DIGESTIVE DISORDERS – Anal complaints – Seat (of) disease
People often suffer from anal complaints when they suffer from digestive disorders. It can also happen vice versa. To understand all about anal complaints, everyone should know about the anus and its functions. Any complaint of the anus makes everyone restless and won’t let them take their seat. Also, most of the anal complaints are left untreated or maltreated due to shyness or shamefulness to discuss/show the thing. For example, people may complain of pile mass in anus, but it may actually be a residual of fissure (sentinel pile – skin tag of linear crack). Likewise, some others may complain of pus discharging boil near the anus, but actually it may be an opening of fistula (tunnel passage from anal canal).
For normal good defecation, a good digestion is ultimately necessary i.e. all the way starting from the mastication of food in the mouth. Our digestive tract starts from the mouth (entry door of food) and ends in the anus (exit door). Any food which enters the stomach needs to pass through the coiled small intestines, where most of the nutrients get absorbed. For getting the nutrients and water absorbed, food passes slowly through this long route by swaying motion of the intestines. After reaching the caecum (first part of the large intestine), food has to ascend with ascending colon and arches left with transverse colon and descend with descending colon of large intestines. Finally it will enter the rectum and anal canal to get expelled.
Anus – is the external opening of the anal canal through which faeces (waste product of digestion) are evacuated. It is guarded and controlled by the anal sphincters.
Anal canal architecture
The anal canal is about 3.5 cms long and it starts from the lower end of the rectum and ends in the anus’ opening. The walls of the anus are well guarded with sphincter muscles which always keep it closed, except during defecation. It is also designed in such a manner to control the release of air (flatus) and watery stools i.e. airtight and leak proof.
The anal canal is anatomically divided into two parts (namely upper part and lower part) by pectinate line (bluish pink ring). These two parts are different from embryonic origin, i.e. the upper part is originated from endoderm and it is covered with mucous membranes like covering of the oral cavity. It will be pink or reddish in colour. This upper anal part is supplied by autonomic nervous system and doesn’t have pain sensitive nerve fibres. So, it responds only to fullness and tightness of intestines. The lower part of the anal canal originates from the ectoderm and is covered by skin. It is usually brown or pale white in colour. Unlike the upper part, it contains sebaceous glands, sweat glands and cutaneous pain sensitive spinal nerves like normal skin.
Defecation – The act of passing stool is called defecation. Defecation is aided by the rectum and anal canal. Defecation can be initiated by increasing abdominal pressure, straining at rectum and anal canal, mind, habits, etc. Anus with brain control controls the defecation process accordingly by time, place and circumstances. The waste products, called faeces, which are excrement discharge of the bowels, are expelled through the anus. The intestines usually secrete, excrete and absorb. But the rectum and anal canal have less work in dealing with this digested food. The absorption of water and minerals are low or very little in the rectum and anal canal.
Normal faeces usually have a water content of 60-70 per cent, fat 15-20 per cent, nitrogen 4-5 per cent, inorganic materials 10-20 per cent. The bile pigments colour the stool as brown or yellow. If the content of fat in the stool is more, it makes it pale and to float. The bile pigments and other wastages are usually excreted through faeces. So even during fasting, a small quantity of faeces will be passed on.
Importance of defecation – Defecation is discharge or evacuation of bacteria-rich faeces from the body. It is very much important in letting out the waste and unwanted toxic substances from the digestive tract to avoid toxicity. Everyone would have heard of headache, abdominal discomfort, poor appetite, sensation of vomiting, etc., when there is defective defecation. For getting energy, continuous support or intake of food is necessary, but if the stool is impacted or stagnated due to defective digestion and assimilation, then the process will make any one to reduce/avoid intake of food.
Dysfunctions causing anal complaints
Constipation is infrequent and inadequate defecation without satisfaction. It may be due to
- Failure in developing habits
- Controlling the urge for a prolonged period
- Low fibre foods with more spices and chillies
- Liver disorders with defective digestion
- Drugs impairing digestion
- Defective expulsion due to nervous disorders or nerve damages
Diarrhoea is commonly called increased motility of the bowels resulting in frequent evacuation of watery stools with uncontrollable purging. While caring for loss of minerals, the strain of the anus should also be considered. Forcible expulsion of diarrhoea from laxatives or enemas can cause anal complaints like piles and prolapse.
Incidences – One who deviates more from nature in diet, living and sitting habits will usually suffer with anal complaints. Anal problems are rare in children due to their bland diet, unless pathological. The incidence of anal complaints increases with age factor and occurs more commonly in the 20 to 30 age group. Females suffer more commonly than males. Sufferers are mostly
- Travellers who sit for long
- Sedentary workers
- Lovers of chillies and spices
- One who have is prone to constipation
- One who has or is prone to diarrhoea
- Sufferers of liver disorders
Other suspected reasons for development of anal complaints
- Erect posture of man – The evolution of man from an animal on four feet to a human being on two feet is considered one of the main causes for anal complaints, when compared to other animals
- Hereditary – development of piles is often noted to run in families
- Physiological – Pregnancy and delivery can cause increased venous pressure and weakness of the anal canal, so piles or constipation can occur
- Physical strain – exerting while passing stool, coughing, weight lifting, etc., can cause piles, prolapsed anus, etc.
- Pathological – pelvic and rectal tumours, liver and portal vein disorders can cause piles
- Infections in skin and mucous membranes of the anal canal can cause boils and proceed to fistulas
- Blood vessels – due to valvular damage or back flow or resistance pressure exerted by obstruction or disease can cause dilatation of blood vessels
- Ligaments – defective support of anal canal can cause prolapsed anus
- Worries and mental strain can also cause havoc to intestines and anus
Diagnosis & investigations – Diagnosis of anal complaints can be easily made on examination of the anus with finger palpation / proctoscope / sigmoidoscope / endoscopy / barium meal X-ray / biopsy / stool examination, etc. Other than anal complaints, anal examination is also done to detect prostate enlargement in males and to detect the changes in consistency of the uterus, ovaries, cervix, etc., in females.
Complications – if any complaint is left untreated or maltreated, then danger begins to unfold. Infection, bleeding, extreme painfulness, prolapse and strangulation may occur, complicating in their own way.
Cautions and precautions:
- Move more towards greens and nature
- Don’t be sedentary and sit idle for a long time
- Keep good diet for good digestion
- Take plenty of water
- Take plenty of fruits/fruit juices
- Follow regular bowel habits to avoid constipation and strain
Follow hygienic measures in cleaning and caring
Common complaints often faced in the anus are:
- Piles or haemorrhoids – dilatation of veins of the anal canal (upper or lower part)
- Fissures – tear in lower sensitive part of anus, which is very painful
- Fistula – tunnel passage developed from boil which gets opened internally into anal canal
- Anal stricture – constriction of the part with the feeling of tightness or compression
- Itchy skin lesions including recurrent boils, since the anus is more prone to bacteria
- Incontinence – defect in controlling or with holding or postponing the defecation process
- Congenital deformities – like miniature anus, imperforate anus
To avoid discomfort, pain, bleeding and unwanted progress of the disease, treatment should be taken at the earliest to heal with all precautionary measures in food, restriction of work/bed rest and juice fasting. Best results are often shown when one reverts to nature in food and habits rather than treatment.
Dr. S. Chidambaranathan, BHMS, MD
24 E. New Mahalipatti Road
Tel: +91-452-233-8833 | +91-984-319-1011
www.drcheena.com / www.drcheena.in
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(Disclaimer: The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)