm. It ends with an anal opening (anus) located on the skin of the perineum.

The rectum consists of three layers: mucous, submucosal and muscular. Outside, it is covered with a fairly strong fascia. Between the muscle membrane and the fascia itself there is a thin layer of adipose tissue. This layer, in addition to the rectum, surrounds the cervix in women, and the prostate gland and seminal vesicles in men.

Slightly above the anus, the mucous membrane forms numerous vertical folds - Morgagni's columns. There are folds between the columns, in which small particles of feces, foreign bodies can linger, which in turn can cause the development of an inflammatory process. Constipation, inflammation can lead to the appearance of folds of papillae on the surface (elevation of the usual mucous membrane), which are sometimes mistaken for rectal polyps.

Functions of the rectum

In the rectum, feces accumulate and harden before the process of defecation. This evacuation function is largely controlled by the consciousness and will of a person.

Diseases of the rectum

All pathologies of the rectum have a huge impact on the quality and standard of living of any person. Therefore, modern medicine pays great attention to the prevention of diseases and the treatment of the rectum. For the diagnosis of diseases, various instrumental and non-instrumental diagnostic methods are used: physiological, radiological, laboratory research methods. However, the most informative method is colonoscopy, which allows to identify many, including precancerous diseases and rectal cancer.

The most common diseases of the rectum are:

Proctitis is an inflammatory process in the rectum;
Prolapse of the rectum - the main cause of this pathology is most often the weakening of the muscles that form the pelvic floor;
Fissures (cracks) - small tears in the mucous membrane of the rectum;
Polyps of the rectum - usually do not cause any discomfort to patients. However, over time, they can degenerate into a malignant tumor;
Colon cancer is a rather formidable and dangerous disease. Its treatment is surgical and consists in the removal of the rectum (partial or complete along with the anus). If a patient with rectal cancer seeks medical help late and it is no longer possible to perform a radical operation, then he is prescribed palliative treatment (radiation, chemotherapy), the purpose of which is to prolong the life of the patient and improve its quality. In order to timely diagnose rectal cancer, you should regularly undergo medical examinations, especially for people suffering from rectal polyps.

The rectum is treated by proctologists. Many diseases are treated conservatively, and only if the therapy is unsuccessful, there are indications for surgical intervention. After removal of the rectum, an unnatural anal opening (colonostomy) is applied or, if the patient's condition allows, reconstructive operations are performed (an artificial rectum is created from the large intestine).

Approximately the same for women and men. But since the intestines are located somewhere in the same area as the genitals, there are some peculiarities and differences.

This article discusses the structure of the organ in men and women, its functions and possible diseases.

More about the rectum

This organ descends to the small pelvis, forming bends. One of them bulges forward, and the other bulges back, repeating the curve of the sacrum.

The length of the intestine is from 10 to 15 cm. The organ consists of muscle tissue, mucous membrane and submucosa, is located in the connective tissue membrane - in the male body it also covers the prostate gland, and in the female body it envelops the cervix.

The mucosa is covered with epithelial tissue, which contains a large number of Lieberkühn crypts (glands).

In turn, these glands are made up of cells that produce mucus, which explains why mucus is secreted from the intestines in various diseases.

Just above the anus are Morgagni's rectal columns, formed by a fold of mucous tissue. They resemble columns, their number varies from 6 to 14.

Between the columns are niches, which are called pockets. They often retain the remains of feces, which can provoke inflammation.

Intestinal diseases and disorders of its motor function irritate the intestinal mucosa, due to which papillae may appear on it, the size of which depends on how strongly the mucosa is irritated. Sometimes irritation is mistaken for a polyp.

Blood in the rectum comes from several hemorrhoidal arteries - from the lower, middle and upper. The first two are paired, but the top one is not.

Blood through the veins moves through the caval and portal, in the lower part of the rectum there are many large venous plexuses.

In women, the structure of the intestine is different from the male body. This is influenced by the characteristics of the female reproductive system.

In women, the rectum is adjacent to the vagina in front - between the organs, of course, there is a separating layer, but it is very thin.

If inflammation occurs in one of these organs, then it is likely that it will spread to a neighboring organ.

Because of this internal structure, fistulas often form in women, which affect both the intestine and the organs of the reproductive system.

This disease is a consequence of problematic childbirth or any injuries.

The rectum is the last part of the intestine that ends with the sphincter. Surprisingly, the anus in men and women has a different structure.

