The feeling of incomplete defecation refers to the feeling that the stool is not clean during the defecation, and the feeling of defecation after the defecation is finished.
1. Intestinal inflammation and functional diseases
(1) Ulcerative colitis
Ulcerative colitis is a chronic non-specific inflammation of the intestinal tract of unknown cause. The lesions start from the rectum and can spread throughout the large intestine. Mild patients may manifest as increased stool frequency, incomplete defecation, mucus and so on. Colonoscopy is helpful for diagnosis.
(2) Irritable bowel syndrome
Irritable bowel syndrome is a functional intestinal disease. The disease can be divided into diarrhea-type irritable bowel syndrome, constipation-type irritable bowel syndrome, mixed irritable bowel syndrome and indeterminate irritable bowel syndrome. Some patients have clinical manifestations of increased stool frequency, 5-6 times a day, or even more than 10 times a day, and often feel incomplete defecation. Patients may also experience symptoms such as abdominal pain and bloating. The abdominal pain usually relieves after defecation.
(3) Bacterial dysentery
Chronic bacillary dysentery is chronic intestinal inflammation caused by dysentery bacillus. The lesions are usually located in the rectum and sigmoid colon. Patients can manifest as increased stool frequency, incomplete defecation and tenesmus, mucus pus and blood in the stool.
2. Anorectal tumors
(1) Rectal cancer
Rectal cancer is a malignant tumor that originates in the rectum. The pathology is mostly adenocarcinoma. The clinical manifestations are increased stool frequency, incomplete defecation, mucus and blood in the stool. Most rectal cancers can be palpable on digital anorectal examinations, manifested as hard, non-smooth, and inactive masses in the rectum that can be palpable, and the finger cots are stained with blood. The pathological changes can be directly observed under the proctoscopy and fiber colonoscopy, and the tissues can be taken for pathological examination.
(2) Anal cancer
Anal canal cancer is a malignant tumor that originates in the anal canal. Pathologically, it is roughly divided into epithelial cell tumors (such as squamous cell carcinoma, basal cell carcinoma, adenocarcinoma, etc.), non-epithelial cell tumors (such as sarcoma, lymphoma, etc.) and malignant Melanoma is mainly squamous epithelial carcinoma. The disease is not obvious in the early stage, and the clinical manifestations of the advanced stage are similar to rectal cancer. It also manifests as increased stool frequency, incomplete defecation, mucus pus and blood in the stool, and thin stool. However, patients often have anal pain, which is more obvious after stool.
(3) Colorectal carcinoid
Colorectal carcinoid, also known as argyrocytoma, occurs in the chromaffin cells of the intestinal mucosal glands. This cell is chromaffin. Most colorectal carcinoids are asymptomatic. When symptoms are present, mild blood in the stool is common, which is a tumor penetration. The surface mucosa is caused by ulcers or erosions, and can also be manifested as increased stool frequency, incomplete defecation, constipation, diarrhea, and anorectal pain. When the tumor grows, abdominal distension, abdominal pain and other intestinal obstruction symptoms may occur. Rectal carcinoid digital rectal tumors are mostly located on the anterior or side wall of the rectum, and are usually 0.3-0.5cm round or oval nodules in the early stage, located under the mucosa, the surface mucosa is smooth and complete, the color is paler than normal mucosa, and the texture is slightly harder Tenderness and easy to tear down. It was yellow or brown under colonoscopy. In barium enema, polypoid masses or apple core-like changes resembling the circular surface of colon cancer can be seen.
3. Anorectal and pelvic floor diseases
(1) Internal hemorrhoids
Internal hemorrhoids are located above the tooth line of the anus, without anal canal skin covered by the submucosal hemorrhoid internal venous plexus, which forms a soft vein cluster. Internal hemorrhoids are mostly located at 3, 7, and 11 points of KC. According to the pathological changes of internal hemorrhoids, they are divided into angiomas, fibrosis, and varicose veins. The main clinical manifestations are bleeding during stool, but when the hemorrhoids are large, they can protrude outside the anus, and may experience incomplete defecation, anal bulging, and difficulty defecation.
(2) Prolapse of the rectal mucosa
Rectal intramucosal prolapse refers to the full-thickness or simple mucosal layer of the proximal rectal wall folded into the distal intestinal cavity or anal canal during defecation, does not extend beyond the outer edge of the anus, and persists after the excrement of the fecal mass. The clinical manifestations of this disease include feelings of incomplete defecation, obstruction of defecation, swelling of the anus, increased stool frequency, and sometimes bleeding, mucus and blood in the stool, abdominal pain, diarrhea, abnormal urination and other symptoms. Digital anus examination showed laxity of mucosa in the lower rectum or accumulation of mucosa in the intestinal cavity. Anoscopy diagnosis can see that the rectal mucosa is loose and prolapsed, and it is difficult to see the opening of the intestinal cavity.
(3) Anal sinusitis
Anal sinusitis, also known as anal cryptitis, refers to the inflammatory lesions of the anal recess at the anal dental line. The clinical manifestations include tenesmus, incomplete defecation, anal pain, anal burning sensation and anal swelling sensation, digital anal sphincter tension, anal sinus and anal papilla tenderness, anal sinus, anal papilla hyperemia and redness under anoscope.
