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redirected from rectal ampulla final portion of the large intestine rectal redirects here for the route of administration see rectal administration for the conic sections see latus rectum and semi latus rectum for the village in the netherlands see rectum netherlands rectum anatomy of the human rectum scheme of digestive tract with rectum marked details precursor hindgut part of large intestine system gastrointestinal system 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 function store feces prior to defecation identifiers latin rectum intestinum mesh d012007 ta98 a05 7 04 001 ta2 2998 fma 14544 anatomical terminology edit on wikidata major parts of the gastrointestinal tract upper gastrointestinal tract mouth pharynx esophagus stomach duodenum lower gastrointestinal tract small intestine jejunum ileum large intestine cecum appendix ascending colon transverse colon descending colon sigmoid colon rectum anus see also gastrointestinal wall human digestive system anatomical terminology outline of human anatomy v t e the rectum pl rectums or recta is the final straight portion of the large intestine in humans and some other mammals and the gut in others before expulsion through the anus or cloaca the rectum stores the feces temporarily the adult 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 diameter is similar to that of the sigmoid colon at its commencement but it is dilated near its termination forming the rectal ampulla 4 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 which is about 4 centimetres 1 6 in long before the gastrointestinal tract terminates at the anal verge the word rectum comes from the latin rēctum intestīnum meaning straight intestine structure the rectum lies in front of the sacrum it lies behind the bladder in males left and the vagina and uterus in females right the human rectum is a part 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 an ampulla where feces is stored before its release via the anal canal an ampulla from latin bottle is a cavity or the dilated end of a duct shaped like a roman ampulla 5 the rectum joins with the sigmoid colon at the level of s3 and joins with the anal canal as it passes through the pelvic floor muscles 5 unlike other portions of the colon the rectum does not have distinct taeniae coli 6 the taeniae blend with one another in the sigmoid colon five centimeters above the rectum becoming a singular longitudinal muscle that surrounds the rectum on all sides for its entire length 7 6 blood supply and drainage the blood supply of the rectum changes between the top and bottom portions 8 the top two thirds is supplied by the superior rectal artery the lower third is supplied by the middle and inferior rectal arteries 8 the superior rectal artery is a single artery that is a continuation of the inferior mesenteric artery when it crosses the pelvic brim 8 it enters the mesorectum at the level of s3 and then splits into two branches which run at the lateral back part of the rectum and then the sides of the rectum these then end in branches in the submucosa which join with anastamose with branches of the middle and inferior rectal arteries 8 arteries of the pelvis blood vessels of the rectum and anus microanatomy see also gastrointestinal wall the microanatomy of the wall of the rectum is similar to the rest of the gastrointestinal tract 9 namely that it possesses a mucosa with a lining of a single layer of column shaped cells with mucus secreting goblet cells interspersed resting on a lamina propria with a layer of smooth muscle called muscularis mucosa this sits on an underlying submucosa of connective tissue surrounded by a muscularis propria of two bands of muscle an inner circular band and an outer longitudinal one 10 there are a higher concentration of goblet cells in the rectal mucosa than other parts of the gastrointestinal tract 9 the lining of the rectum changes sharply at the line where the rectum meets the anus here the lining changes from the column shaped cells of the rectum to multiple layers of flat cells 9 cross section microscopic shot of the rectal wall dog rectum cross section 40 microscopic cross section of the rectum of a dog 400 showing a high concentration of goblet cells in amongst the column shaped lining goblet cells can be seen as the circular cells with a clear inner material cytoplasm function this section relies on a single source please help improve this section by adding citations to reliable sources unsourced material may be challenged and removed january 2022 learn how and when to remove this message the rectum acts as a temporary storage site for feces the rectum receives fecal material from the descending colon transmitted through regular muscle contractions called peristalsis 11 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 pass feces a process called defecation 11 an internal and external anal sphincter and resting contraction of the puborectalis prevent leakage of feces fecal incontinence as the rectum becomes more distended the sphincters relax and a reflex expulsion of the contents of the rectum occurs expulsion occurs through contractions of the muscles of the rectum 11 the urge to voluntarily defecate occurs after the rectal pressure increases to beyond 18 mmhg and reflex expulsion at 55 mmhg in voluntary defecation in addition to contraction of the rectal muscles and relaxation of the external anal sphincter abdominal muscle contraction and relaxation of the puborectalis muscle occurs this acts to make the angle between the rectum and anus straighter and facilitate defecation 11 clinical significance the inside of a normal human rectum in a 70 year old seen during colonoscopy retroflexed view of the human rectum seen at colonoscopy showing anal verge a digital rectal exam is conducted to investigate or diagnose conditions including of the prostate examination main article rectal exam 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 12 forms of medical imaging used to examine the rectum include ct scans and mri scans an ultrasound probe may be inserted into the rectum to view nearby structures such as the prostate colonoscopy