Swelling of the sphincter
The causes of disruption of the sphincter. Causes of an incontinence of a feces.
Some patients with functional violations of the act of defecation enters the surgical departments for treatmentthe root causes of these disorders. These include patients with congenital defects of innervation of the pelvic organs, as well as patients with damage to the brain and especially the spinal cord.
Permanent incontinence without the hope of improvement is in children,born with low spinal hernia - spina bifida lumbalis operta. Hernial protrusion in such children is covered only by a transparent, white shell of the type of the varton jelly of the navel of the newborn. Through this shell there are spinal fluid and floating in it roots of the horse's tail. One or more rootlets can be soldered from the inside to the belly.
If the child is left without surgical help. then on day 3-6 the belly coat is perforated, the cerebrospinal fluid becomes infected. The child dies in the coming days.
Consequently, newborn with open cerebrospinal herniaoperate in the first 2-3 days of life. The protein coat is removed. Soldered nerves with it are cut off at the place of attachment to the shell. These nerves normally had to innervate the lower extremities or pelvic organs, and they were underdeveloped, so, naturally, there are persistent phenomena of violation of the innervation of the relevant areas: various types of congenital paralytic clubfoot of the lower limbs, constant incontinence of intestinal contents and urine.
Skin of the perineal region. gluteal areas of the inner surfacehips, boys - scrotum, always moisturized, hydropic, macerated. Sphincter gaping. In the anus easy to enter one, two and even three near the set fingers. The strength of the sphincter in the study of the Amineva sphincterometer is zero. No methods of physiotherapeutic or surgical treatment can restore the impaired function of the lower extremities and pelvic organs in these patients.
In patients with spinal cord injuries the periphery separates from the cortical centersbrain. The centers of the spinal cord, located below the injury, create conditions for the automatism of the primary reflex arc. Therefore, spastic phenomena predominate in the lower limbs and pelvic organs.
Sphincter of anus is spastically reduced. The patient does not feel the urge to defecate, does not own the abdominal press, and, naturally, can not force through the rigid pulp accumulated stool in the colon. Self-defecation is absent.
Purgation It is produced with the passive participation of thepatient and with the active intervention of external forces. The nurse stretches the anal sphincter several times in the patient and with her finger, and also with a tea or dessert spoon, scoops out dense stool from the rectum. The higher, milder, gruel-like intestinal contents are washed out by repeated siphon enemas. To facilitate the removal of enema water mixed with intestinal masses, it is useful to press a hand on the abdominal wall with light massaging movements towards the small pelvis.
Initial spasm of the sphincter after such daily or every other dayprocedures is replaced by paralysis of the sphincter. But in the future, as Pavlov said about this, collateral paths of vegetative innervation develop. To some extent, the strength of the abdominal press is restored, and in many patients, even with a complete spinal cord break, an independent, arbitrary defecation is possible.
Violation of the cortical center of defecation occurs with congenital underdevelopment of the centralnervous system in microcephalus, idiots and debility children. They physiological evacuation of the intestine in the underwear in early childhood turns into pathological incontinence of a later age with the constant untidiness of such children. Various mental illnesses in adults and in the elderly are also often accompanied by incontinence and extreme untidiness of these patients.
They also include patients elderly and senile age. in whom, due to general weakness, senility, senile psychosis, the strength of the sphincter of the rectum can be so reduced that partial or complete incontinence of intestinal contents occurs.
A. Ya. Dukhanov in a small monograph "Incontinence of feces in children "(1950) does not divide encomrez into a functional andorganic. Apparently, he always dealt with functional incontinence of stool in all cases. He noted that incontinence affects children under 18 years of age, both sexes, but more often boys. According to our observations, out of 30 children under the age of 16 who suffered from incontinence, there were 18 boys and 12 girls.