(4) Rectal protrusion
Rectal protrusion is the protrusion of the front wall of the rectum, also known as anterior bulging. It is one of the outlet obstruction syndromes. The patient's rectal vaginal septum is weak and the rectal wall protrudes into the vagina. The clinical manifestations of this disease include difficulty in passing stool, increased stool frequency, incomplete defecation, and anal swelling. Digital rectal examination can be palpable at the upper end of the anal canal. There is a round or oval weak area protruding to the vagina on the front wall of the rectum, which is more prominent when defecating forcefully. Defecography shows that the front wall of the rectum protrudes forward, and it is difficult for the barium to pass through the anal canal. The shape of the protrusion is mostly sac-shaped; if it is combined with puborectal muscle disease, it usually has a goose sign.
(5) Perineal descent syndrome
Perineal descent syndrome means that the anal canal is at a lower level when the patient is at rest, and the perineum drops below the level of the ischial tuberosity during forced defecation. The clinical manifestations of this disease include incomplete defecation, difficulty in passing stool, struggling in the anal canal during defecation, pain in the perineum, and sometimes mucus and blood in the stool and prolapse of mucous membranes and hemorrhoids outside the anus. The anal canal can be located in the normal position or 1.0cm below the pelvic bony outlet. However, when the patient is asked to squat and struggle with the anus, it can be seen that the anal canal drops more than 2.0cm or even exceeds the level of the ischial tuberosity. In digital rectal examination, the expansion force of the anal canal decreases during the resting period. When the patient is asked to contract at will, the contraction force of the anal canal is significantly weakened. Anoscopy showed that mucosa accumulated on the anterior wall of the rectum and blocked the end of the mirror. Anal canal pressure measurement, anal canal resting pressure, maximum systolic pressure can be reduced. The static phase of defecography showed a slight decline of the perineum and a small amount of bulging of the anterior wall of the rectum; the force discharge phase showed that the entire perineum dropped by 3.5 cm, especially the posterior part. In addition to the abnormally low position of the pelvic floor, other lesions can be found, such as anterior bulge and prolapse.
(6) Puborectalis syndrome
Puborectalis syndrome is a defecation disorder characterized by spasmodic hypertrophy of the puborectalis muscle, resulting in obstruction of the pelvic floor outlet. The histological changes are puborectalis muscle fiber hypertrophy. The clinical manifestations of this disease are progressively worsening stool excretion, prolonged defecation time, thinner stool, and incomplete defecation. Some patients have pain in the anus or sacral area and often nervousness during defecation. Digital rectal examination showed increased anal canal tension, anal canal lengthening, puborectal muscles were obviously hypertrophy, tenderness, and sometimes sharp edges. Anal pressure measurement showed that the constriction pressure was increased, suggesting an abnormal defecation reflex curve, and the functional length of the sphincter was significantly increased, reaching 5-6cm. The air sac forced out test showed that neither 50ml or 100ml air sacs could be expelled from the rectum, and expelled within 5 minutes under normal conditions. Pelvic floor electromyography showed significant abnormal electromyographic activity in the puborectalis muscle. Colonic transmission function test has retention in the rectum. The defecography showed that the measurement data was normal, but the anal canal did not open during defecation, and there were "attic signs" at rest and forced defecation.
(7) Pelvic floor spasm syndrome
Pelvic floor spasm syndrome refers to a functional disease in which the pelvic floor muscles contract and cannot relax in coordination when defecation forcefully, resulting in difficulty in passing stool. The clinical manifestations of this disease are irregular bowel movements, few bowel movements, once every 2 to 3 days, difficulty in passing stool, incomplete defecation, and anal pain. The anal sphincter muscles were tense on the digital rectal examination, and the anorectal ring became hard and tender. The defecography showed that the anus angle did not increase during defecation, the puborectalis muscle pressure was deepened, the anal canal was poorly open, and the level of the pelvic floor did not move downward. Anal pressure measurement The resting pressure and systolic pressure of the anal canal were normal, and there was a rectal-anal suppression reflex. The electromyogram of the pelvic floor showed slight electrical activity at rest and sharp increase in electrical activity during defecation.
(8) Internal sphincter achalasia
Internal sphincter achalasia refers to an anorectal dysfunction disease in which the internal anal sphincter cannot relax coordinately during defecation, causing defecation disorders. The clinical manifestations of this disease are painless dysfeces, indifferent or involuntary defecation, dry stool, or perineal swelling and discomfort, and sometimes incomplete defecation. In digital rectal examination, the elasticity of the internal anal sphincter is increased, there is tenderness, the pressure of the anal canal is increased, and it is even difficult for the fingertips to enter the anal canal, and there are more stools in the rectum. The performance of defecography showed that except for the perineal decrease in force and discharge phase, the other measurements were all in the normal range, and the anal canal was not open, the rectal neck showed symmetrical cystic dilatation, and the anal canal junction "radish root" "Such changes, the rectal dilation was obvious at rest, and the barium could not be discharged completely. The resting pressure measured by the anal pressure was significantly higher than normal, and the amplitude of the suppression reflex of the internal rectal sphincter decreased. When the air sac dilated the rectum, the pressure of the anal canal did not decrease significantly or increased. The patient's maximum tolerable rectal dose was significantly increased. Pelvic floor electromyography shows the discharge frequency and discharge interval of the internal sphincter, and whether there is electrical rhythm suppression when the rectum is dilated is of great significance for the diagnosis of the disease.