The sphincter or anus is a depression that goes into the rectum. Depending on the structure of the body, it may be located deep enough or not very deep.

In men, for example, the sphincter may be funnel-shaped, while in women it is flatter and protrudes slightly forward.

Such a structure of the sphincter may be in women from the fact that its muscles are stretched too much.

How does defecation happen?

The rectum is a part of the large intestine, which also includes the sigmoid, ascending, descending and transverse. It is necessary to understand how everything works as a whole in order to consider the rectum separately.

In men and women, about 4 liters of digested food (chyme) that comes from the stomach comes from the small intestine to the large intestine per day.

The large intestine mixes this gruel, as a result of which feces are formed in a person.

This happens due to the fact that the body performs wave-like contractions, due to which the chyme thickens. In the end, out of 4 liters of digested food, about 200 g of feces remain.

Usually, stool masses consist not only of chyme residues, but also of mucus, cholesterol, bacteria, cholic acid, etc.

The body absorbs food, and all the toxic and harmful substances of the chyme penetrate into the blood, which enters the liver. In the liver, "harmful" blood lingers, and then is thrown out with bile.

After all this, a bowel movement occurs, which is provided by the actions of some of the mechanisms of the intestine.

With the help of peristalsis, feces enter the sigmoid colon, where they accumulate and are temporarily retained.

Stopping the further movement of feces in this part of the intestine occurs due to contractions of the muscles that are in the intestine.

Pushing out the contents of the intestine helps not only its own muscle layer, but also the abdominal muscles.

Additional help from another muscle group helps to push feces into the anal canal with constipation and various spasms. After a bowel movement, the organ is free for some time and does not fill up.

This part of the intestine has a strong influence on the work of the stomach. If there are any problems, then this affects the digestive process, the release of saliva and bile.

The brain also affects defecation: if a person is worried or tired, then this delays bowel movement.

Possible diseases

Since the structure of the intestine in the female and male body is different, there are also a lot of diseases that can be in this organ.

One of the most common diseases of the rectum is proctitis. In other words, inflammation of the mucosa.

This disease can be caused by excessive consumption of spicy foods and spices, as well as constipation, during which stagnation of feces is observed.

Faeces can remain in the "pockets" between Morgagni's columns, gradually poisoning the body, which can also lead to congestive proctitis.

Inflammation of the rectal mucosa can begin after unsuccessful therapy with laser beams.

For example, if a person has a tumor in the pelvic region, then as a result of radiation therapy, proctitis may well develop.

Inflammation of the mucosa can also occur from hypothermia, hemorrhoids, cystitis, prostatitis, etc.

Proctitis is chronic and acute. The first type of pathology proceeds almost imperceptibly, accompanied by slight itching and burning in the anus.

Acute proctitis comes on suddenly and is characterized by high fever, heaviness in the intestines, chills, and burning in the intestines.

This type of proctitis occurs infrequently, with timely treatment, a fairly quick recovery of the patient is possible.

But the prognosis for chronic proctitis is more disappointing, because with this type of disease, exacerbations periodically occur.

Rectal prolapse is a pathology in which the wall of the organ falls out through the sphincter.

Most often this is observed in women who have had a difficult birth, because after them the muscles of the anus can be significantly stretched and injured in a woman, tears are possible.

However, prolapse of the intestine also occurs in men. Usually this can happen due to changes in the muscles of the anus during aging, from previous operations on the intestines. Constipation can lead to pathology if a person regularly pushes for a long time in the toilet.

Usually the disease begins with constipation and other difficulties in defecation in childhood, but the first signs of the disease in adulthood are also possible.

With this pathology, a person begins itching in the anus, incontinence of feces, blood and mucus are released.

Diagnosis of rectal prolapse is by palpation. Also, the doctor may ask the patient to push - then part of the intestine becomes visible. If polyps are suspected, a colonoscopy may be performed.

For adults in such cases, only surgical intervention is indicated. During the operation, the ligaments of the intestine are strengthened for the patient.

If a person also complains of incontinence, then the muscles of the anus are additionally strengthened.

The operation, although rather big, can be carried out by almost everyone - even the elderly.

Quite often, prolapse of the intestine occurs along with the prolapse of the uterus in women. If a woman of advanced age or is not going to have children, then the uterus is cut out.

If the prolapse of the intestine occurred in a young man without other health problems, then conservative treatment may be prescribed, which includes special physical exercises that strengthen the muscles of the anus, and a diet rich in essential vitamins.

