CLINICAL FEATURES OF RECTAL DISEASE Symptoms

CLINICAL FEATURES OF RECTAL DISEASE Symptoms

Rectal diseases are common and can occur at any age. The symptoms of many of them overlap. In general, infl ammatory conditions a ff ect younger age groups, while tumours occur in the middle-aged and elderly . Summary box 79.2 Main symptoms of rectal disease /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF Bleeding This is often painless and bright red in colour and should be carefully investigated at any age. A l t e r e d b o w e l h a b i t Early morning stool frequency (spurious diarrhoea) is a symp- tom of rectal carcinoma, while blood-stained, frequent, loose stools characterise the infl ammatory diseases.

Fresh bleeding per rectum Tenesmus Altered bowel habit with Prolapse loose stool Proctalgia (pain) Mucus discharge

Mucus and pus are associated with rectal inflammation. Tenesmus Often described by the patient as ‘I feel I want to go but nothing happens’, this is normally an ominous symptom of rectal cancer, but can occur with other rectal conditions and is a common symptom of rectal prolapse. Prolapse This usually indicates either mucosal or full-thickness rectal wall protrusion from the anus. Internal prolapse or intussus- ception refers to a telescoping of the rectum into itself without protrusion from the anus. Pain: ‘proctalgia’ This is usually a severe and episodic pain resulting from spasm of the levator ani muscle. It may last for a few seconds to minutes then recur, or it can be constant (see Chapter 80