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In 20% of cases, the reason for contacting a proctologist is purulent paraproctitis. It is an inflammatory process in the rectum, accompanied by subcutaneous abscesses, purulent discharge, and pain. The disease poses a threat to the body, with it often fistulas appear. If paraproctitis appears: treatment should be timely. Let us examine in more detail what means and methods are used to eliminate such a pathology.

Paraproctitis - what is it?

Paraproctitis is a tumor - a purulent abscess, which, due to various factors, occurs in the area of ​​pararectal tissue or other tissues located around the rectum (see photo: a - subcutaneous, b - ischiorectal, c - pelviorectal, d - submucosal).

The disease can occur in acute and chronic form. Acute paraproctitis is a disease that is diagnosed by a doctor for the first time. Chronic paraproctitis is a recurrence of acute paraproctitis.

In the acute form of the disease, the patient may feel relief at the time of opening a purulent abscess - in this case, unpleasant discharge (pus, ichorus) will be observed from the anus. However, this entails a complication - the appearance of a hole (fistula), which requires surgical intervention.

Knowing the causes and conditions for the appearance of paraproctitis will help to avoid treatment and get timely help. The main factor causing purulent paraproctitis is infection. Pathogens that contribute to the infection of the tissues of the anus are anaerobic flora, E. coli, etc. Basically, tissue infection occurs due to constipation and hemorrhoids, accompanied by the appearance of cracks on the walls of the rectum or wounds. Through them, the infection enters the body.

The focus of infection can be the mucous membrane of the anal gland, which has crypts - depressions that become inflamed due to exposure to pathogens. Later, the infection passes to the gland itself and to the subcutaneous tissue. Postoperative or accidental trauma to the anus, proctitis, and diabetes can also lead to paraproctitis.

For more information about paraproctitis, the causes of its occurrence and operational measures for the treatment of the disease, see the video:

Symptoms and signs

Purulent paraproctitis appears abruptly and requires immediate treatment. If you find pathological symptoms in yourself, consult a proctologist who will help you cope with the disease. Signs of paraproctitis:

• Intoxication - high fever, general weakness, headache, loss of appetite, muscle aches.
• The stool becomes hard, causing constipation. The patient has numerous ineffectual urges to defecate and pain during it.
• The urinary process is accompanied by pain.
• The patient experiences acute pain in the lower abdomen, near the anus, in the small pelvis.

Localization of inflammation affects the symptoms of paraproctitis. For example, subcutaneous paraproctitis is characterized by redness, pain when sitting, swelling, and seals in the anus.

Other types are more difficult to diagnose, as the process goes deeper, in the subcutaneous tissues. Due to the general signs of intoxication, the patient perceives his condition as influenza-like, begins to be treated on his own, which leads to deterioration and complications. When general symptoms appear, it is important to consult a doctor who will diagnose, prescribe treatment, and perform the necessary surgical intervention.

Forms of paraproctitis

Paraproctitis has different clinical forms. Depending on them, the course of the disease will differ in terms of symptoms, treatment, and severity. Allocate acute, chronic, purulent, subcutaneous and ischiorectal paraproctitis.

Spicy

The acute form of paraproctitis begins unexpectedly, has pronounced manifestations, differs only in the localization of the focus of infection and the type of pathogen. The severity of the disease depends on the immunity of the patient. All common symptoms are present, but treatment is selected individually.

Chronic paraproctitis (fistulous form)

The chronic form of the disease is accompanied by the formation of a pathological passage, which begins in the rectum and ends on the skin of the anus. The fistula is formed after the rupture of the abscess in the subcutaneous adrectal tissue, but basically the pus "punches" its way out, forming an external opening. If the canal drains well, the fluid comes out, the patients do not experience severe pain, but periods of remission are necessarily replaced by exacerbations.

This type of paraproctitis requires surgical treatment - dissection or excision of the resulting fistula.

Purulent

With paraproctitis, a cavity filled with pus is formed. The patient experiences discomfort in the anal area, there is intoxication, swelling, redness of the anal areas. The condition requires immediate treatment to prevent the appearance of a fistula, however, improper surgical measures, on the contrary, will only contribute to its formation.

Subcutaneous

Subcutaneous purulent paraproctitis is characterized by the localization of the abscess near the anus, under the skin of the perineum. Diagnosis is simple, thanks to the manifestations on the skin - swelling, bulge of the place where the abscess is localized, redness.

Ischiorectal

The ischiorectal type of paraproctitis is more difficult to diagnose due to the fact that the abscess is located at the level of the deep layer of the subcutaneous adrectal tissue. During illness, people resort to the wrong treatment on their own, mistaking the symptoms of paraproctitis for a respiratory infection.

Paraproctitis in children and infants - causes

Children's paraproctitis is a rare phenomenon, but does not have any special differences with the disease of adults. Its appearance is facilitated by the disturbed intestinal microflora of the child, an infectious infection, which, as a rule, occurs under external circumstances - wounds or skin irritations. Basically, the pathogenic process is caused by pathogens staphylococci.

