File:Gynecological diagnosis (1910) (14798113703).jpg

Identifier: gynecologicaldia00burr (find matches)
Title: Gynecological diagnosis
Year: 1910 (1910s)
Authors: Burrage, Walter L. (Walter Lincoln), 1860-1935
Subjects: Women
Publisher: New York, London, D. Appleton and Company
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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e size of the lesion and is described as a burning, aching, andthrobbing sensation just within the anus. It begins while thefeces are being passed (it may be delayed for half an hour) andlasts from half an hour to six or eight hours, to return when thenext motion of the bowels takes place. The patient is induced toput off defecation because of the discomfort and thus the fissure isaggravated. The spasm of the sphincter causes great pain andalso interferes with defecation, besides diminishing the diameterof the fecal mass. 504 DISEASES OF THE RECTUM Diagnosis.—Inspection shows a fissure, when the buttocks arewidely separated, and the skin of the anus is apt to be redundantand thrown into exaggerated folds in these cases. The externalsphincter is palpated to detect abnormal thickening or induration,and when the patient is asked to strain down, the amount of spasmof the sphincter may be estimated, the straining causing pain inthe fissure. Discharge from the fissure, small in amount and
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Fig. 194.—Fissure in Ano. (Tuttle.) non-purulent, is to be looked for. Digital exploration of the rectumshould be made, with an anesthetic if the pain is too severe, prep-arations being made at the same time to treat the suspectedfissure, so that only one anesthetization may be necessary. Theulcer is felt as a roughened patch in the smooth mucosa of the analcanal.If the situation of a fissure can be determined, the finger should INFLAMMATION OF THE RECTUM 505 be pressed against the opposite wall to cause as little pain aspossible. The spasmodic contraction of the sphincters and leva-tores ani is now apparent and feces are apt to be found in therectum. The rectum should be cleared by enema and further ex-amination made. The complications of anal fissure, such as polypi,piles, and blind internal fistula, are generally situated in the lowestpart of the rectum. Unless the patient is anesthetized it is notwise to pass the proctoscope in the case of fissure, because of thegreat pain cause

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