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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.
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.