Operating methods of treatment

Surgery is an effective method of treatment that helps get rid of paraproctitis. In this case, the surgeon opens the purulent inflammation, drains the area, eliminates the source of infection. This procedure cannot be performed under local anesthesia, so general anesthesia or epidural anesthesia (drugs are injected into the epidural spine) is mainly used. If after the operation there is no deformation of the walls, and the fistula does not appear, the patient recovers completely.

By itself, a fistula (fistula) occurs during the chronic form of paraproctitis. Therefore, treatment is carried out when the patient has a period of remission and pain does not bother him. However, a long remission period of the chronic form may interfere with the operation - the fistulous course may be "dragged out". After treatment, the patient must comply with preventive measures.

How to treat the disease - suppositories and antibiotics

Antibiotics (metronidazole, amikacin, gentamicin, etc.) are not an obligatory part of the treatment - antibacterial agents are more often prescribed. There are cases when they need to be used:

• The moment after the operation, when the final analysis of the patient's condition was carried out.
• After excision of the fistula in the chronic form of the disease.
• When the patient has an elevated body temperature.

Supportive therapy with suppositories (antibacterial, healing, with antibiotics) is used in the treatment when:

• The patient goes through the postoperative period, for prevention.
• To relieve symptoms if surgery is not possible.
• During the treatment of chronic purulent paraproctitis in children who are under one year old.
• The presence of hemorrhoids, cracks (candles will help the healing of micro-wounds).

Treatment of paraproctitis with folk remedies, without surgery

Folk remedies will help to cope with severe symptoms, promote healing, but it must be remembered that in the treatment of purulent paraproctitis, surgical intervention is always necessary. Useful folk remedies to relieve symptoms are easy to prepare at home:

• Microclysters. Their use requires safety precautions - you need to use pears with a rubber tip lubricated with oil. Insert the tip carefully so as not to cause additional irritation. Before a microclyster, as a rule, they put a regular enema so that the substances work better. As a filler, calendula tincture, honey diluted in 100 ml of water is suitable (perform in a course of two weeks).
• Mummy. Ten tablets of the drug must be dissolved in a glass of water, strain. Fill the basin with five liters of warm water, add the mixture, take a bath for 15 minutes.
• Badger fat. Tampons with fat are inserted into the anus at night.
• Rowan. Squeeze half a glass of juice from berries for a day, take 3 times before meals. Apply a compress of squeezed fresh berries to the anus.
• St. John's wort will help from purulent paraproctitis. It is necessary to boil water, add 3 tablespoons of St. John's wort, cook for 15 minutes. Then strain the infusion, and put the hot grass on a rag or cellophane and sit on top of it with the affected area. Sit until cool. After such treatment, the pus will begin to come out on its own.

Diet and disease prevention

Simple preventive measures will make it possible to avoid the appearance of paraproctitis, it is necessary to carefully consider the diseases that cause it - hemorrhoids, diabetes, colitis, constipation. Need:

• take vitamins to strengthen the immune system;
• avoid local and general hypothermia;
• follow a diet, eat foods that do not cause constipation, do not irritate the rectal mucosa;
• do not neglect intimate hygiene.

Video: operation to remove paraproctitis

The video below shows how to treat chronic paraproctitis with an operative method of excision of the resulting fistula:

Paraproctitis is a disease that can cause serious complications. Be attentive to the symptoms of the disease that appear. If you have them, contact your doctor immediately.

If you have experience in the treatment of paraproctitis, leave a comment at the bottom of the page.

Attention! The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment based on the individual characteristics of a particular patient.

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paraproctitis(pararectal abscess) - acute or chronic inflammation of pararectal tissue. It accounts for about 30% of all diseases, the process affects about 0.5% of the population. Men suffer 2 times more often than women, get sick at the age of 30-50 years.

Etiology and pathogenesis. Paraproctitis occurs as a result of microflora (staphylococcus, gram-negative and gram-positive rods) entering the pararectal tissue. With ordinary paraproctitis, polymicrobial flora is most often detected. Inflammation involving anaerobes is accompanied by particularly severe manifestations of the disease - gas cellulitis of the pelvic tissue, putrefactive paraproctitis, anaerobic sepsis. Specific pathogens of tuberculosis, syphilis, actinomycosis are very rarely the cause of paraproctitis.

Ways of infection are very diverse. Microbes enter the pararectal tissue from the anal glands that open into the anal sinuses. During an inflammatory process in the anal gland, its duct is blocked, an abscess is formed in the intersphincteric space, which breaks into the perianal or pararectal space. The transition of the process from the inflamed gland to pararectal tissue is also possible by the lymphogenous route.

In the development of paraproctitis, injuries of the rectal mucosa by foreign bodies contained in the feces, hemorrhoids, anal fissures, ulcerative colitis, Crohn's disease, and immunodeficiency states can play a certain role.