The diameter of the rectum varies in different ways (2.5 - 7.5 centimeters). The rectum takes its beginning from the sigmoid colon, only at the end it ends with a hole - it is called the anus.

In fact, the rectum is not straight, since it has two bends, and they are located in the longitudinal plane. The very first bend is called sacral. This curve is concave towards the sacrum and ends in a convexity at the back. The second bend is called the perineal, since its bulge is directed forward and it most directly represents the inflection of the intestine through the coccyx.

Sections of the rectum

The rectum can be divided into three different sections. The lowest and narrowest is called the perineal, in other words, it can be called the anal canal. It is this channel that performs the function of opening outward (anus). Its length is only 2-4 centimeters.

Above the anal canal is the widest part in the rectum, its length ranges from 10 to 12 centimeters, it is called the ampulla. The third section of the rectum is called "nadampulyarny", in comparison with the ampulla, this section is small, only 5-6 centimeters long.

Coccyx

The coccyx is located directly behind the rectum, and there is also the sacrum. In front of the rectum in men in this zone are the ampullae of the vas deferens, the prostate gland, the seminal vesicles and, of course, the bladder. In women, the uterus and vagina are located in this area. In the drawings, one can remarkably consider the difference in how the rectum and closely located organs are located.

Rectal protection

Several layers of protection are located on the walls of the rectum itself. As we have already said, the upper part - it is also nadampular, is under the reliable protection of the peritoneum - a thin and very transparent film (shell) from the outside. The anal and ampullar canals are covered with reliable layers formed from fats and connective fibers; it does not apply to the peritoneum.

The rectum also has a middle layer, which is firmly protected by a pair of rows of muscles. Muscle fibers are outside (they are longitudinal). And the longitudinal muscle fibers inside contain circular fibers of the same composition, which are called the internal sphincter, it is also called the pulp, and are surrounded by the external sphincter so that the masses of feces are closed and do not fall prematurely out.

The fibers of the sphincters are securely connected and attached in a circular fashion to the anus.

The mucosa of the rectum

The mucous membrane is called the wall of the rectum (inner wall). Incredibly thin layers of mucous membrane are separated from the muscle layer. It is thanks to these ultra-thin layers that the muscular mobility of the connective tissues is formed.

Epithelial cells in the form of a cylinder form the mucous membrane of the rectum. They also consist of intestinal glands, they are called mucous and goblet. They have the ability to secrete a secret in the form of mucus. It is designed to prevent wounds, scratches and other damage to the walls of the rectum when stool passes through it. The mucus also serves as a lubricant for the feces, which pass through the rectum more quickly. Follicles - small lymphoid nodules - are also found in the rectum.

Folds of the rectum

When the rectum is not filled with feces, its mucosa is able to form folds - there are many of them, and they go in different directions. Two or three folds of the rectum run across, next to them are the fibers of the muscle layer, which run in a circle. Their course is obtained in the form of a screw, and they are located in the ampoule of the rectum. There are also other folds that are not permanent, they are longitudinal, and straighten out when the intestine is full.

In the area of the anus, the mucous membrane forms more folds - there are from 6 to 10 of them. These folds are permanent, they are called funny - anal columns. They are located at the anus and have an elevation in the form of a ring at their base. Here is the place where the rectal mucosa forms a transition into the skin of the anus - the anus.

Circulatory system of the rectum

To have a clear idea of what causes hemorrhoids, it is important to understand how the rectal blood supply system works. The fact is that hemorrhoids are a disease that affects the blood vessels located in the submucosal layer of the rectum. It is because of the violation of their structure and work that a person suffers from pain in the anus.

The work of the five arteries

Five arteries work in order to start the flow of blood into the rectum. Or rather, not in the intestine itself, but to it, to its submucosal layer. One of these arteries is not a paired artery, it is located at the top and is called the hemorrhoidal artery. This artery is the end of the lower artery, which is called the mesenteric.

So, the hemorrhoidal artery has an important role - it carries the blood flow to the back wall of the rectum. These are the areas located above the ampulla and in the part of the ampulla (we have already talked about them).

But there are 4 more arteries that carry blood to the rectum. They create couples. These pairs are located on the right and left, in the middle and at the bottom of the rectum. They end with the hypogastric arteries.

These arteries do not work on their own - they form a single whole network of arteries that work harmoniously for the benefit of our body. The arteries are interconnected vertically and horizontally in the walls of the rectum.

