# Rectum

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Final portion of the large intestine

"Rectal" redirects here. For the route of administration, see [Rectal administration](/source/Rectal_administration). For the conic sections, see [Latus rectum](/source/Latus_rectum) and [Semi-latus rectum](/source/Semi-latus_rectum). For the village in the Netherlands, see [Rectum, Netherlands](/source/Rectum%2C_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](/source/Large_intestine) in humans and some other [mammals](/source/Mammal), and the [gut](/source/Gastrointestinal_tract) in others. Before expulsion through the [anus](/source/Anus) or [cloaca](/source/Cloaca), the rectum stores the [feces](/source/Feces) temporarily. The adult human rectum is about 12 centimetres (4.7 in) long,[2] and begins at the [rectosigmoid junction](/source/Rectosigmoid_junction) (the end of the [sigmoid colon](/source/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](/source/Puborectalis) sling) or the [dentate line](/source/Dentate_line), again depending upon which definition is used.[3] In humans, the rectum is followed by the [anal canal](/source/Anal_canal), which is about 4 centimetres (1.6 in) long, before the gastrointestinal tract terminates at the [anal verge](/source/Anal_verge). The word rectum comes from the [Latin](/source/Latin) *[rēctum](https://en.wiktionary.org/wiki/rectum) [intestīnum](https://en.wiktionary.org/wiki/intestinum)*, meaning *straight intestine*.

## Structure

The rectum lies in front of the [sacrum](/source/Sacrum). It lies behind the bladder in males (left), and the [vagina](/source/Vagina) and [uterus](/source/Uterus) in females (right).

The human rectum is a part of the [lower gastrointestinal tract](/source/Lower_gastrointestinal_tract). The rectum is a continuation of the [sigmoid colon](/source/Sigmoid_colon), and connects to the [anus](/source/Human_anus). The rectum follows the shape of the [sacrum](/source/Sacrum) and ends in an expanded section called an ampulla where [feces](/source/Human_feces) is stored before its release via the [anal canal](/source/Anal_canal). An ampulla (from [Latin](/source/Latin_language) *bottle*) is a cavity, or the dilated end of a duct, shaped like a Roman [ampulla](/source/Ampulla).[5] The rectum joins with the sigmoid colon at the level of [S3](/source/Sacrum), and joins with the anal canal as it passes through the [pelvic floor](/source/Pelvic_floor) muscles.[5]

Unlike other portions of the colon, the rectum does not have distinct [taeniae coli](/source/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](/source/Superior_rectal_artery). The lower third is supplied by the [middle](/source/Middle_rectal_artery) and [inferior rectal arteries](/source/Inferior_rectal_arteries).[8]

The superior rectal artery is a single artery that is a continuation of the [inferior mesenteric artery](/source/Inferior_mesenteric_artery), when it crosses the [pelvic brim](/source/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](https://en.wiktionary.org/wiki/anastamose#English)*) 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](/source/Gastrointestinal_wall)

The microanatomy of the wall of the rectum is similar to the rest of the [gastrointestinal tract](/source/Gastrointestinal_wall);[9] namely, that it possesses a mucosa with a lining of [a single layer of column-shaped cells](/source/Columnar_epithelium) with mucus-secreting [goblet cells](/source/Goblet_cell) interspersed, resting on a [lamina propria](/source/Lamina_propria), with a layer of smooth muscle called [muscularis mucosa](/source/Muscularis_mucosa). This sits on an underlying [submucosa](/source/Submucosa) of connective tissue, surrounded by a [muscularis propria](/source/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](/source/Anus). Here, the lining changes from the column-shaped cells of the rectum to [multiple layers of flat cells](/source/Stratified_squamous_epithelium).[9]

		- Cross-section microscopic shot of the rectal wall

		- Dog rectum cross-section (40×)

		- [Microscopic cross-section](/source/Histology) of the rectum of a dog (400×), showing a high concentration of [goblet cells](/source/Goblet_cell) in amongst the column-shaped lining. Goblet cells can be seen as the circular cells with a clear inner material ([cytoplasm](/source/Cytoplasm)).

