By Dr. med. Ernst Stein (auth.)

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Extra resources for Anorectal and Colon Diseases: Textbook and Color Atlas of Proctology

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Dilated anus with badly damaged sphincter function in a two-year-old boy as a result of sexual abuse by his father (anal penetration with the penis) [19] Finally, in every incontinent patient, one is obliged to exclude a malignant process . In the anorectal region, early diagnosis of tumors is usually possible and thus a complete cure can often be obtained if presenting signs and symptoms, such as incontinence, are appropriately evaluated. • Incontinence can be associated with a variety of neurological problems and is sometimes the presenting symptom.

Chemical disinfectants function in a variety of ways. Alcohols, phenols, and aldehydes tend to cause irreversible protein denaturation. Quaternary ammonium compounds damage cell walls and cell membranes, while heavy metals tend to block enzymes, a process which is to some extent reversible. The use of chemical disinfection once again requires detailed knowledge, so that the correct agent is chosen, the solution is prepared in the appropriate concentration, and then applied in the correct fashion for a sufficient length of time.

The degree of disinfection must be much more aggressive as the skin contains microbes throughout most of the stratum corneum, not just on the outer surface layer, as well as in hair follicles and, to a much lesser extent, sweat gland ducts. Surgical hand disinfection kills both the transient and the more deeply situated resident flora. The hands are never truly sterilized, even though this term is frequently employed. Even when the hands are adequately disinfected, the skin surface is recolonized by deeper lying organisms that have not been reached by the procedure.

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