Paraproctitis can be secondary - with the spread of the inflammatory process to pararectal tissue from the prostate, urethra, female genital organs. Injuries to the rectum are a rare cause of paraproctitis (traumatic).

Classification of paraproctitis

Acute paraproctitis.

According to the etiological principle: ordinary, anaerobic, specific, traumatic.

According to the localization of abscesses (infiltrates, streaks): subcutaneous, ischiorectal, submucosal, pelviorectal, retrorectal.

Chronic paraproctitis (fistulas of the rectum).

According to the anatomical feature: complete, incomplete, external, internal.

According to the location of the internal opening of the fistula: anterior, posterior, lateral.

In relation to the fistulous tract to the fibers of the sphincter: intrasphincteric, transsphincteric, extrasphincteric.

Difficulty level: simple, difficult.

Acute paraproctitis characterized by rapid development of the process.

Clinically, paraproctitis is manifested by rather intense pain in the rectum or perineum, fever, accompanied by chills, malaise, weakness, headaches, insomnia, loss of appetite. Extensive phlegmon of pararectal tissue leads to severe intoxication, the development of a syndrome of dysfunction of vital organs, threatening the transition to multiple organ failure and sepsis. Often there is a delay in stool, tenesmus, dysuric phenomena. As the pus accumulates, the pains intensify, become jerking, throbbing. If the abscess is not opened in a timely manner, then it breaks into the adjacent cellular spaces, the rectum, out through the skin of the perineum.

The breakthrough of the abscess into the rectum is a consequence of the melting of its wall with pus in pelviorectal paraproctitis. A message is formed between the cavity of the abscess and the lumen of the rectum (incomplete internal fistula).

When pus breaks out (on the skin of the perineum), an external fistula is formed. The pain subsides, the body temperature decreases, the general condition of the patient improves.

A breakthrough of the abscess into the lumen of the rectum or outside very rarely leads to a complete recovery of the patient. More often a fistula of the rectum (chronic paraproctitis) is formed.

Subcutaneous paraproctitis is the most common form of the disease (up to 50% of all patients with paraproctitis). Characterized by sharp, jerking pains, aggravated by movement, straining, defecation; dysuria is observed. The body temperature reaches 39 "C, chills often occur. On examination, hyperemia, swelling and swelling of the skin in a limited area near the anus, deformation of the anal canal are revealed. Palpation of this zone causes sharp pain, sometimes fluctuation is determined. Finger examination of the rectum causes increased pain. However, it is advisable to carry it out under anesthesia, since this makes it possible to determine the size of the infiltrate on one of the walls of the rectum near the anal canal and decide on the method of treatment.

Ischiorectal paraproctitis occurs in 35-40% of patients. Initially, general signs of a purulent process appear, characteristic of the syndrome of a systemic reaction to inflammation with a sharp increase in body temperature, chills, tachycardia and tachypnea, and a high content of leukocytes in the blood. Along with this, weakness, sleep disturbance, signs of intoxication are noted. Dull pains in the depths of the perineum become sharp, throbbing. They are aggravated by coughing, physical activity, defecation. With the localization of the abscess in front of the rectum, dysuria occurs. Only after 5-7 days from the onset of the disease, moderate hyperemia and swelling of the skin of the perineum in the area of ​​​​the abscess is noted. Attention is drawn to the asymmetry of the gluteal regions, the smoothness of the semilunar fold on the side of the lesion. Soreness on palpation medially from the ischial tuberosity is moderate. Very valuable in the diagnosis of ischiorectal ulcers is a digital examination of the rectum. Already at the beginning of the disease, it is possible to determine the soreness and compaction of the intestinal wall above the rectal-anal line, the smoothness of the folds of the mucous membrane of the rectum on the side of the lesion.

Submucosal paraproctitis observed in 2-6% of patients with acute paraproctitis. Pain in this form of the disease is very moderate, somewhat aggravated by defecation. Body temperature subfebrile. Palpation determines the bulging in the lumen of the intestine, in the area of ​​​​the abscess, sharply painful. After a spontaneous breakthrough of the abscess into the intestinal lumen, recovery occurs.

Pelviorectal paraproctitis- the most severe form of the disease, occurs in 2-7% of patients with acute paraproctitis. Initially, there are general weakness, malaise, fever to subfebrile, chills, headache, loss of appetite, aching pain in the joints, dull pain in the lower abdomen.