## Function

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The rectum acts as a temporary storage site for feces. The rectum receives fecal material from the [descending colon](/source/Descending_colon), transmitted through regular muscle contractions called [peristalsis](/source/Peristalsis).[11] As the rectal walls expand due to the materials filling it from within, stretch receptors from the [nervous system](/source/Nervous_system) located in the rectal walls stimulate the desire to pass feces, a process called [defecation](/source/Defecation).[11]

An [internal](/source/Internal_anal_sphincter) and [external anal sphincter](/source/External_anal_sphincter), and resting contraction of the [puborectalis](/source/Puborectalis), prevent leakage of feces ([fecal incontinence](/source/Fecal_incontinence)). As the rectum becomes more distended, the sphincters relax and a [reflex](/source/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](/source/Colonoscopy)

Retroflexed view of the human rectum seen at colonoscopy showing anal verge

A [digital rectal exam](/source/Digital_rectal_exam) is conducted to investigate or diagnose conditions including of the [prostate](/source/Prostate).

### Examination

Main article: [Rectal exam](/source/Rectal_exam)

For the diagnosis of certain ailments, a [rectal exam](/source/Rectal_exam) may be done. These include [faecal impaction](/source/Faecal_impaction), [prostatic cancer](/source/Prostatic_cancer) and [benign prostatic hypertrophy](/source/Benign_prostatic_hypertrophy) in men, [faecal incontinence](/source/Faecal_incontinence), and internal [haemorrhoids](/source/Haemorrhoids).[12] Forms of [medical imaging](/source/Medical_imaging) used to examine the rectum include [CT scans](/source/Computed_tomography_of_the_abdomen_and_pelvis) and MRI scans. An [ultrasound](/source/Transrectal_ultrasound) probe may be inserted into the rectum to view nearby structures such as the prostate.

[Colonoscopy](/source/Colonoscopy) and [sigmoidoscopy](/source/Sigmoidoscopy) are forms of [endoscopy](/source/Endoscopy) that use a guided camera to directly view the rectum. The instruments may have the ability to take [biopsies](/source/Biopsy) if needed, for diagnosis of diseases such as [cancer](/source/Cancer). A [proctoscope](/source/Proctoscope) is another instrument that is used to visualise the rectum.

[Body temperature](/source/Human_body_temperature) can also be taken in the rectum. Rectal temperature can be taken by inserting a [medical thermometer](/source/Medical_thermometer) not more than 25 mm (0.98 in) into the rectum via the [anus](/source/Human_anus). A [mercury thermometer](/source/Mercury-in-glass_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](/source/Axilla) (armpit) temperature.[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia: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](/source/Rectal_administration)

Some medications are also administered via the rectum ([Latin](/source/Latin_language): *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](/source/Constipation)

One cause of [constipation](/source/Constipation) is [faecal impaction](/source/Faecal_impaction) in the rectum, in which a dry, hard [stool](https://en.wiktionary.org/wiki/stool) forms.[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed)*] Constipation is most commonly due to dietary and lifestyle factors such as inadequate [hydration](/source/Drinking), 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](/source/Spinal_cord_injury) and [multiple sclerosis](/source/Multiple_sclerosis); use of medications such as [opioids](/source/Opioids), and conditions such as [diabetes mellitus](/source/Diabetes_mellitus), as well as severe illness.[17] High calcium levels and [low thyroid activity](/source/Hypothyroidism) may also cause constipation.[17]

Testing may be carried out to investigate the cause. This may include [blood tests](/source/Blood_test) such as [biochemistry](/source/Biochemistry), [calcium](/source/Calcium) levels, [thyroid function tests](/source/Thyroid_function_test).[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](/source/CT_scan) may be ordered.[17] If constipation persists despite simple treatments, testing may also include [anal manometry](/source/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](/source/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](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed)*] Although [peristalsis](/source/Peristalsis) in the colon delivers material to the rectum, laxatives such as [bisacodyl](/source/Bisacodyl) or [senna](/source/Senna_glycoside) 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](/source/Proctitis) is [inflammation](/source/Inflammation) of the anus and the rectum.