Venous system of the rectum

This is a very important system that ensures the outflow of blood running through the veins in the rectum. Blood runs from smaller veins to larger ones, then runs through the arteries.

Where is the network of veins located in the rectum? Its location is in the layer called the submucosa (we already know about it). The most solid section of the rectum is the final one, in which the arteries and veins do not branch out to the smallest capillaries, but stretch directly to the so-called anal columns. From this, cavernous bodies are formed in the rectum, located under the mucous membrane. These bodies are also called cavernous.

When a person develops hemorrhoids, it is these cavernous bodies that swell and cause pain reflexes in a person, sometimes unbearable. This is the anatomical features of the rectum.

Why do bumps appear in the anus with hemorrhoids?

And this is just swell cavernous or cavernous bodies. They are pierced with many tiny wreaths that look like bunches of grapes. When blood accumulates in them, the "grapes" swell and increase. Approximately the way the phallus swells during an erection. And then the walls of these cavernous bodies cannot withstand the influx of blood and can burst, be damaged, stretch, and, of course, hurt a lot.

Then the person complains of bleeding from the anus. To avoid or stop it, anti-inflammatory drugs are needed that will remove the inflammatory process in the cavernous bodies, and at the same time pain. In the meantime, you need to remember that when hemorrhoids occur, the blood from the anus is not dark, but scarlet, because in the cavernous bodies it is just that because of the accumulation of oxygen.

The role of the cavernous bodies

Their role is not only to give us trouble when hemorrhoids attack the body. How long have doctors not studied the human body, they have not yet fully understood what roles the cavernous bodies perform, except for the accumulation of blood. It is known that they help the sphincter to hold stool, performing an additional function of clamping.

Cavernous bodies, like the appendix, are like a vestige in the human body. They are found even in babies who have just been born, so the body needs them, maybe even for those roles that we still don’t know about.

Nerves of the rectum

There are a lot of nerve endings in the rectum. Like spies that form their network, the fibers of the parasympathetic and sympathetic nervous system are located in it. This is how nature conceived anatomically, since there are many reflexogenic zones in the rectum, and signals are transmitted through these zones from the cerebral cortex.

When a boy or girl is born, their rectum is cylindrical, has no folds or ampulla, and the folds of the intestine are not very pronounced.

The length of the rectum of a newborn child is up to 6 cm, at least 5 cm. The anal columns of small children are very well developed. The ampulla completes its formation before the age of 8 years. And then the rectum forms bends. When a child reaches 8 years old, not only bends are formed in the rectum - it generally begins to grow very quickly, lengthen and by the age of 14 becomes more than three times longer - from 15 to 18 centimeters. And the diameter of the rectum in adolescence is from 3.2 cm to 5.4 cm.

When a person gets older and reaches the age of 50-60 years, his rectum lengthens even more, the curves are no longer so clear, lose their direction, and the rectal mucosa becomes much thinner. At the same time, the cavernous (cavernous) bodies become thin, empty, so hemorrhoids in men and women over 60-65 years old are very rare.

The job of the rectum to remove toxins

When the rectum works, it ensures the functioning of the digestive system as a whole. The rectum does the job of eliminating toxins from the body and all unnecessary substances that are no longer needed there.

When a lot of unnecessary toxins accumulate in the rectum, they need to be removed from there. And if the rectum does not work normally, these rotten and fetid masses will accumulate there, poisoning the entire body. That is why it is so important that the rectum is healthy and performs all its functions of evacuating substances that are unnecessary to the body.

Statistical role of the rectum

There are main roles of the rectum. There are two main roles. One is static, the other is dynamic. The statistical role of the rectum suggests that it will accumulate and retain intestinal excrement.

If the stool is normal, it will be a uniform brown color. It is dense, shades of brown can vary. Normal stool contains 30% food debris and 70% water. Among the remnants of food are intestinal epithelial cells along with dead bacteria. The mass of feces of a healthy person per day will be no more than 350 grams.

As stool builds up in the rectum, it can become wider and the folds of the rectum (its mucosa) straighten out. Feces are held in the rectum by means of the anal sphincter, because the walls of the anus are tightly compressed. The anal sphincter is designed so that the contents of the intestine do not fall out of it on their own and gases are not released involuntarily.

sphincter strength

The anal sphincter is a very powerful and strong muscle. Scientific studies prove that in a healthy person the sphincter strength is such that at rest it reaches 550 grams, and when it contracts, this force increases to 850 grams at maximum contraction.

