STUDY - Technical - New Dacian's Medicine
Rectal
pain (Classical / Allopathic Medicine)
A
common symptom of anorectal disorders, rectal pain is
discomfort that arises in the anal-rectal area. Although
the anal canal is separated from the rest of the rectum by
the internal sphincter, the patient may refer to all local
pain as rectal pain.
Because the mucocutaneous border of the anal canal and the
perianal skin contains somatic nerve fibers, lesions in
this area are especially painful. This pain may result
from or be aggravated by diarrhea, constipation, or
passage of hardened stools. It may also be aggravated by
intense pruritus and continued scratching associated with
drainage of mucous, blood, or fecal matter that irritates
the skin and nerve endings. Other possible causes of
rectal pain include rectal trauma and the presence of a
foreign object.
HISTORY:
Ask the patient to describe the pain. Is it sharp or dull? Is it burning or knifelike?
Ask the patient how often the pain occurs and whether anything alleviates or aggravates the pain.
Ask the patient if the pain is worse during or immediately after defecation.
Review the patient's medical history for rectal trauma.
Ask the patient about associated signs and symptoms such as bleeding. Also, ask the patient whether he has noticed other drainage, such as mucous or pus, and whether he's experiencing constipation or diarrhea.
Ask the patient to describe the pain. Is it sharp or dull? Is it burning or knifelike?
Ask the patient how often the pain occurs and whether anything alleviates or aggravates the pain.
Ask the patient if the pain is worse during or immediately after defecation.
Review the patient's medical history for rectal trauma.
Ask the patient about associated signs and symptoms such as bleeding. Also, ask the patient whether he has noticed other drainage, such as mucous or pus, and whether he's experiencing constipation or diarrhea.
PHYSICAL
ASSESSMENT:
Inspect the anal area for rectal bleeding, and abnormal drainages such as pus, foreign objects, or protrusions, such as skin tags or thrombosed hemorrhoids.
Observe the area for inflammation and other lesions. A rectal examination may be necessary.
Inspect the anal area for rectal bleeding, and abnormal drainages such as pus, foreign objects, or protrusions, such as skin tags or thrombosed hemorrhoids.
Observe the area for inflammation and other lesions. A rectal examination may be necessary.
SPECIAL
CONSIDERATIONS:
If rectal pain results from prolapsed hemorrhoids, apply cold compresses to help shrink protruding hemorrhoids, avoid thrombosis, and reduce pain.
If rectal pain results from prolapsed hemorrhoids, apply cold compresses to help shrink protruding hemorrhoids, avoid thrombosis, and reduce pain.
PEDIATRIC
POINTERS:
Observe a child with rectal pain for associated bleeding, drainage, and signs and symptoms of infection (fever and irritability).
Acute anal fissure is a common cause of rectal pain and bleeding in children, whose fear of provoking the pain may lead to constipation.
Infants who seem to have pain on defecation should be evaluated for congenital anomalies of the rectum.
Consider the possibility of sexual abuse in all children who complain of rectal pain.
Observe a child with rectal pain for associated bleeding, drainage, and signs and symptoms of infection (fever and irritability).
Acute anal fissure is a common cause of rectal pain and bleeding in children, whose fear of provoking the pain may lead to constipation.
Infants who seem to have pain on defecation should be evaluated for congenital anomalies of the rectum.
Consider the possibility of sexual abuse in all children who complain of rectal pain.
AGING
ISSUES:
Because elderly people typically underreport their symptoms and have an increased risk of neoplastic disorders, they should always be thoroughly evaluated.
Because elderly people typically underreport their symptoms and have an increased risk of neoplastic disorders, they should always be thoroughly evaluated.
PATIENT
COUNSELING:
Teach the patient how to give himself a sitz bath. Stress the importance of following a proper diet to maintain soft stools and thus avoid aggravating pain during defecation.
Teach the patient how to give himself a sitz bath. Stress the importance of following a proper diet to maintain soft stools and thus avoid aggravating pain during defecation.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.