Rectal discharge

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Rectal discharge (also called anal discharge, anal drainage, or anal leakage) is intermittent or continuous expression of liquid from the anus (per rectum). This is closely related to types of fecal incontinence (e.g. fecal leakage) but the term rectal discharge does not necessarily imply degrees of incontinence. Types of fecal incontinence that produce a liquid leakage could be thought of as a type of rectal discharge.

Types[edit source | edit]

Different types of discharge are described. Generally rectal discharge refers to either a mucous or purulent discharge, but, depending upon what definition of rectal discharge is used, the following could be included:

Symptoms[edit source | edit]

As described above, there are many different types of rectal discharge, but the most common presentation of a discharge is passage of mucus or pus wrapped around an otherwise normal bowel motion.[4]

Rectal discharge has many causes, and may present with other symptoms:[4][5]

Purulent rectal discharge (suppurative discharge)[edit source | edit]

Pus usually indicates infection. Frequently medical sources do not differentiate between the two types of discharge, instead using the general term mucopurulent discharge, which strictly speaking should be used to refer to a discharge that contains both mucus and pus. Purulent discharges may be blood streaked.

Mucous rectal discharge (mucinous rectal discharge, mucoid rectal discharge)[edit source | edit]

Mucus coats the walls of the colon in health, functioning as a protective barrier and also to aid peristalsis by lubrication of stool. Mucous discharges can be thought of in 2 broad categories; viz:

A mucous rectal discharge may be blood streaked. With some conditions, the blood can be homogenously mixed with the mucus, creating a pink goo. An example of this could be the so-called "red currant jelly" stools in intussusception. This appearance refers to the mixture of sloughed mucosa, mucus and blood.[6]

Note: "mucus" is a noun, used to name the substance itself, and "mucous" is an adjective, used to apply a description to a discharge. "Mucoid" is also an adjective and means mucus-like. "Mucinous" strictly speaking refers to something having a mucin-like attribute, but it often is used interchangeably with the word mucous (as mucus usually contains a high percentage of mucin).

Differential diagnosis[edit source | edit]

The differential of rectal discharge is an extensive, but the general etiological themes are infection and inflammation.[5] Some lesions can cause a discharge by mechanically interfering with, or preventing the complete closure of the anal canal. This type of lesion may not cause discharge intrinsically, but instead allow transit of liquid stool components and mucus.

Perianal Crohn's disease is associated with fistulizing, fissuring and perianal abscess formation.[12]

After colostomy, the distal section of bowel continues to produce mucus despite fecal diversion, often resulting in mucinous discharge.[13]

Occasionally, intestinal parasitic infection can present with discharge, for example Whipworm.[14]

Perianal discharge[edit source | edit]

2 pilonidal cysts in the gluteal cleft showing mucopurulent discharge

While several pathologies can present with perianal discharge, this is not strictly speaking rectal discharge, however given the anatomical proximity this may be misinterpreted as such.

Fistulae draining into the perianal region, and pilonidal diseases are the main entities that fall within this category. Perianal tumours may also discharge when they fungate, or become cystic/necrotic.

Causes[edit source | edit]


Proctitis[edit source | edit]

Proctitis is inflammation of the anal canal and the distal 6 inches of the rectum.

There are many causes of proctitis, some due to infections and others not. Proctitis does not necessarily imply rectal discharge, however some of the types known to be associated with rectal discharge are discussed briefly.

Tuberculous proctitis can create a mucous discharge.[15]

Infections[edit source | edit]

Anal warts (condyloma acuminatum, anogenital warts)[edit source | edit]

Anal warts are irregular, verrucous lesions caused by human papilloma virus. Anal warts are usually transmitted by unprotected, anoreceptive intercourse. Anal warts may be asymptomatic,[16] or may cause rectal discharge, anal wetness, rectal bleeding and pruritus ani.[8] Lesions can also occur within the anal canal, where they are more likely to create symptoms.