With abscessing of the pelviorectal fiber infiltrate (after 7-20 days from the onset of the disease), the body temperature becomes hectic, symptoms of purulent intoxication are expressed. The pains become more intense, localized, tenesmus, constipation, dysuria are noted. There is no pain on palpation of the perineum. The diagnosis can be confirmed by ultrasound, computed tomography or magnetic resonance imaging. Without instrumental studies, it is difficult to make a diagnosis until the purulent fusion of the pelvic floor muscles leads to the spread of the inflammatory process to the ischiorectal and subcutaneous fatty tissue with the appearance of edema and hyperemia of the skin of the perineum, pain when pressed in this area. During a digital examination of the rectum, infiltration of the intestinal wall, infiltration in the tissues surrounding the intestine and its bulging into the intestinal lumen can be detected. The upper edge of the bulge is not reached with the finger.

Retrorectal paraproctitis observed in 1.5-2.5% of all patients with paraproctitis. Characterized by intense pain in the rectum and sacrum, aggravated by defecation, in a sitting position, with pressure on the coccyx. Pain radiates to the thighs, perineum. With a digital examination of the rectum, a sharply painful bulging of its posterior wall is determined. Of the special research methods, sigmoidoscopy is used, which is informative for pelviorectal paraproctitis. Pay attention to hyperemia and slight bleeding of the mucous membrane in the area of ​​the ampoule, smoothing of the folds and infiltration of the wall, the internal opening of the fistulous passage when the abscess ruptures into the intestinal lumen. In other forms, endoscopy is not needed.

Treatment. In acute paraproctitis, surgical treatment is performed. The operation consists in opening and draining the abscess, eliminating the entrance gate of the infection. The operation is performed under general anesthesia. After anesthesia (anesthesia), the localization of the affected sinus is established (examination of the intestinal wall with the help of a rectal mirror after the introduction of methylene blue solution and hydrogen peroxide solution into the abscess cavity). If the breakthrough of the abscess has occurred outward through the skin, then good drainage, as a rule, does not occur.

With subcutaneous paraproctitis, it is opened with a semilunar incision, the purulent cavity is well inspected with a finger, the bridges are separated and purulent streaks are eliminated. A bellied probe is passed through the cavity into the affected sinus and an area of ​​skin and mucous membrane is excised, forming the wall of the cavity together with the sinus (Gabriel's operation). With subcutaneous-submucosal paraproctitis, the incision can be made in the radial direction - from the comb line through the affected anal crypt (the entrance gate of infection) to the perianal skin. Then the edges of the incision are excised, the affected crypt together with the internal opening of the fistula. A bandage with ointment is applied to the wound, a gas outlet tube is inserted into the lumen of the rectum.

With ischiorectal and pelviorectal paraproctitis, such surgical intervention is impossible, since most of the external sphincter will be crossed in this case. In such cases, the abscess is opened with a semilunar incision, its cavity is carefully examined and all purulent streaks are opened, the wound is washed with a solution of hydrogen peroxide and loosely packed with a gauze swab with dioxidine ointment.

With retrorectal (presacral) acute paraproctitis, a skin incision 5-6 cm long is made in the middle between the projection of the tip of the coccyx with the posterior edge of the anus. At a distance of 1 cm from the coccyx, the anal-coccygeal ligament is crossed. The pus is evacuated, the abscess cavity is examined with a finger, separating the jumpers. Using hooks, the posterior wall of the anal canal is exposed, surrounded by the muscles of the sphincter, where the area of ​​the fistulous passage leading to the intestinal lumen is found. The second stage of the operation - conducting a ligature - is performed in the same way as described above.

Chronic paraproctitis (fistulas of the rectum) occurs in 30-40% of all proctologic patients. The disease develops as a result of acute paraproctitis and is manifested by fistulas of the rectum. This happens if there is an internal opening leading from the rectum to the cavity of the abscess. With the formation of chronic paraproctitis, the inner opening of the fistula opens into the lumen of the rectum, the outer one - on the skin of the perineum. Gases and feces enter the fistula from the rectum, which constantly supports the inflammatory process.

The reasons for the transition of acute paraproctitis to chronic are: late appeal of patients for medical help after spontaneous opening of the abscess; erroneous surgical tactics in the acute period (opening the abscess without sanitation of the entrance gate of infection).

The fistula may be complete or incomplete. A complete fistula has two or more openings: internal - on the wall of the rectum and external - on the skin of the perineum. An incomplete fistula has one opening on the wall of the rectum, blindly ending in the pararectal tissue (internal fistula).

The fistula of the rectum, depending on its location in relation to the sphincter fibers, can be intrasphincteric, transsphincteric and extrasphincteric.

With an intrasphincteric fistula, the fistulous canal is completely inside the rectal sphincter. Usually such a fistula is straight and short.

With a transsphincteric fistula, part of the fistulous canal passes through the sphincter, part is located in the fiber.

With an extrasphincteric fistula, the fistulous canal passes through the cellular spaces of the pelvis and opens on the skin of the perineum, bypassing the sphincter.

Clinical picture and diagnosis. The amount of purulent discharge from the fistula is different and depends on the volume of the cavity that it drains, as well as on the degree of the inflammatory process in it. With a wide fistulous passage, gases and feces can exit through it, with a narrow one, a meager serous-purulent discharge. Episodic closure of the fistula leads to impaired drainage of the purulent cavity, accumulation of pus, exacerbation of paraproctitis. Such an alternation of exacerbations and remissions is often observed in chronic paraproctitis, the duration of remissions can reach several years.