When a person is concerned about hemorrhoids or other diseases of the rectum, this is immediately reflected in the strength of the sphincter. It becomes almost four times weaker - its compression force reaches only 200 to 300 grams instead of 850. And then the contents of the intestine can come out spontaneously, and this happens during the most common household activities - coughing, squatting, laughing, sneezing, simple walking . In addition to feces, gases, liquid feces do not hold in the rectum, and this unpleasant process is constant - as long as the rectum is unhealthy.

The dynamic role of the rectum

This role is no less important than the first - statistical. It is characterized by the peculiarity of the rectum to evacuate out of the body what it does not need: feces, foreign substances. Namely, due to the dynamic function of the rectum, a person is able to defecate. This is a rather complex physiological reflex process, which Academician Pavlov wrote about. He spoke in his lectures that the need for a bowel movement can be known through signals from the sensory nerves of the rectum.

This means that when the walls of the rectum are irritated by the feces that have accumulated there, there is a signal through the reflex endings that it is time to evacuate them from the rectum.

Sometimes it happens that a person feels the urge to evacuate feces from the rectum when it is empty. This means that there are failures in its work. For example, with diseases such as ulcerative colitis, hemorrhoids, infections that have penetrated the intestines.

Muscles involved in defecation

Muscle fibers play the most direct role in the process of defecation. These muscle fibers are located on the walls of the intestine. They are joined by the abdominal muscles, which we so stubbornly do not want to pump. But in vain: this would significantly strengthen the body, since human health depends on the success of the defecation process.

How does defecation happen?

When the process of defecation begins, a person inhales deeply, this closes the glottis, and the sphincter of the anus weakens its press, relaxes, while the abdominal press tenses. If the abdominal press is weak, a person will not be able to perform a normal act of defecation, he strains for a long time, feces from the rectum may go weakly.

When a person takes a deep breath, the diaphragmatic muscle goes down, from this the abdominal cavity contracts, decreases in volume. At this time, a lot of pressure is created in the abdominal cavity, and feces are ejected through the anus. The pressure is so strong that it reaches 220 mm of water column pressure, which is more than one and a half times higher than the level of blood pressure created by the blood flow.

Patterns of the act of defecation

The process of defecation, like any other processes occurring in the body, has its own patterns. Scientists tracked these patterns and found that there are two types of defecation: one-stage and two-stage.

During a single bowel movement, the rectum is able to eject its contents in one go. If the defecation is two-stage, then the feces are thrown out by the intestines not at once, but in parts. This may take three to seven minutes. So, with a two-moment ejection of feces, a person is forced to stay in the toilet for more than seven minutes, because during the first act of ejection of feces, he remains with the feeling that the process is not finished.

Both the first and second types of defecation are normal and characteristic of a person - these are just anatomical features that do not pose a health hazard, given the properties of their contraction.

Prolonged defecation

It happens that a person cannot defecate for more than 15 minutes. Then the process is delayed up to half an hour. All this time, a person is trying to forcefully push the stool out of the rectum.

Instead of waiting, waiting for the next contraction of the intestinal walls and pushing out the feces in a period of 7-15 minutes, the person begins to panic and push them out, pushing. And then the constant tension in the abdominal press causes overvoltage in the veins of the rectum, in particular - in the already familiar to us cavernous (cavernous) bodies.

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Statistics on types of defecation

Studies show that up to 70% of people experience a single bowel movement. Then a two-stage defecation is experienced - there is no other way to put it - up to 25% of people. The rest of the people make a defecation of a mixed type.

There are exercises that allow a person to achieve a one-time, most convenient type of bowel movement for them. How to do them, you need to consult a proctologist.

As for patients with hemorrhoids, up to 90% of them suffer from the fact that they have a two-stage type of defecation. They need to be especially careful during bowel movements and use the natural processes inherent in the rectum, that is, the time of its contraction.

Why self-medication is dangerous

Often a person does not pay attention to the type of his bowel movement and considers it just a simple inconvenience, not suspecting that it causes irreparable harm to his body.

If a person suffers from constipation, if he develops hemorrhoids, you should not self-medicate, because the rectum, with improperly selected methods, can become cracked from the inside or outside, bleeding can occur from swollen cavernous bodies, there may be a danger of retention of feces in the rectum and poisoning body with toxins. It is not necessary to neglect these symptoms and go to the clinic at the first sign of pain and discomfort in the rectal area.