Complications
Forceful expulsion of hard stool through an incompletely effaced anal sphincter leads to trauma and anal mucosal injury, causing a fissure.
With repeated injury there may be incomplete healing, leading to a chronic fissure.
Treatment consists of topical ointments of 2% diltiazem, corticosteroid preparations, and local anaesthetic preparations.
The pathogenesis has been hypothesised to be due to excessive straining over a period of several years leading to damage to the conjoining ligament of Treitz and to loss of connective tissue that supports the endovascular cushions, leading to haemorrhoid formation.
Treatment consists of: avoiding excessive straining; sitz baths; topical therapy with corticosteroid and anaesthetic preparations; banding; or surgery.
Impaired sensation, hard stools, psychological problems, and drugs that impair sensation or motility may lead to faecal impaction.
Treatment consists of stool disimpaction with enemas, suppositories, large volume polyethylene glycol (PEG) solution (macrogols), stimulant laxatives, or manual disimpaction with sedation may be required.
Excessive push effort over prolonged periods of time may lead to anterior bulging of the rectal wall and ultimately cause a rectocele.
Treatment should focus on treating the underlying dyssynergia and surgical rectocele repair.
Impaired rectal sensation and dyssynergia can lead to faecal seepage.
The underlying pathophysiology should be treated with biofeedback therapy and rectal sensory conditioning.
Excessive straining, digital manipulation, trapping of rectal mucosa in the anal high-pressure zone, rectal hypersensitivity and, most importantly, dyssynergia can lead to solitary rectal ulcer syndrome.
Treatment consists of biofeedback, avoiding excessive straining, or digital disimpaction and laxatives.
Loading and accumulation of stool along with loss of sensation may lead to secondary megarectum and/or megacolon.
Treatment consists of stool disimpaction, sensory training, or vertical reduction rectoplasty.
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