- [Ulcerative colitis](/source/Ulcerative_colitis), one form of [inflammatory bowel disease](/source/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[\[update\]](https://en.wikipedia.org/w/index.php?title=Rectum&action=edit), the cause is unknown.

### Cancer

- [Rectal cancer](/source/Rectal_cancer), a subgroup of [colorectal cancer](/source/Colorectal_cancer) specific to the rectum.

### Other diseases

Other diseases of the rectum include:

- [Rectal prolapse](/source/Rectal_prolapse), referring to the [prolapse](/source/Prolapse) of the rectum into the anus or external area. This is commonly caused by a weakened [pelvic floor](/source/Pelvic_floor) after childbirth

- In the context of [mesenteric ischemia](/source/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](/source/Inferior_mesenteric_artery) circulation and the [internal iliac artery](/source/Internal_iliac_artery) circulation via the [middle rectal artery](/source/Middle_rectal_artery) and thus prone to ischemia. Sudeck's point is often referred to along with [Griffith's point](/source/Griffith's_point) at the [splenic flexure](/source/Splenic_flexure) as a watershed region.

## Society and culture

### Sexual stimulation

See also: [Anal sex](/source/Anal_sex)

Due to the proximity of the anterior wall of the rectum to the [vagina](/source/Vagina) in females or to the [prostate](/source/Prostate) in males, and the shared nerves thereof, the rectum is an [erogenous zone](/source/Erogenous_zone) and its [stimulation](/source/Stimulus_(physiology)#Touch_and_pain) or penetration can result in [sexual arousal](/source/Sexual_arousal).[19]

## History

### Etymology

English *rectum* is derived from the Latin *intestinum rectum*[20] 'straight gut',[21][22] a [calque](/source/Calque)[23][24] of [Ancient Greek](/source/Ancient_Greek) ἀπευθυσμένον ἔντερον, derived from ἀπευθύνειν, *to make straight*,[25] and ἔντερον, *gut*,[25] attested in the writings of Greek [physician](/source/Physician) [Galen](/source/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](/source/Andreas_Vesalius) in 1543.[28]

## See also

- [Gastrointestinal tract](/source/Gastrointestinal_tract)

- [Murphy drip](/source/Murphy_drip)

- [Pectinate line](/source/Pectinate_line)

- [Rectal prolapse](/source/Rectal_prolapse)

- [Rectal thermometry](/source/Rectal_thermometry)

## References

1. **[^](#cite_ref-1)** Nosek, Thomas M. ["Section 6/6ch2/s6ch2_30"](https://web.archive.org/web/20160324124828/http://humanphysiology.tuars.com/program/section6/6ch2/s6ch2_30.htm). *Essentials of Human Physiology*. Archived from [the original](http://humanphysiology.tuars.com/program/section6/6ch2/s6ch2_30.htm) on 2016-03-24.

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## Sources

- Barrett KE, Barman SM, Yuan JX, Brooks H (2019). *Ganong's review of medical physiology* (26th ed.). New York. [ISBN](/source/ISBN_(identifier)) [9781260122404](https://en.wikipedia.org/wiki/Special:BookSources/9781260122404). [OCLC](/source/OCLC_(identifier)) [1076268769](https://search.worldcat.org/oclc/1076268769).{{[cite book](https://en.wikipedia.org/wiki/Template:Cite_book)}}: CS1 maint: location missing publisher ([link](https://en.wikipedia.org/wiki/Category:CS1_maint:_location_missing_publisher))

- Ralston SH, Penman ID, Strachan MW, Hobson RP (2018). *Davidson's principles and practice of medicine* (23rd ed.). Elsevier. [ISBN](/source/ISBN_(identifier)) [978-0-7020-7028-0](https://en.wikipedia.org/wiki/Special:BookSources/978-0-7020-7028-0).