and sigmoidoscopy are forms of endoscopy that use a guided camera to directly view the rectum the instruments may have the ability to take biopsies if needed for diagnosis of diseases such as cancer a proctoscope is another instrument that is used to visualise the rectum body temperature can also be taken in the rectum rectal temperature can be taken by inserting a medical thermometer not more than 25 mm 0 98 in 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 97 to 100 f and is about 0 5 c 0 9 f above oral mouth temperature and about 1 c 1 8 f above axilla armpit temperature citation needed availability of less invasive temperature taking methods including tympanic ear and forehead thermometers has facilitated reduced use of this method route of administration main article rectal administration some medications are also administered via the rectum latin per rectum 13 by their definitions suppositories are inserted and enemas are injected into the rectum 14 15 medications might be given via the rectum to relieve constipation to treat conditions near the rectum such as fissures or haemorrhoids or to give medications that are systemically active when taking them by mouth is not possible 16 people do not tend to like medications administered by this route because of both cultural issues discomfort and issues that may affect the medication working such as leakage 16 constipation main article constipation one cause of constipation is faecal impaction in the rectum in which a dry hard stool forms citation needed constipation is most commonly due to dietary and lifestyle factors such as inadequate hydration immobility and lack of dietary fibre although there are many potential causes 17 such causes may include obstruction because of narrowing local disease such as crohn s disease fissures or haemorrhoids or diseases affecting the neurological control of the bowel or slow bowel transit time including spinal cord injury and multiple sclerosis use of medications such as opioids and conditions such as diabetes mellitus as well as severe illness 17 high calcium levels and low thyroid activity may also cause constipation 17 testing may be carried out to investigate the cause this may include blood tests such as biochemistry calcium levels thyroid function tests 17 a digital rectal examination may be performed to see if there is stool in the rectum and whether there is an obstruction 17 when symptoms such as weight loss bleeding through the rectum or pain are present additional investigations such as a ct scan may be ordered 17 if constipation persists despite simple treatments testing may also include anal manometry to measure pressures in the anus and rectum electrophysiological studies and magnetic resonance proctography 17 in general however constipation is treated by improving factors such as hydration exercise and dietary fibre 17 laxatives may be used constipation that persists may require enemas or suppositories sometimes use of the fingers or hand manual evacuation is required citation needed although peristalsis in the colon delivers material to the rectum laxatives such as bisacodyl or senna that induce peristalsis in the large bowel do not appear to initiate peristalsis in the rectum they induce a sensation of rectal fullness and contraction that frequently leads to defecation but without the distinct waves of activity characteristic of peristalsis 18 inflammation proctitis is inflammation of the anus and the rectum 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 update the cause is unknown cancer rectal cancer a subgroup of colorectal cancer specific to the rectum other diseases other diseases of the rectum include 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 in the context of mesenteric ischemia the upper rectum is sometimes referred to as sudeck 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 sudeck s point is often referred to along with griffith s point at the splenic flexure as a watershed region society and culture sexual stimulation see also anal sex 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 the rectum is an erogenous zone and its stimulation or penetration can result in sexual arousal 19 history etymology english rectum is derived from the latin intestinum rectum 20 straight gut 21 22 a calque 23 24 of ancient greek ἀπευθυσμένον ἔντερον derived from ἀπευθύνειν to make straight 25 and ἔντερον gut 25 attested in the writings of greek physician galen 23 24 during his anatomic investigations on animal corpses galen observed the rectum to be straight instead of curved as in humans 23 24 the expressions ἀπευθυσμένον ἔντερον and intestinum rectum are therefore not appropriate descriptions of the rectum in humans apeuthysmenon 26 is the latinization of ἀπευθυσμένον and euthyenteron 27 has a similar meaning εὐθύς straight 25 much of the knowledge of the anatomy of the rectum comes from detailed descriptions provided by andreas vesalius in 1543 28 see also gastrointestinal tract murphy drip pectinate line rectal prolapse rectal thermometry references nosek thomas m section 6 6ch2 s6ch2_30 essentials of human physiology archived from the original on 2016 03 24 12 colon and rectum pdf ajcc cancer staging atlas american joint committee on cancer 2006 p 109 archived from the original pdf on 2018 06 12 retrieved 2017 09 10 1 2 wolff bg fleshman jw beck de pemberton jh wexner sd church jm garcia aguilar j roberts pl saclarides tj eds 2007 the ascrs textbook of colon and rectal surgery new york springer isbn 978 0 387 24846 2 wang yun hwa w wiseman jeffrey 2023 anatomy abdomen and pelvis rectum statpearls statpearls publishing pmid 30725930 retrieved 24 may 2023 1 2 gray s anatomy 2016 pp 1146 7 1 2 gray s anatomy 2016 p 1137 sneh agarwal january march 2012 anatomy of the pelvic floor and anal sphincters pdf jimsa 25 1 archived from the original pdf on 2019 08 19 retrieved 2018 08 19 1 2 3 4 gray s anatomy 2016 p 1151 1 2 3 wheater s 2013 p 273 wheater s 2013 pp 252 4 1 2 3 4 ganong s 2019 p 492 4 o connor nj talley s 2009 clinical examination a systematic guide to physical diagnosis 6th ed chatswood n s w elsevier 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