Physiology of Defecation

The rectum ampulla acts as a temporary storage facility for the unneeded material. As the rectal walls expand due to the material filling it, stretch receptors from the nervous system located in the rectal walls stimulate the desire to defecate. This urge to defecate arises from the reflex contraction of rectal muscles, relaxation of the internal anal sphincter , and an initial contraction of the skeletal muscle of the external anal sphincter . If the urge is not acted upon, the material in the rectum is often returned to the colon by reverse peristalsis, where more water is absorbed and the faeces is stored until the next mass peristaltic movement of the transverse and descending colon. If defecation is delayed for a prolonged period the fecal matter may harden, resulting in constipation. If defecation occurs too fast, before excess liquid is absorbed, diarrhea may occur. When the rectum is full, an increase in intra-rectal pressure forces apart the walls of the anal canal, allowing the fecal matter to enter the canal. The rectum shortens as material is forced into the anal canal and peristaltic waves push the feces out of the rectum. The internal and external anal sphincters along with the puborectalis muscle allow the feces to be passed by muscles pulling the anus up over the exiting feces. Defecation is normally assisted by taking a deep breath and trying to expel this air against a closed glottis (Valsalva maneuver). This contraction of expiratory chest muscles, diaphragm, abdominal wall muscles, and pelvic diaphragm exerts pressure on the digestive tract. Ventilation at this point temporarily ceases as the lungs push the chest diaphragm down to exert the pressure. When defecating, the external sphincter muscles relax. The anal and urethral sphincter muscles are closely linked

Relation of Diarrhea with Bloody Stools, Abdominal Pain & Low Weight
redding/bleeding ulceration/inflammation mucosa/submuosa damage in colon
muscularis propia & other layers cells reflex of inflammatory material from colon attack autonomic nerve fibers control muscular contraction increase levels of toxins toxic damage layers severe dehydration

combines with stools in colon

Low Weight

Bloody stools

increase calcium levels intracellular cells massive act of electrolyte sensation failure to absorbs dysfunction fluid/electrolyte function binds to epithelial celss

Diarrhea

Lower abdominal pain

relief by defecation

COLORECTAL CANCER Definition Colorectal cancer is cancer of the colon and rectum. The colon and rectum are segments of the large intestine that play an important role in the body's ability to digest food and pass waste. Colorectal cancer is also known as colon cancer or bowel cancer. Epidemiology CRC is a type of cancer is the third most in Indonesia, with the number of cases 1.8 / 100,000 population (DepKes, 2006) and this number is expected to increase along with the population of Indonesia lifestyle changes. Etiology Results from the growth and reproduction of abnormal cells beginning to form in the lining of the colon/rectum It is the cancer cell's ability to multiply continuously, invade normal tissue, and spread to other parts of the body (metastasize) that identifies it as malignant Pathogenesis