- Solomon EP, Schmidt RR, Adragna PJ (1990). *Human anatomy & physiology* (2nd ed.). Philadelphia: Sunders College Publishing. [ISBN](/source/ISBN_(identifier)) [0-03-011914-6](https://en.wikipedia.org/wiki/Special:BookSources/0-03-011914-6).

- Standring S, ed. (2016). *Gray's anatomy : the anatomical basis of clinical practice* (41st ed.). Philadelphia. [ISBN](/source/ISBN_(identifier)) [9780702052309](https://en.wikipedia.org/wiki/Special:BookSources/9780702052309). [OCLC](/source/OCLC_(identifier)) [920806541](https://search.worldcat.org/oclc/920806541).{{[cite book](https://en.wikipedia.org/wiki/Template:Cite_book)}}: CS1 maint: location missing publisher ([link](https://en.wikipedia.org/wiki/Category:CS1_maint:_location_missing_publisher))

- Young B, O'Dowd G, Woodford P (2013). *Wheater's functional histology: a text and colour atlas* (6th ed.). Philadelphia: Elsevier. [ISBN](/source/ISBN_(identifier)) [9780702047473](https://en.wikipedia.org/wiki/Special:BookSources/9780702047473).

## External links

- [Cross section image: pembody/body15a](https://www.meduniwien.ac.at/plastination/pembody/body15a-text.html)—Plastination Laboratory at the Medical University of Vienna

- [Cross section image: pelvis/pelvis-e12-15](https://www.meduniwien.ac.at/plastination/pelvis/pelvis-e12-15-text.html)—Plastination Laboratory at the Medical University of Vienna

- [Anatomy image:7808](http://ect.downstate.edu/courseware/haonline/imgs/00000/7000/800/7808.jpg) at the SUNY Downstate Medical Center

- [Anatomy photo:43:11-0101](http://ect.downstate.edu/courseware/haonline/labs/l43/110101.htm) at the SUNY Downstate Medical Center

v t e Anatomy of the gastrointestinal tract, excluding the mouth Upper Pharynx Muscles Spaces peripharyngeal retropharyngeal parapharyngeal retrovisceral danger prevertebral Pterygomandibular raphe Pharyngeal raphe Buccopharyngeal fascia Pharyngobasilar fascia Pyriform sinus Esophagus Sphincters upper lower glands crop Stomach Curvatures greater lesser Angular incisure Cardia Body Fundus Pylorus Gastric mucosa Gastric folds Microanatomy Gastric pits Gastric glands Cardiac glands Fundic glands Pyloric glands Foveolar cells Parietal cells Gastric chief cells Enterochromaffin-like cells Lower Small intestine Microanatomy Intestinal villi Microvilli Intestinal glands Enterocytes Enteroendocrine cells Goblet cells Paneth cells Duodenum Suspensory muscle Major duodenal papilla Minor duodenal papilla Duodenojejunal flexure Brunner's glands Jejunum No substructures Ileum Ileocecal valve Peyer's patches Microfold cells Large intestine Cecum Appendix Colon Ascending colon Hepatic flexure Transverse colon Splenic flexure Descending colon Sigmoid colon Continuous taenia coli haustra epiploic appendix Rectum Transverse folds Ampulla Anal canal Anus Anal columns Anal valves Anal sinuses Pectinate line Internal anal sphincter Anocutaneous line External anal sphincter Wall Serosa / Adventitia Subserosa Muscular layer Submucosa Circular folds Mucosa Muscularis mucosa

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Adapted from the Wikipedia article [Rectum](https://en.wikipedia.org/wiki/Rectum) by Wikipedia contributors ([contributor history](https://en.wikipedia.org/wiki/Rectum?action=history)). Available under [Creative Commons Attribution-ShareAlike 4.0 International](https://creativecommons.org/licenses/by-sa/4.0/). Changes may have been made.