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Proctitis

Proctitides

Proctitis is a condition characterized by inflammation of the rectum wherein there is discharge of mucus and/or pus. It can cause pain in the rectum along with a constant desire to pass stool.


Presentation

Individuals with proctitis experience the following signs and symptoms:

  • Pain in the rectal region accompanied by a constant urge to pass stools
  • Bleeding from the rectum
  • Passing blood in stools
  • Onset of diarrhea
  • Experiencing a sense of fullness in the rectum
  • Pain during bowel movements
  • Pain in the abdomen, especially on the left side
  • Passing of mucus in the stools
Rectal Bleeding
  • INTRODUCTION: In severe cases refractory to medical treatment, APC appears to be the preferred alternative to control persistent rectal bleeding of patients with chronic radiation proctitis.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Awareness of this rare condition is important when investigating patients presenting with rectal bleeding to prevent unnecessary treatment and delay surgery. Prompt intervention is necessary to prevent severe rectal haemorrhage.[ncbi.nlm.nih.gov]
  • bleeding Chronic ulcerative proctitis with abscess Chronic ulcerative proctitis with complication Chronic ulcerative proctitis with fistula Chronic ulcerative proctitis with obstruction Chronic ulcerative proctitis with rectal bleeding Complication due[icd9data.com]
  • Rectal bleeding was recorded and scored using the CTCAE v.4. Telangiectasias were graded using the Vienna Rectoscopy Score (VRS).[ncbi.nlm.nih.gov]
  • About half of the reports describe sexually transmitted cytomegalovirus proctitis following anal intercourse, which typically presents with rectal bleeding and a mononucleosis-like syndrome.[ncbi.nlm.nih.gov]
Rectal Pain
  • Mild symptoms include rectal pain with bowel movements, rectal discharge, and cramping. With severe cases, people may have discharge containing blood or pus, severe rectal pain, and diarrhea.[en.wikipedia.org]
  • Sexually active females presenting with rectal pain and complaints should be screened for CT infection of the rectum. Copyright 2013 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.[ncbi.nlm.nih.gov]
  • Patients who suffer from proctitis often experience rectal pain and constant bowel movement and these symptoms can be either temporary or permanent.[singaporemedicalclinic.com]
  • Mild symptoms might be mild rectal pain with bowel movement, anal discharge, and cramping. With a severe case, you may have discharge containing blood and pus, severe rectal pain, and diarrhea .[emedicinehealth.com]
  • Syphilis (syphilitic proctitis): The symptoms are similar to those of other causes of infectious proctitis—rectal pain, discharge, and spasms during bowel movements, or you may have no symptoms.[premiermedicalhv.com]
Rectal Discharge
  • Mild symptoms include rectal pain with bowel movements, rectal discharge, and cramping. With severe cases, people may have discharge containing blood or pus, severe rectal pain, and diarrhea.[en.wikipedia.org]
  • Risk factors include: Autoimmune disorders, including inflammatory bowel disease High-risk sexual practices, such as anal sex Symptoms Symptoms include: Bloody stools Constipation Rectal bleeding Rectal discharge, pus Rectal pain or discomfort Tenesmus[ufhealth.org]
  • Tests to determine sexually transmitted infections: Swab samples from rectal discharge are taken to detect the presence of bacteria that cause sexually transmitted diseases. The results would help in designing an effective treatment regime.[symptoma.com]
  • discharge, either mucous or pus Chronic diarrhea or loose stools In most cases, your doctor will listen to your symptoms and record your medical history.[marcusgi.com]
Rectal Mass
  • The colonoscopy showed a nodular ulcerated lesion in the rectum suggestive of rectal malignancy, but biopsies from rectal mass did not reveal malignancy.[ncbi.nlm.nih.gov]
Episodic Abdominal Pain
  • CASE: A 16-year-old female presented with 5 months of chronic, episodic abdominal pain of increasing severity with associated mucoid stools, constipation, encopresis, and a 15-25 lb weight loss.[ncbi.nlm.nih.gov]

Workup

Proctitis is diagnosed by using the following tests [7]:

