ENKOPRYoZ (encopresis; Greek kopros of kcal; a synonym an incontience a calla) — the dysfunction of a rectum and a sphincter of an anus which is shown involuntary defecation.
Normal keeping of contents of a rectum is carried out by the muscles squeezing an anus, among to-rykh the major role belongs to the outside sphincter providing any short circuit, and internal which tonic is closed. A part in strengthening of function of proctal sphincters is played by the muscles lifting an anus. Function of proctal sphincters is regulated by the centers of an innervation located in a head and spinal cord and also in distal department of a large intestine. Defeat of one of these centers leads to an enkoprez.
Damage of muscular tissue and mucous membrane of a gut as a result of an injury, inborn malformations of anorectal area (see the Rectum), various inflammatory diseases of intestines reducing sensitivity of a receptor zone and increasing motility of a large intestine, napr, nek-ry forms of colitis (see), dysentery (see), cholera (see), tumors in a small pelvis, disturbance of the central or peripheral innervation of a rectum, napr at spina bifida (see), inborn syphilis (see) and
DR-E can be the reasons of defeat. it can be observed at patients with mental disturbances — more often at various forms of an oligophrenia (see) and dementias (see Weak-mindedness). Special version E. the so-called bear disease — the rough vegetative reaction to action of an extraordinary psychoemotional irritant which is characterized by a sudden involuntary liquid chair is.
Establishment of the reason E. demands comprehensive examination of the patient. At survey determine the size of an anal orifice, its form, deformations of skin in perianal area, cicatricial changes of skin of a crotch and a rump. At the same time investigate a proctal reflex: apply with a stupid needle shaped irritations on skin of perianal area, big vulvar lips, a root of a scrotum and determine expressiveness of a proctal reflex by extent of reduction of an outside sphincter of an anus (it is raised, live, it is weakened, is absent). Determine by a manual research a tone and strong-willed reduction of a proctal sphincter and the muscles lifting an anus. Make the rector about a manoskopiya for an exception of various diseases of a rectum and distal department of a sigmoid gut (see). With the same purpose, and also for an exception of various defeats of pelvic bones and a backbone (splitting of handles of vertebrae) carry out rentge-nol. researches. Special functional researches are of great importance for objective assessment of a condition of the locking device of a rectum. For definition of a condition of separate mechanisms of intestinal deduction it is necessary to investigate by means of a sfinkteromet-riya sokratitelny ability of a proctal sphincter — a tone, the maximum force and strong-willed effort (see the Rectum, Sfinkte-rometr). Apply the electromyography (see) allowing to estimate activity of outside and internal sphincters, to define border of muscular tissue, the hems and muscles lifting an anus, to define a functional condition of muscles of a crotch to functional assessment of safety of muscular tissue and its innervation. It is possible to determine pressure in the proctal channel in the field of an arrangement of outside and internal sphincters by manometrical methods of a research, the threshold of a rekto-proctal reflex and other data characterizing a condition of proctal sphincters and the receptor device. The method of a dilatometriya allows to estimate distensibility of a proctal sphincter.
Distinguish conservative and operational methods of treatment E. Conservative treatment is shown in the absence of rough organic damages of the locking device of a rectum and includes drug treatment, psychotherapy, physiotherapeutic procedures, physiotherapy exercises.
At drug treatment use the strychnine in pills stimulating sokratitelny ability of an intestinal wall and recovering a tone of a proctal sphincter, and also prozerin in subcutaneous injections. Besides, appoint ATP, vitamins of group B and polyvitamins. At patients with a hyperexcitability of a nervous system use of tranquilizers (see) and sedatives is shown (see). The psychotherapy shall be directed to creation and fixing of a conditioned reflex on the place and a situation, in to-rykh the patient can make the act of defecation. Hypnotherapy is applied seldom. For elimination of a functional incontience of intestinal contents use physiotherapeutic treatment. For the purpose of increase in a tone of a proctal sphincter and sokratitelny ability of a muscular wall of a rectum apply electro stimulation (darsonvalization with a rectal electrode). At an enkopre-za with the raised threshold of stimulation of a rectum, and also at the general restrictions to electrotreatment electrostimulation is contraindicated. The hydrotherapy is used more often in the form of a perineal shower, sedentary or general heat baths, and mud cure — in the form of mud tampons, applications, bathtubs and mud enemas, Favorable results allows to lay down. the physical culture against the background of fortifying to lay down. gymnastics, in particular a training of a proctal sphincter across Dukhanov. Through an anus enter the rubber tube greased with vaseline on depth of 6 — 8 cm into a rectum and offer the patient according to the command to squeeze and weaken a proctal sphincter. Spend daily by the 5th duration of sessions ot3 up to 10 — 15 min., in process of recovery of function of a proctal press number of sessions reduce to 1 — 2 times a day. Trainings continue within 3 — 8 weeks. Along with it it is necessary to carry out the exercises strengthening muscles of a prelum abdominale, a rump and adductors of a hip.
Surgical correction is shown to patients with organic lesions of the locking device of a rectum. The type of an operative measure depends on size and localization of defect, prevalence of cicatricial process. Apply various reconstructive operations directed to recovery of the damaged sphincter of an anus, its plastic substitution by sites of the next muscles, napr, the muscle lifting an anus (sfinkte-rolevatoroplastika) or a big gluteus (sfinkteroglyu-teoplastik). In nek-ry cases at major defects of a sphincter plastic surgeries make after temporary shutdown of a passage a calla through a rectum by imposing of a kolostoma (see. To an olostomiya).
At the majority of forms functional y organic insufficiency of a sphincter of an anus, defiant E., as a result of correctly chosen complex treatment it is possible to eliminate completely enkoprez or to considerably improve functions of a sphincter. At the enkoprez caused by mental disturbances at patients with an oligophrenia or the acquired weak-mindedness the forecast concerning recovery of function of a sphincter adverse.
Bibliography: Aminev A. M. Guide to a proctology, t. 4, page 240, Kuibyshev, 1979; Ya. A Gypsophilas. Some data on intra rectal pressure, Klin, hir., No. 10, page 51, 1964; JI e N yu sh-to and A. I. Proktologiya's N of children's age, page 362, M., 1976. A. M. Koplatadze.