PROCTITIS 215 



copious quantities are ejected from the rectum. In severe 

 forms, due to poisons, infections, etc., the epithelium becomes 

 desquamated, and quantities of it will become loosened from 

 the submucosa. Further, when due to injuries, the lesions 

 are usually confined to the lower part of the rectum, and 

 depend upon the extent of injury. 



Symptoms.— Difficult and painful defecation with frequent 

 attempts at defecating and only a small quantity of feces 

 being passed. The feces are streaked or covered with blood. 

 Edema of the mucosa, which can be seen slightly pouching 

 out through the anal opening. Direct examination reveals 

 the painful, inflamed mucous membrane. Digital examina- 

 tion produces severe pain. Through the rectal speculum the 

 mucous membrane will be found highly congested, swollen 

 and the surface covered with dark, bloody fecal matter. 



Diagnosis.— This is not difficult as a direct examination 

 will readily detect the inflammatory condition. 



Prognosis.— Usually favorable when localized in the rectum. 

 However, a careful examination should be made of the other 

 portions of the digestive tract before a positive prognosis is 

 made. It depends also somewhat upqn the cause and the 

 extent of injury to the mucosa and the adjacent structures. 



Treatment.— The cause should first be found if possible, 

 and removed, to prevent further injury and irritation to the 

 mucous membrane. 



Rectal injections of mild astringent and antiseptic solutions 

 (alum 1-2 per cent., boric acid 2 per cent.) are indicated. 

 These should be introduced with a syringe having a blunt, 

 well rounded nozzle, and the injection made slowly only a 

 small quantity at each time. The fluid should be at or near 

 the body temperature to avoid straining. 



Tincture of opium is indicated as an injection when pain 

 is severe, to allay irritation and to prevent straining. A 

 solution of one part tincture opium to thirty parts water will 

 be found useful for this condition. This injection should be 

 repeated as often as necessary. 



In some cases it is advisable, where irritants are sus- 

 pected of being present, to irrigate the rectum with warm 

 water or a bicarbonate of soda solution (2 per cent.). 