  • Blood tests: These are done to detect occult infections, and also the source of proctitis. They can also reveal anemia due to rectal bleeding.
  • Stool examination: Stool of the affected individual is examined in order to determine the presence of any bacterial infections.
  • Sigmoidoscopy: In this test, a flexible tube is inserted through the anus to examine the sigmoid colon (the last part of the colon including the rectal region). This is done to examine the rectum for abnormalities. During this procedure, biopsy sample can also be taken for further analysis.
  • Colonoscopy: In this test, the entire colon can be examined with the help of flexible tube having a camera attached to it. As in sigmoidoscopy, biopsy samples can also be taken during the procedure.
  • Tests to determine sexually transmitted infections: Swab samples from rectal discharge are taken to detect the presence of bacteria that cause sexually transmitted diseases. The results would help in designing an effective treatment regime.
Chlamydia
  • Abstract Lymphogranuloma venereum (LGV) is a condition caused by invasive serovars of Chlamydia trachomatis.[ncbi.nlm.nih.gov]
  • SUMMARY AND CONCLUSION: Clinicians should be increasingly aware of the potential for rectal infection and disease associated with chlamydia among women.[ncbi.nlm.nih.gov]
  • Among HIV-positive men the detection of M. genitalium was comparable to that for chlamydia (21%, 95% CI 9.5-32.5), gonorrhoea (25%, 95% CI 16.2-41.8) and HSV (19%, 95% CI 7.9-30.1).[ncbi.nlm.nih.gov]
  • 抄録 Chlamydia trachomatis による直腸炎の1例を経験したので報告した。症例は37歳女性で,粘血便を主訴に来院した。注腸造影および大腸内視鏡検査で,下部直腸に限局し,集簇した小顆粒の粘膜を認めた。生検組織はリンパ濾胞の増生を多数認めるのみであったが,直腸擦過診で Chlamydia trachomatis 抗原が陽性,また血清での Chlamydia trachomatis 抗体のIgG,IgMともに陽性であったため,クラミジア直腸炎と診断した。[ci.nii.ac.jp]
  • It can be caused by organisms such as gonorrhea, chlamydia and herpes (see also sections on herpes and intestinal parasites).[hasslefreeclinic.org]
Entamoeba Histolytica
  • ., Entamoeba histolytica , and LGV serovars of C. trachomatis . CMV or other opportunistic agents can be involved in immunosuppressed HIV-infected patients.[cdc.gov]

Treatment

Treatment for proctitis is tailored according to the cause of the condition. The following are the various methods employed differently for each causative factor:

  • Proctitis caused due to infections: If infections are the cause of proctitis, then antibiotics or antiviral medications are given for treating the condition.
  • Proctitis caused due to radiation therapy: If proctitis is caused due to radiation therapy, then anti-inflammatory medications are given to reduce the inflammation and control rectal bleeding. Later, stool softeners are administered to open up obstruction in the bowel area. Dilatation of any constricted region in the anal canal may also be done. In addition, ablation procedures such as argon plasma coagulation are performed on damaged tissues [8].
  • Proctitis caused due to inflammatory bowel disease: In such cases, medications such as steroids, sulfasalazine and immunosuppressants are given for reducing the inflammation in the gut [9]. Surgery is usually the last resort when drugs do not improve the symptoms [10].

Prognosis

The majority of the cases of proctitis can be successfully treated with medications and changes in lifestyle. However, in rare cases, various complications can set in. These include the formation of ulcers and abscesses; and the development of anemia due to loss of blood in the stool [6].

Etiology

The various factor that favor the development of proctitis include:

  • Diseases: Underlying disease conditions such as inflammatory bowel disease can predispose an individual to the development of proctitis.
  • Infections: Infections associated with sexually transmitted diseases and food borne illnesses can also cause proctitis. Individuals who practice anal intercourse are at an increased risk of developing proctitis.
  • Radiation therapy: Radiation therapy when administered to the neighboring areas of the rectum can cause irritation in the rectal lining favoring the development of proctitis [2] [3].
  • Antibiotics: Certain antibiotics can kill the beneficial bacteria contained in the bowels promoting clostridium difficile bacteria to gain control causing inflammation of the rectum.

