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Cryptitis
Cryptitis is a common type of active rectal infection.
It is, in turn, also the cause of many other
serious rectal diseases.
Cryptitis is inflammation of the small crypts (cavities) in the
rectum, called the cryptum orgagne or crypts of orgagne,
which we all have. At the base of each crypt there are anal
glands, and about 90% of all infections around
the ano-rectum originate at these anal
glands.
The crypts themselves are tiny mucus glands of lubrication arranged
in a circle around the upper end of the anal canal. They resemble
pockets in a coat without flaps or covers. The mouths or openings
of these pockets point upward into the rectum and they are within
the grasp of the sphincter (shut off) muscles. Just before bowel
movement, the sphincter muscles contract and squeeze out a little
drop of lubricating mucus from each of these crypts.
How Cryptitis Develops
Because of their delicate nature and position
in the rectum with the openings upward, they
are easily injured (usually by hard particles
in the stool). It turns
out to be one of the most common sources
of infection in the rectum. The
opening or mouth of the crypt, normally closed,
now swells open. Fecal matter and other infectious
material collects in the crypt, beginning
the formation of an abscess.
The disease process will now take one of several courses. The abscess
may extend itself out through the external
skin of the buttocks causing a fistula, or
it may lodge in the soft tissue causing a
large abscess cavity. The
infection may extend downward toward the
anal opening causing a large swelling there
which is either lanced and cleaned out, or
it ruptures on its own, resulting a sizeable skin
tag. It can also cause a fissure to
form.
Treatment
All of these courses are usually accompanied
by the throbbing pain and pressure of acute
abscess and all
require treatment in order to heal.
The pain of cryptitis (inflamed or infected crypt) is usually of
the sharp burning variety. The sphincter muscle may develop a chronic
spasm from the inflammatory process, causing further pain. The bladder
and genitals may be affected. At other times, the infection of cryptitis
maintains such a low-grade nature that the patient simply adapts
to the pain involved, such as a feeling of heaviness, a dull rectal
ache, uneasiness after bowel movement, or aching in the hips and
legs (which may indicate sciatica).
Many years ago, if a surgeon were working in that region on a patient,
they would often examine the crypts and open them up even if they
were not symptomatic. The thinking was that it was a preventive
measure, to keep abscess or infection from forming. As a result,
in the 50s and 60s, cryptitis was probably overdiagnosed. They
stopped doing these routinely (called cryptotomies) when
there was no immediate diagnostic reason. The procedure itself
is quite painful, and the clinical results did not show they were
preventing many cases of disease.
More recently, the tide in the medical profession has shifted all
the way in the other direction and so cryptotomies or crytectomies
are rarely done unless the glands have become abscessed or actively
symptomatic in some way. Cryptitis can become quite
painful, and yet it very often goes undiagnosed. I find that
it accounts for a lot of cases of proctalgia, or “pain in the
rectum of unknown origin.”
Rectal surgeons will treat infected crypts when they get big but
probably don't pay them much attention when they're small. I
say “when” because the small ones rarely heal on their
own. Over the course of months they become bigger, and quite
painful.
That’s when I tend to see them.
Our Treatment Methods
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When To Seek Help
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