Rectum

Rectum
Drawing of colon seen from front (rectum coloured red)
Anatomy of the anus and rectum
Details
Precursor	Hindgut
Artery	Superior rectal artery (first two-thirds of rectum), middle rectal artery (last third of rectum)
Vein	Superior rectal veins, middle rectal veins
Nerve	Inferior anal nerves, inferior mesenteric ganglia[1]
Lymph	Inferior mesenteric lymph nodes, pararectal lymph nodes, internal iliac lymph nodes, Deep inguinal lymph nodes
Identifiers
Latin	Rectum
MeSH	A03.556.124.526.767
TA	A05.7.04.001
FMA	14544
Anatomical terminology [edit on Wikidata]

The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the large intestine in some mammals, and the gut in others. The human rectum is about 12 centimetres (4.7 in) long,^[2] and begins at the rectosigmoid junction (the end of the sigmoid colon), at the level of the third sacral vertebra or the sacral promontory depending upon what definition is used.^[3] Its caliber is similar to that of the sigmoid colon at its commencement, but it is dilated near its termination, forming the rectal ampulla. It terminates at the level of the anorectal ring (the level of the puborectalis sling) or the dentate line, again depending upon which definition is used.^[3] In humans, the rectum is followed by the anal canal, before the gastrointestinal tract terminates at the anal verge.

Structure

The rectum is a component of the lower gastrointestinal tract. The rectum is a continuation of the sigmoid colon, and connects to the anus. The rectum follows the shape of the sacrum, and ends in an expanded section called the rectal ampulla where feces are stored before their release via the anal canal. An ampulla is a cavity, or the dilated end of a duct, shaped like a Roman ampulla.

Unlike other portions of the colon, the rectum does not have taeniae coli.^{[4]: 397}

The rectum connects with the sigmoid colon at the level of S3, and connects with the anal canal as it passes through the pelvic floor muscles.^{[4]: 397}

Supports of the rectum include:

• Pelvic floor formed by levator ani muscles.
• Waldeyer's fascia
• Lateral ligaments of rectum which are formed by the condensation of pelvic fascia
• Rectovesical fascia of Denonvillers, which extends from rectum behind to the seminal vesicles and prostate in front.
• Pelvic peritoneum
• Perineal body

Function

The rectum acts as a temporary storage site for feces. As the rectal walls expand due to the materials filling it from within, stretch receptors from the nervous system located in the rectal walls stimulate the desire to defecate. If the urge is not acted upon, the material in the rectum is often returned to the colon where more water is absorbed from the feces. If defecation is delayed for a prolonged period, constipation and hardened feces results.

When the rectum becomes full, the increase in intrarectal pressure forces the walls of the anal canal apart, allowing the fecal matter to enter the canal. The rectum shortens as material is forced into the anal canal and peristaltic waves propel the feces out of the rectum. The internal and external sphincter allow the feces to be passed by muscles pulling the anus up over the exiting feces.

Clinical significance

Examination

For the diagnosis of certain ailments, a rectal exam may be done. These include faecal impaction, prostatic cancer and benign prostatic hypertrophy in men, faecal incontinence, and internal haemorrhoids.^{[5]: 179–180}

A colonoscopy or sigmoidoscopy are forms of endoscopy that use a guided camera to view the rectum. These may have the ability to take biopsies if needed, and may be used to diagnose diseases such as cancer.

Body temperature can also be taken in the rectum. Rectal temperature can be taken by inserting a medical thermometer not more than 25 mm (1 inch) into the rectum via the anus. A mercury thermometer should be inserted for 3 to 5 minutes; a digital thermometer should remain inserted until it beeps. Normal rectal temperature generally ranges from 36 to 38 °C (96.8 to 100.4 °F) and is about 0.5 °C (1 °F) above oral (mouth) temperature and about 1 °C (2 °F) above axilla (armpit) temperature.

Pediatricians recommend that parents take infants' and toddlers' temperature in the rectum for two reasons:

1. Rectal temperature is the closest to core body temperature and in young children, accuracy is critical.
2. Younger children frequently do not cooperate when having their temperature taken by mouth (oral), which is recommended for children ages 6 and above as well as adults.

In recent years, the introduction of non-invasive temperature taking methods including tympanic (ear) and forehead thermometers, and changing attitudes on privacy and modesty have led some parents and doctors to discontinue taking rectal temperatures.

Route of administration

The rectum may also be used as a site for the delivery of drugs, by way of a suppository.

Constipation

One cause of constipation is faecal impaction in the rectum, in which a dry, hard stool forms. Manual evacuation is the use of a gloved finger to evacuate faeces from the rectum, and, after the application of stool softeners, is utilised in acute constipation.^{[6]: 914} It is also in the long-term management of neurogenic bowel, seen most frequently in people with a spinal cord injury or multiple sclerosis. Digital rectal stimulation, the insertion of one finger into the rectum, may be used to induce peristalsis in patients whose own peristaltic reflex is inadequate to fully empty the rectum.

Diseases

• Proctitis is inflammation of the anus and the rectum.
• Rectal cancer, a subgroup of colorectal cancer specific to the rectum.
• Rectal prolapse, referring to the prolapse of the rectum into the anus or external area. This is commonly caused by a weakened pelvic floor after childbirth.

Other diseases

Other diseases of the rectum include:

• Ulcerative colitis, one form of inflammatory bowel disease that causes ulcers that affect the rectum. This may be episodic, over a person's lifetime. These may cause blood to be visible in the stool. As of 2014 the cause is unknown.
• In the context of mesenteric ischemia, the upper rectum is sometimes referred to as Sudak's point and is of clinical importance as a watershed region between the Inferior mesenteric artery circulation and the Internal iliac artery circulation via the Middle rectal artery, and thus prone to ischemia. Sudak's point is often referred to along with Griffith's point at the splenic flexure as a watershed region.