Chlamydia[edit source | edit]

The bacterium Chlamydia trachomatis can cause 2 conditions in humans; viz. trachoma and lymphogranuloma venereum. Trachoma can cause an asymptomatic proctitis, but the symptoms of lymphogranuloma venereum are usually more severe, including pruritus ani, purulent rectal discharge, hematochezia rectal pain and diarrhea or constipation.[8][16] Lymphogranuloma venereum can cause fistulas, strictures and anorectal abscesses if left untreated. Hence, it can be confused with Crohn's disease.

Rectal gonorrhea[edit source | edit]

Rectal gonorrhea is caused by Neisseria gonorrhoeae (also Neisseria meninigitidis).[16] The condition is usually asymptomatic, but symptoms can include rectal discharge (which can be creamy, purulent or bloody), pruritus ani, tenesmus, and possibly constipation. When symptomatic, these usually appear 5–7 days post exposure.[8] Discharge is the most common symptom, and it is usually a brownish mucopurulent consistency.[17]

Syphilis[edit source | edit]

Anorectal syphilis is caused by Treponema pallidum and is contracted through anoreceptive intercourse. Symptoms are usually minimal, but mucous discharge, bleeding, and tenesmus may be present.[17]

Anorectal abscess[edit source | edit]

Anorectal fistulae[edit source | edit]

Ileocolic actinomycosis[edit source | edit]

Non infectious inflammation[edit source | edit]

Ulcerative colitis[edit source | edit]

Diversion colitis[edit source | edit]

When the fecal stream is diverted as part of a colostomy, a condition called diversion colitis may develop in the section of bowel that no longer is in contact with stool. The mucosal lining is nourished by short chain fatty acids, which are produced as a result of bacterial fermentation in the gut. Long term lack of exposure to this nutrients can cause inflammation of the colon (colitis).[18] Symptoms include rectal bleeding, mucous discharge, tenesmus and abdominal pain.[17]

Volvulus[edit source | edit]

Colonic ulcers[edit source | edit]

Functional[edit source | edit]

Mucosal prolapse syndromes[edit source | edit]

Solitary rectal ulcer syndrome Colitis cystical profunda Internal intussusception Mucosal prolapse Rectal prolapse

Irritable bowel syndrome[edit source | edit]

Pneumatosis cystoides intestinalis[edit source | edit]

Pruritis ani[edit source | edit]

Malignancy[edit source | edit]

Anal carcinoma[edit source | edit]

Anal carcinoma is much less common than colorectal cancer. The most common form is squamous cell carcinoma, followed by adenocarcinoma and melanoma.[19] SCC usually occurs in the anal canal, and more rarely on the anal margin. Anal margin SCC presents as a lesion with rolled, everted edges and central ulceration.[17] Symptoms include a painful lump, bleeding, pruritus ani, tenesmus, discharge or possibly fecal incontinence. SSC in the anal canal most commonly causes bleeding, but may also cause anal pain, a lump, pruritus ani, discharge, tenesmus, change in bowel habits and fecal incontinence. Because these symptoms are so unspecific, and because symptoms of anal carcinoma may not always be typical, this can lead to delays in diagnosis.[20]

Rare neoplasms at this site that can give rise to discharge include Paget's disease (which is possibly a type of adenocarcinoma) and verrucous carcinoma.[17]

Colorectal cancer[edit source | edit]

Pelvic sepsis[edit source | edit]

Orlistat[edit source | edit]

Herpes simplex virus[edit source | edit]

Hemorrhoids[edit source | edit]

Cryotherpay

Colorectal polyp[edit source | edit]

Adenoma is the most common colorectal polyp. Adenomas are not malignant, but rarely adenocarcinoma can develop from them. Large adenomas can cause rectal bleeding, mucus discharge, tenesmus, and a sensation of urgency. Mucus production may be so great that it can cause electrolyte disturbances in the blood.[17]

Juvenile polyps[edit source | edit]

(Hamartomas)

Familial adenomatous polyposis[edit source | edit]

See also[edit source | edit]

References[edit source | edit]