Epidemiology

It has been estimated that about 30% of the individuals with inflammatory bowel disease develop proctitis later in their life. Also, 5 to 20% of individuals who have undergone radiation therapy for cancer treatment are susceptible to the development of proctitis. Development of chronic radiation proctitis can occur any time within 30 years after the first exposure to radiation [4].

Males are at an increased risk to contract this condition. Proctitis is more prevalent amongst the adult population. It has also been reported that the incidence of proctitis is higher amongst the Jewish population.

Sex distribution
Age distribution

Pathophysiology

The condition of proctitis essentially involves inflammation of the lining of rectum. Such a type of condition causes loss of mucosal cells along with fibrosis of connective tissues of the rectum. If the condition is not promptly treated, it can favor ischemia of the rectal tissue which can in turn cause bleeding accompanied by the development of ulcers and formation of fistula. Proctitis affects only the last 6 inches of the rectum [5].

Prevention

Practicing safe sex and preventing the sexually transmitted diseases can help keep proctitis at bay. Individuals who are sexually active are advised against practising anal sex. In addition, those individuals who already have been diagnosed with sexually transmitted diseases are advised not to indulge in sex until they have been completely cured.

Summary

Rectum is a muscular tube which is connected to the end of the colon. It is responsible for passage of stool out of the body. Inflammation in the lining of the rectum can cause significant amount of discomfort. Pain in the rectum and constant urge to pass stool are the common symptoms experienced by the patients. Proctitis can be acute or chronic in nature [1].

Patient Information

Proctitis is characterized by inflammation of the lining of rectum. It is a cause of great discomfort for the affected individuals. Males are more prone to develop the condition than females. Inflammatory bowel disease, radiation therapy and infections are the major cause of proctitis. It has been reported that, about 30% of individuals with inflammatory bowel disease develop proctitis. Radiation therapy received as a part of cancer treatment also predisposes an individual to develop such a type of condition. Affected individuals suffer from pain in the rectum, accompanied by bleeding and passing of blood and mucus in the stools. In addition, there is constant urge to pass stools and certain percentage of individuals also suffers from diarrhea. The treatment varies with the type of causative factor that has triggered the onset of proctitis.

References

Article

  1. Babb RR. Radiation proctitis: a review. Am J Gastroenterol. Jul 1996;91(7):1309-11.
  2. Baxter NN, Tepper JE, Durham SB, et al. Increased risk of rectal cancer after prostate radiation: a population-based study. Gastroenterology 2005; 128:819.
  3. Tagkalidis PP, Tjandra JJ. Chronic radiation proctitis. ANZ J Surg 2001; 71:230.
  4. Nostrant TT. Diagnosis and treatment of chronic radiation proctitis. October 7, 2009. Accessed. March 14, 2010.
  5. Manojlovic N, Babic D. Radiation-induced rectal ulcer--prognostic factors and medical treatment. Hepatogastroenterology 2004; 51:447.
  6. Spencer CM, McTavish D. Budesonide. A review of its pharmacological properties and therapeutic efficacy in inflammatory bowel disease. Drugs. Nov 1995;50(5):854-72
  7. Regueiro MD. Diagnosis and treatment of ulcerative proctitis. J Clin Gastroenterol. Oct 2004;38(9):733-40
  8. Karamanolis G, Triantafyllou K, Tsiamoulos Z, Polymeros D, Kalli T, Misailidis N, et al. Argon plasma coagulation has a long-lasting therapeutic effect in patients with chronic radiation proctitis. Endoscopy. Jun 2009;41(6):529-31.
  9. Denton AS, Andreyev HJ, Forbes A, Maher EJ. Systematic review for non-surgical interventions for the management of late radiation proctitis. Br J Cancer. Jul 15 2002;87(2):134-43.
  10. Marks G, Mohiudden M. The surgical management of the radiation-injured intestine. Surg Clin North Am 1983; 63:81.

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Last updated: 2017-08-09 17:59