Society and culture

Sexual stimulation

Due to the proximity of the anterior wall of the rectum to the vagina in females or to the prostate in males and the shared nerves thereof, rectal stimulation or penetration can result in sexual arousal.

History

Etymology

English rectum is derived from the full Latin expression intestinum rectum.^[7] The English name straight gut^[8] truly expresses the literal meaning of this expression, as Latin rectum means straight,^[9] and intestinum means gut.^[9] This Latin expression is a translation^[10][11] of Ancient Greek ἀπευθυσμένον ἔντερον, derived from ἀπευθύνειν, to make straight,^[12] and ἔντερον, gut,^[12] attested in the writings of Greek physician Galen.^[10][11] During his anatomic investigations on animal corpses, Galen observed the rectum to be straight instead of curved as in humans.^[10][11] The expressions ἀπευθυσμένον ἔντερον and intestinum rectum are therefore not appropriate descriptions of the rectum in humans. Apeuthysmenon^[13] can be considered as Latinization of ἀπευθυσμένον ἔντερον and euthyenteron^[14] has a similar meaning (εὐθύς = straight^[12]).

Additional images

• 
  Posterior aspect of rectum exposed by removing lower part of sacrum and coccyx
• 
  Median sagittal section of male pelvis, showing arrangement of fasciae
• 
  Arteries of the pelvis
• 
  Median sagittal section of male pelvis
• 
  Median sagittal section of female pelvis
• 
  Sagittal section of the lower part of a female trunk, right segment
• 
• 
  Organs of the female reproductive system
• 
  Cross-section microscopic shot of the rectal wall
• 
  Section of mucous membrane of human rectum (60×)
• 
  Dog Rectum cross-section (40×)
• 
  Dog Rectum cross-section (400×)

See also

• Gastrointestinal tract
• Murphy drip
• Pectinate line
• Rectal prolapse
• Rectal thermometry

References

1. Physiology: 6/6ch2/s6ch2_30 - Essentials of Human Physiology
2. "12. Colon and Rectum", AJCC Cancer Staging Atlas (PDF), American Joint Committee on Cancer, 2006, p. 109
3. al.], senior editors, Bruce G. Wolff ... [et (2007). The ASCRS textbook of colon and rectal surgery. New York: Springer. ISBN 0-387-24846-3.
4. Drake, Richard L.; Vogl, Wayne; Tibbitts, Adam W.M. Mitchell; illustrations by Richard; Richardson, Paul (2005). Gray's anatomy for students. Philadelphia: Elsevier/Churchill Livingstone. ISBN 978-0-8089-2306-0.
5. O'Connor, Nicholas J. Talley, Simon (2009). Clinical examination : a systematic guide to physical diagnosis (6th ed.). Chatswood, N.S.W.: Elsevier Australia. ISBN 978-0-7295-3905-0.
6. Nicki R. Colledge, Brian R. Walker, Stuart H. Ralston, editors (2010). Davidson's principles and practice of medicine. illustrated by Robert Britton (21st ed.). Edinburgh: Churchill Livingstone/Elsevier. ISBN 978-0-7020-3084-0.
7. Federative Committee on Anatomical Terminology (FCAT) (1998). Terminologia Anatomica. Stuttgart: Thieme
8. Schreger, C.H.Th.(1805). Synonymia anatomica. Synonymik der anatomischen Nomenclatur. Fürth: im Bureau für Literatur.
9. Lewis, C. T. & Short, C. (1879). A Latin dictionary founded on Andrews' edition of Freund's Latin dictionary. Oxford: Clarendon Press.
10. Hyrtl, J. (1880). Onomatologia Anatomica. Geschichte und Kritik der anatomischen Sprache der Gegenwart. Wien: Wilhelm Braumüller. K.K. Hof- und Universitätsbuchhändler.
11. Triepel, H. (1910). Die anatomischen Namen. Ihre Ableitung und Aussprache. Mit einem Anhang: Biographische Notizen.(Dritte Auflage). Wiesbaden: Verlag J.F. Bergmann.
12. Liddell, H.G. & Scott, R. (1940). A Greek-English Lexicon. revised and augmented throughout by Sir Henry Stuart Jones. with the assistance of. Roderick McKenzie. Oxford: Clarendon Press.
13. Kossmann, R. (1895). Die gynäcologische Anatomie und ihre zu Basel festgestellte Nomenclatur. Monatsschrift für Geburtshülfe und Gynaekologie, 2 (6), 447-472.
14. Gabler, E. & Winkler, T.C. (1881). Latijnsch-Hollandsch woordenboek over de geneeskunde en natuurkundige wetenschappen. (2nd edition). Leiden: A.W. Sijthoff.

• Henry Gray: Anatomy of the human body (Bartleby.com; Great Books Online).
• Eldra P. Solomon, Richard R. Schmidt, and Peter J. Adragna: Human anatomy & physiology, 2nd ed. 1990 (Sunders College Publishing, Philadelphia). ISBN 0-03-011914-6.

External links

• Blue Histology
• Cross section image: pembody/body15a - Plastination Laboratory at the Medical University of Vienna
• Cross section image: pelvis/pelvis-e12-15 - Plastination Laboratory at the Medical University of Vienna
• Anatomy image:7808 at the SUNY Downstate Medical Center
• Anatomy photo:43:11-0101 at the SUNY Downstate Medical Center