Pain occurs only with an exacerbation of the disease, disappearing during the functioning of the fistula. On examination, pay attention to the number of fistulas, scars, the nature and amount of discharge from them, the presence of maceration of the skin. Already with palpation of the perianal zone, it is often possible to determine the fistulous course. A digital examination of the rectum allows you to determine the tone of the sphincter of the rectum, sometimes - to identify the internal opening of the fistula, its size, to establish the complexity of the fistula, its course and features.

Additional information about the localization of the internal opening of the fistula, its course and features, which is necessary for choosing the method of operation, is obtained by introducing methylene blue into the fistula, careful probing of the fistula, fistulography, anoscopy, sigmoidoscopy, endorectal ultrasound.

Treatment. With conservative treatment, sitz baths are prescribed after defecation, washing the fistula with antiseptic solutions, introducing antibiotics into the fistula, using microclysters with sea buckthorn oil, collargol. Conservative treatment rarely leads to a complete recovery of patients, so it is usually used only as a preparatory stage before surgery.

Surgery is a radical treatment for rectal fistulas. The timing of surgical intervention depends on the nature of the course of the disease: in case of exacerbation of chronic paraproctitis, urgent surgical intervention is indicated; in the subacute course of paraproctitis (the presence of infiltrates), anti-inflammatory treatment is carried out for 1-3 weeks, then surgical intervention; in chronic course - a planned operation; in the case of persistent remission, the operation is postponed until the exacerbation of paraproctitis.

Surgical intervention for fistulas of the rectum is carried out depending on the type of fistula (its relationship to the sphincter), the presence of inflammatory processes in the pararectal tissue, purulent streaks, the condition of the tissues in the area of ​​​​the internal opening of the fistula.

With intrasphincteric fistulas, they are excised into the lumen of the rectum. Excision of the fistula is best done wedge-shaped, together with skin and tissue. The bottom of the wound is scraped out with a Volkmann spoon. In the presence of a purulent cavity in the subcutaneous adipose tissue, it is opened using a probe, the walls are scraped off with a Volkmann spoon and gauze turunda with ointment is injected (levosin, levomekol, etc.), a gas outlet tube is installed.

Transsphincteric fistulas are eliminated by excision of the fistula into the lumen of the rectum with or without suturing the deep layers of the wound (sphincter muscles) and draining the purulent cavity.

With extrasphincteric fistulas, which are the most difficult, they resort to various operations, the essence of which is the complete excision of the fistulous tract and the elimination (suturing) of the internal opening of the fistula. For complex fistulas, the ligature method is used. Incomplete fistulas are excised into the lumen of the rectum using a probe bent at a right angle.

Paraproctitis is an inflammatory process that affects the fatty tissue (fiber) surrounding the rectum. This disease is considered as common as hemorrhoids or colitis, however, not everyone knows about it.

According to statistics, men suffer from paraproctitis almost twice as often as women. It is necessary to start treating inflammation immediately and with a specialist. Otherwise, it is likely that the disease will become chronic and the risk of complications will increase.

The disease is characterized by the occurrence of severe pain in the area of ​​the perineum and anus, fever, problems with urination and defecation. Local manifestations are redness and swelling of the anal area, the occurrence of an infiltrate (seal) and later an abscess.

Inflammation and suppuration of the tissues around the rectum occurs due to the penetration of a bacterial infection into them. It follows from the lumen of the intestine and through the glands enters the deeper layers.

Distinguish between acute (first appeared in the patient) and chronic (constantly recurring) paraproctitis. The latter is most often the result of incomplete or completely incorrect treatment of the acute stage.

Causes of acute paraproctitis

As mentioned above, the main cause of this disease is an infection that enters the cell space from the surface of the rectal mucosa. The causative agents of infection are representatives of mixed flora, namely streptococci, staphylococci and E. coli. In extremely rare cases (1-2% of patients), infection can occur due to the addition of a specific infection: tuberculosis, clostridium or actinomycosis.

Bacteria can be very different, but the result of their impact on the body is the same - the development of the disease

In this case, the entrance gates are any wounds, microscopic injuries or scars formed after operations on the mucous membrane.

In addition, there is another way of infection - internal. It includes various chronic human infections, as well as processes such as sinusitis and caries. The causative agents of these diseases follow from the epicenter of inflammation and are transferred to the tissues of the rectum with the flow of blood and lymph.

Predisposing factors

The development of the disease can also contribute to malnutrition, prolonged bed rest of the patient, the presence of one or more chronic diseases. Additional aspects that increase the risk of paraproctitis include:

• weak immunity;
• atherosclerosis;
• diabetes;
• anal fissures;
• unprotected anal intercourse.

