or absence of the anus, is a rare anomaly in newborn babies; it is corrected by surgery.

at the anal opening is common and can be troublesome. It may be due to slight abrasions, piles, the presence of threadworms (see ENTEROBIASIS), and/or anal sex. The anal area should be bathed once or twice a day; clothing should be loose and smooth. Local application of soothing preparations containing mild astringents (for example bismuth subgallate, zinc oxide and hamamelis) and CORTICOSTEROIDS may provide symptomatic relief. Proprietary preparations contain lubricants, VASOCONSTRICTORS and mild ANTISEPTICS.

on defaecation is commonly caused by a small ulcer or fissure, or by an engorged haemorrhoid (pile). Haemorrhoids may also cause an aching pain in the rectum. (See also PROCTALGIA.)

in the cellular tissue at the side of the rectum – known from its position as an ischio-rectal abscess – is fairly common and may produce a fistula. Treatment is by ANTIBIOTICS and, if necessary, surgery to drain the abscess.

or protrusion of the rectum is sometimes found in children, usually between the ages of six months and two years. This is generally a temporary disorder but can also be a sign of CYSTIC FIBROSIS. Straining at defaecation by adults can cause the lining of the rectum to protrude outside the anus, resulting in discomfort, discharge and bleeding. Treatment of the underlying constipation is essential as well as local symptomatic measures (see above). Haemorrhoids sometimes prolapse. If a return to normal bowel habits with the production of soft faeces fails to restore the rectum to normal, surgery to remove the haemorrhoids may be necessary. If prolapse of the rectum recurs, despite a return to normal bowel habits, surgery may be required to rectify it.

of small size situated on the skin near the opening of the bowel, and consisting of nodules, tags of skin, or cauliflower-like excrescences, are common, and may give rise to pain, itching and watery discharges. These are easily removed if necessary. Polyps (see POLYP) occasionally develop within the rectum, and may give rise to no pain, although they may cause frequent discharges of blood. Like polyps elsewhere, they may often be removed by a minor operation. (See also POLYPOSIS.)

of the rectum and colon is the commonest malignancy in the gastrointestinal tract with around 36,000 people a year diagnosed in the United Kingdom. It is a disease of later life with symptoms appearing gradually and consisting of diarrhoea, alternating with attacks of constipation, and, later on, discharges of blood or blood-stained fluid from the bowels, together with weight loss and weakness. A growth can be well advanced before it causes much disturbance. Treatment is surgical and usually consists of removal of the whole of the rectum and the distal two-thirds of the sigmoid colon, and the establishment of a COLOSTOMY. Depending upon the extent of the tumour, approximately 50 per cent of the patients who have this operation are alive and well after five years. In some cases in which the growth occurs in the upper part of the rectum, it is now possible to remove the growth and preserve the anus so that the patient is saved the discomfort of having a colostomy. RADIOTHERAPY and CHEMOTHERAPY may also be necessary.

The NHS has a screening programme for all those aged 60–69, using a test for faecal occult blood (the test is sent to them in the post). About two in a hundred will have a positive test, and about 10 per cent of these will turn out to have cancer.