  1. ^ Robles, I; Vásquez, JM; Loehnert, R; Espino, A; Biel, F; Correa, I; Gobelet, J; Sáenz, M; Saenz, C; Sáenz, R (2012 Feb). "[Orange oily anal leakage: a new entity linked to dietary changes].". Gastroenterologia y hepatologia 35 (2): 74–7. doi:10.1016/j.gastrohep.2011.11.009. PMID 22266298. 
  2. ^ Ling, KH; Nichols, PD; But, PP (2009). "Fish-induced keriorrhea.". Advances in food and nutrition research 57: 1–52. doi:10.1016/S1043-4526(09)57001-5. PMID 19595384. 
  3. ^ Berman, P; Harley, EH; Spark, AA (1981 May 23). "Keriorrhoea--the passage of oil per rectum--after ingestion of marine wax esters.". South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 59 (22): 791–2. PMID 7195080. 
  4. ^ a b "Rectal discharge". Queensland health. Retrieved 10 July 2012. 
  5. ^ a b Schueler, Stephen. "Anal Discharge: Overview". Retrieved 18 July 2012. 
  6. ^ Yamamoto, LG; Morita, SY; Boychuk, RB; Inaba, AS; Rosen, LM; Yee, LL; Young, LL (1997 May). "Stool appearance in intussusception: assessing the value of the term "currant jelly".". The American journal of emergency medicine 15 (3): 293–8. PMID 9148991. 
  7. ^ Gupta, PJ (2005 Jul). "A study of suppurative pathologies associated with chronic anal fissures.". Techniques in coloproctology 9 (2): 104–7. doi:10.1007/s10151-005-0206-5. PMID 16007366. 
  8. ^ a b c d al., edited by Tadataka Yamada ; associate editors, David H. Alpers ... et (2009). Textbook of gastroenterology (5th ed. ed.). Chichester, West Sussex: Blackwell Pub. ISBN 978-1-4051-6911-0. 
  9. ^ McCutcheon, T (2009 Sep-Oct). "Anal condyloma acuminatum.". Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates 32 (5): 342–9. doi:10.1097/SGA.0b013e3181b85d4e. PMID 19820442. 
  10. ^ Knott, Laurence. "Gonorrhoea". Patient.co.uk. 
  11. ^ Urrejola, G; Villalón, R; Rodríguez, N (2010 Feb). "[Perianal tuberculosis: report of two cases].". Revista medica de Chile 138 (2): 220–2. PMID 20461312. 
  12. ^ Solomon, MJ (1996). "Fistulae and abscesses in symptomatic perianal Crohn's disease.". International journal of colorectal disease 11 (5): 222–6. PMID 8951512. 
  13. ^ "About rectal discharge". Colostomy association. 
  14. ^ Feigen, GM (1987 Aug). "Suppurative anal cryptitis associated with Trichuris trichiura. Report of a case.". Diseases of the colon and rectum 30 (8): 620–2. PMID 3622166. 
  15. ^ Gierthmühlen, M; Laiffer, G; Viehl, CT; Savic, S; Bremerich, J; Mueller, C; Christ, M (2008 Apr). "[No ordinary anal fistula...].". Der Internist 49 (4): 490, 492–4. doi:10.1007/s00108-008-2063-6. PMID 18320154. 
  16. ^ a b c Warren, RE (1987 Aug). "Ano-rectal symptoms of sexually transmitted disease.". Canadian family physician Medecin de famille canadien 33: 1859–62. PMC 2218235. PMID 21263807. 
  17. ^ a b c d e f al., senior editors, Bruce G. Wolff ... et (2007). The ASCRS textbook of colon and rectal surgery. New York: Springer. ISBN 0-387-24846-3. 
  18. ^ Roediger, WE (1990 Oct). "The starved colon--diminished mucosal nutrition, diminished absorption, and colitis.". Diseases of the colon and rectum 33 (10): 858–62. PMID 2209275. 
  19. ^ Klas, JV; Rothenberger, DA; Wong, WD; Madoff, RD (1999 Apr 15). "Malignant tumors of the anal canal: the spectrum of disease, treatment, and outcomes.". Cancer 85 (8): 1686–93. PMID 10223561. 
  20. ^ Jensen, SL; Hagen, K; Shokouh-Amiri, MH; Nielsen, OV (1987 May). "Does an erroneous diagnosis of squamous-cell carcinoma of the anal canal and anal margin at first physician visit influence prognosis?". Diseases of the colon and rectum 30 (5): 345–51. PMID 3568924.