In rare cases, if the disease is started, inflammation can cover not one, but several layers of tissue at once and reach the border with the intestines.

Main symptoms

The clinical manifestations of acute and chronic paraproctitis differ very much, so it is very important to know their initial symptoms in order to contact a specialist in a timely manner.

The first signs of acute paraproctitis

The acute phase of the disease, as a rule, is characterized by the usual symptoms of the inflammatory process in the body. These are: fever (up to 38-39 degrees), weakness, muscle and joint pain, loss of appetite. Immediately these symptoms are followed by a violation of the discharge of feces and urine. The patient may have an unnatural desire to defecate, constipation, frequent urination, pain during these acts.

Symptoms of the acute phase largely depend on the location of the inflammatory process. With the subcutaneous form, changes in the affected area can be seen with the naked eye. Around the focus of inflammation, redness and swelling of the tissue is observed, near the anus and directly on the mucous membrane of the anus there is a tumor. As a result of this, the patient experiences very severe pain, which makes it difficult to stand, sit and lead an active lifestyle. Acute paraproctitis most often occurs in the form of subcutaneous inflammation.

Symptoms of submucosal paraproctitis are very similar to the subcutaneous form of the disease. The differences are only in body temperature, which does not rise very much, and not very pronounced pain. The abscess itself is formed in close proximity to the intestines.

Symptoms of acute paraproctitis depend on the location of the abscesses

Quite often, specialists may experience difficulties in diagnosing the pelvic-rectal type of the disease. Its symptoms are absolutely identical to those described above, so doctors sometimes cannot determine the type of illness. There are frequent cases when patients begin to try to get rid of the disease on their own, naively believing that the most common respiratory disease has become the cause of their indisposition. With this form of paraproctitis, the focus is located right in the middle between the muscles of the pelvic floor and the abdominal cavity.

Such inflammation can disturb the patient for up to 2 weeks. During this period, a person feels not only pain in the anus, but also a general deterioration. At the time of defecation, pus and blood may appear in the feces, while their number will gradually increase from day to day. The temperature will decrease, and the pain will subside slightly. All this indicates that the resulting abscess burst into the rectum. If the inflammation manifested itself in the fairer sex, then a certain part of the pus can enter the vagina (and exit the perineum, respectively).

Important: if the abscess did not break into the rectum, but into the abdominal cavity, then this will cause peritonitis. This is in the worst case scenario, if the contents of the abscess linger in the cavity, with a more optimistic purulent mass can quickly leave this area.

Another type of paraproctitis is ileo-rectal. Its main distinguishing symptom is the manifestation of signs of the disease only on the seventh day, before that they will be very weak and easy to confuse with another ailment. If it is on the seventh day that the buttocks become of different sizes, and the skin around the epicenter of inflammation turns red, then it will not be difficult for a specialist to make a diagnosis.

And, finally, the most dangerous type of paraproctitis, which is called necrotic. It is characterized by instant intoxication of the entire affected area and the occurrence of very severe pain, the localization of which covers the entire perineum. At the same time, the patient has cyanosis of the skin, a sharp decrease in pressure and an increase in the frequency of contraction of the heart muscles. Within literally 1-2 days, soft tissue begins to die. Pus in the abscess is not observed, instead, the specialist fixes increased gas formation and necrosis.

This species develops as a result of the penetration of putrefactive microbes into the body:

• fusobacteria;
• clostridia;
• other anaerobic microorganisms.

If the patient decides to open the abscess on his own or the doctor prescribes the wrong course of treatment, then acute paraproctitis transforms into chronic.

You should know: self-medication is prohibited! This will only aggravate the situation and accelerate the process of turning the disease into a chronic one. Along with this, other tumors and other complications may appear in the body.

The first signs of chronic paraproctitis

Chronic paraproctitis is a condition in which there is constant inflammation and the formation of a fistula in the anus (holes in the skin that appeared after the breakthrough of the abscess). Almost always, the form proceeds without pain.

This type of ailment occurs as a result of improperly selected treatment or if the patient turned to a specialist late. The main distinguishing features are:

• the appearance of a fistula on the skin of the buttocks and in the anus;
• severe pain during bowel movements;
• excretion of feces and remnants of pus from;
• the appearance of itching and irritation at the site of the breakthrough of the abscess.

Chronic paraproctitis can be unstable - exacerbations and remissions can alternate with each other, and it is impossible to predict the timing in advance. If you do not start treatment on time, then a neglected ailment will manifest itself in the form of inflammation of the rectum or fecal incontinence.

Advice: do not delay the visit to a specialist, since in case of penetration of pus and bacteria into the fat layer of the pelvis, there is a high probability of death!

During the period of exacerbation of the disease, the patient will experience all the symptoms described above, but during remission, only the discharge of pus with blood from the epicenter of the fistula will become noticeable. If at the same time there is free space in the fistulous canal, then pain will not occur, but when this canal becomes clogged, new abscesses begin to develop, which will eventually lead to the formation of new fistulas. With a strong neglect of the disease, a whole network of fistulous canals appears with one large epicenter. It is in it, as a rule, that the focus of infection is located.

You should know: to let the course of chronic paraproctitis take its course and hope that the disease will pass by itself - to initiate tissue necrosis and the appearance of malignant tumors.

In no case should you start this disease. If the acute form is treated by a specialist doctor at any stage (at the initial stage, of course, it is easier), then serious problems will arise with the chronic one.

Treatment Methods

Modern medicine in the treatment of paraproctitis does not shine with diversity, so the best option is surgery. Before the operation, standard tests are prescribed:

• general blood analysis;
• general urine analysis;
• examination by an anesthesiologist;
• electrocardiography.

General anesthesia is used, the solution is administered intravenously or through a special mask.

During the operation, the doctor opens and cleans the abscess, after which he excises the affected tissue in search of a crypt - the focus of a purulent infection. As soon as it is detected, the specialist cleans the entire excision cavity to avoid the appearance of new abscesses. If the crypt is located deep, then the operation will be more difficult.

A similar method of treating paraproctitis is prescribed if the patient is diagnosed with an acute form of paraproctitis. In chronic cases, surgery is also chosen, but it will necessarily be accompanied by one of the types of conservative therapy, which includes:

• sitz baths after each act of defecation;
• washing the fistula with antiseptics - this contributes to the effective cleaning of the canal and prevents the development of infection;
• the introduction of antibiotics deep into the fistulous canal. It is prescribed only after bacteriological examination of a sample of purulent masses, as this helps to determine how sensitive infectious agents are to different types of antibiotics;
• microclysters with a solution of sea buckthorn oil and antiseptic.

Sea buckthorn oil for the treatment of paraproctitis

Important: All information is presented for informational purposes only and is for reference only. Only a doctor should choose the method of treatment and methods of therapy.

The operation is prescribed immediately, as soon as the doctor has identified paraproctitis. In the case of the chronic form, it will be carried out at the time of exacerbation, since it is quite difficult to detect a purulent focus during remission.

Surgical treatment of the acute stage of the disease is the key to getting rid of the disease

Very often, the operation is carried out with pauses and in several stages. At the first, the abscess is opened and cleaned, which cannot serve as an absolute guarantee of getting rid of the disease. Therefore, after a certain time, the second stage is carried out, during which the doctor removes the affected tissue, glands and sinuses.

If the abscess is not deep and the doctor has accurately determined its location, and also found that the tissue around it is not infected with bacteria, then both stages can be performed in one operation. In any case, the course of treatment of paraproctitis without surgery will not completely get rid of the disease.

All decisions about the operation are made exclusively by the proctologist after a thorough examination and study of the test results. After surgery, the patient is prescribed a course of antibiotics and dressings are made. Recovery usually occurs within 4-5 weeks after surgery. All this time, it is necessary to strictly follow the instructions of the doctor, as this will contribute to the speedy rehabilitation.

Acute paraproctitis is an acute inflammation of pararectal tissue.

Most often it occurs due to the penetration of infection from the rectum through the anal glands, resulting in a focus with purulent contents.

Treatment requires surgery.

Kinds

Acute paraproctitis, depending on the location of its localization, is of 3 types:

• Subcutaneous- located directly at the anus.
• Acute ischiorectal paraproctitis- is located in an area limited by the bones and gluteal muscles, and does not affect other tissues, except for the pelvic floor.
• submucosal-located inside the rectum near the anus.

Symptoms

Acute purulent paraproctitis is characterized by the following symptoms:

• Increase in body temperature.
• Weakness, chills.
• Pain in the rectum, extending to the perineum or pelvis.
• Decreased appetite.
• The presence of seals and redness in the anus.
• Inconsistency in the size of the buttocks.
• Irritability and redness around the anus.

Symptoms depend on the location of the source of the infection and the bacteria that caused it.

If the abscess is closer to the skin, the disease has vivid symptoms and is easy to diagnose.

The most difficult is with deep abscesses, the removal of which requires complex operations.

Diagnostics

Most often, diagnosing paraproctitis is quite simple. The pathology is treated by a proctologist.

In order to make a diagnosis, in most cases, it is enough to interview the patient, visual examination and palpation, during which the doctor can detect an infiltrate of a dense consistency. In addition, there is a thickening of the intestinal walls, their soreness and swelling.

It is most difficult to diagnose paraproctitis with abscesses that are formed deep in the pelvis. In this case, additional instrumental studies of the intestine are required.

With paraproctitis, changes can also be seen in laboratory tests, where there is an increase in leukocytes and an acceleration of ESR.

Causes

Paraproctitis can occur in absolutely any person. In order for an abscess to arise, it is enough to have an inflammatory process in the body. Self-infection through the blood is quite common in this pathology.

However, in most cases, paraproctitis appears against the background of hemorrhoids and anal fissures.. These diseases increase the risk of infection.

Risk factors also include people suffering from diabetes, atherosclerosis, immunodeficiency.

Non-compliance with the rules of hygiene, trauma to the rectal region, anal sex and the presence of inflammatory bowel processes can cause paraproctitis.

Treatment Methods

Currently, the treatment is carried out surgically or conservatively.

However, it is impossible to cure an acute inflammatory process with the help of medicines.. At best, it is possible to stop the infection and relieve inflammation, which is not a reason to refuse surgery.

Only if the abscess is located close to the skin and the pus breaks through, self-healing is possible, which is extremely rare.

The operation for acute paraproctitis is aimed at removing the source of infection with further pumping of pus. In addition, excision of fistulas and passages through which the infection has penetrated is performed. Without these manipulations, abscesses may appear again.

Surgery is performed under general anesthesia.

Treatment after surgery involves:

• Conducting dressings.
• The use of general strengthening drugs.
• antibiotic therapy.
• Wound disinfection.
• Careful hygiene.

Treatment at home after surgery involves the use of antibacterial baths based on chamomile, calendula, sage and oak bark after each bowel movement. Antibiotics may be prescribed. It usually takes 3 to 4 weeks for the wound to heal completely.

Diet and Nutrition

During treatment a person must adhere to a diet aimed at preventing constipation:

• Food should be eaten often, but in small portions.
• High-calorie, fatty, smoked and salty foods should be discarded.
• The diet should be dominated by vegetables, fruits, dairy products, lean meats.
• Alcohol and coffee are contraindicated.

Prevention

In order to avoid acute paraproctitis in children and adults, it is required to treat all inflammatory diseases at the initial stage. After all, absolutely any infection can cause this pathology.

Particular attention should be paid to diseases of the intestines and digestive organs.

An important role is played by the hygiene of the anal area and the rejection of non-traditional sexual intercourse.

Paraproctitis is a disease characterized by purulent inflammation of fatty tissue around the rectum and in the perianal region.

The main reason for its occurrence is the entry of pathogenic bacteria through the anal glands into the surrounding tissues. Paraproctitis can occur in acute and chronic form.

First signs

Paraproctitis develops acutely. The person feels general malaise, headache and weakness. After a short time, there is a growing pain in the rectal area, which radiates to the perineum or pelvis. In this case, there is an increase in body temperature and chills.

The symptoms of the disease and the severity of the pain syndrome depend on the location of the inflammatory process and the nature of the infectious agent.

With the appearance of a purulent formation in the subcutaneous tissue, the symptoms are especially pronounced:

• An abscess is formed, accompanied by swelling of the skin.
• The temperature rises significantly.
• Skin hyperemia.
• There are strong pain sensations.

The severity of the symptoms of paraproctitis, accompanied by tissue edema and the appearance of an infiltrate, is usually observed on the 5th-6th day, but may be earlier. It depends on the individual characteristics of the organism and the bacteria that caused the inflammation.

The most dangerous formations that are located deep in the pelvis. With them, a person is tormented by symptoms:

• Strong headache.
• Fever.
• Increase in body temperature.
• Pain in the joints, lower abdomen, perineum.

Symptoms of paraproctitis in men and women are similar. If the formation is deep in the pelvis, a person will suffer from general malaise for about 2 weeks, after which the pain in the rectal area increases significantly, stool retention and general intoxication of the body are observed.

General symptoms and signs:

Causes

The disease appears due to the penetration of pathogenic bacteria into fatty tissue and tissue from the rectum. Often this is facilitated by anal fissures or other damage to the mucous membranes.

In rare cases, the causes of paraproctitis in men and women are associated with wounds and ulcers that have appeared on the surface of the skin. In men, inflammation of the representative gland can contribute to the disease.

In very rare cases, self-infection is observed when pathogenic bacteria are transferred through the bloodstream from other foci of inflammation.

People who have reduced immunity, diabetes mellitus, atherosclerosis, hemorrhoids and anal fissures are most susceptible to this pathology.

Other causes in women and men are poor hygiene and.

Diagnostics

The disease is treated by a proctologist.

In most cases, visual examination and digital examination are sufficient to make an accurate diagnosis.

To eliminate the risk of complications, women are recommended to visit a gynecologist, men - a urologist.

Treatment Methods

Paraproctitis is treated only surgically, regardless of its form. The operation is carried out immediately after the diagnosis. The task of the surgeon is to open the abscess and drain the cavity.

In addition, it is necessary to excise the course along which the infection spreads. Otherwise, a full recovery will not work.

However, most surgeons do not perform burrow excision due to lack of experience and skills. As a result, only the opening of the infiltrate and the drainage of pus are carried out. This can cause the formation of abscesses in the future or cause the appearance of a fistulous tract.

After the operation, antibiotic therapy is indicated.