Proctitis


Proctitis

Description, Causes and Risk Factors:

Proctitis is an inflammation of the lining of the rectum. It causes pain, soreness, bleeding, and a discharge of mucus or pus. Proctitis can last a long (chronic) or a short (acute) amount of time. When the inflammation goes beyond the rectum, the condition is often called proctocolitis. Proctitis can usually be treated successfully. Treatment depends on what's causing the inflammation. Sometimes proctitis can be treated the same way as inflammatory bowel disease, a condition where the lining of other parts of the digestive tract get inflamed.

Causes:

    Sexually transmitted diseases (STDs). STDs that can be passed when a person is receiving anal sex are a common cause of proctitis. Common STD infections that can cause proctitis include gonorrhea, chlamydia, syphilis, and herpes. Herpes-induced proctitis may be particularly severe in people who are also infected with the HIV virus.

  • Non-STD infections. Infections that are not sexually transmitted also can cause proctitis. Salmonella and Shigella are examples of foodborne bacteria that can cause proctitis. Streptococcal proctitis sometimes occurs in children who have strep throat.

  • Anorectal trauma. Proctitis can be caused by trauma to the anorectal area — which includes the rectum and anus — from anal sex or the insertion of objects or harmful substances into the rectum, including the chemicals in some enemas.

  • Ulcerative colitis and Crohn's disease. Two forms of inflammatory bowel disease (IBD) — ulcerative colitis and Crohn's disease — can cause proctitis. Ulcerative colitis causes irritation and ulcers, also called sores, in the inner lining of the colon — part of the large intestine — and rectum. Crohn's disease usually causes irritation in the lower small intestine — also called the ileum — or the colon, but it can affect any part of the GI tract.

  • Radiation therapy. People who have had radiation therapy that targets the pelvic area also may develop proctitis. Examples of those at risk are people with rectal, ovarian, or prostate cancer who have received radiation treatment directed to those areas. Symptoms of radiation proctitis, most commonly rectal bleeding, will typically occur within 6 weeks after beginning radiation therapy or more than 9 months after its completion.

  • Antibiotics. Use of antibiotics may be associated with proctitis in some people. While meant to kill infection causing bacteria, antibiotics can also kill non-harmful, or commensal bacteria in the GI tract. The loss of commensal bacteria can then allow other harmful bacteria known as Clostridium difficile to cause an infection in the colon and rectum.

People with proctitis symptoms need medical attention. If diagnosed with proctitis, patients should take all medications as prescribed and see their doctor for a followup appointment to be sure the cause of the inflammation has been treated successfully.

Symptoms:

Symptoms include:

    Bloody bowel movements.

  • Rectal bleeding.

  • A feeling of rectal fullness.

  • Anal or rectal pain.

  • Crampy abdominal pain.

  • Rectal discharge of mucus or pus.

  • Diarrhea or frequent passage of loose or liquid stools.

Diagnosis:

To diagnose proctitis, a healthcare provider will take a complete medical history and do a physical exam. The health care provider will ask the patient about symptoms, current and past medical conditions, family history, and sexual behavior that increases the risk of STD-induced proctitis. The physical exam will include an assessment of the patient's vital signs, an abdominal exam, and a rectal exam.

Based on the patient's physical exam, symptoms, and other medical information, the doctor will decide which lab tests and diagnostic tests are needed. Lab tests may include blood tests such as a complete blood count to evaluate for blood loss or infection, stool tests to isolate and identify bacteria that may cause disease, and an STD screening. The doctor also may use one of the following diagnostic tests:

    Rectal culture. A cotton swab is inserted into the rectum to obtain a sample that can be used in tests that isolate and identify organisms that may cause disease.

  • Anoscopy. This test allows examination of the anal canal and lower rectum by opening the anus using a special instrument called an anoscope.

  • Flexible sigmoidoscopy and colonoscopy. These tests are used to help diagnose Crohn's disease. The tests are similar, but colonoscopy is used to view the entire colon and rectum, while flexible sigmoidoscopy is used to view just the lower colon and rectum. For both tests, a healthcare provider will provide written bowel prep instructions to follow at home before the test. The person may be asked to follow a clear liquid diet for 1 to 3 days before the test. A laxative may be required the night before the test. One or more enemas may be required the night before and about 2 hours before the test.

Treatment:

Treatment of proctitis depends on its cause. The goal of treatment is to reduce inflammation, control symptoms, and eliminate infection, if it is present. Only a doctor can determine the cause of proctitis and the best course of treatment. With proper medical attention, proctitis can be successfully treated.

If lab tests confirm that an STD or non-STD infection is present, medication is prescribed based on the type of infection found. Antibiotics are prescribed to kill bacteria; antiviral medications are prescribed to treat viruses. Although some STD viruses cannot be eliminated, antivirals can control their symptoms.

In more severe cases of proctitis from radiation therapy, ablation therapy may be used to destroy bleeding tissue. Laser therapy uses a laser to cauterize the tissue, while argon plasma coagulation uses argon gas to get rid of abnormal tissue.

Other Treatment Options:

Herbs: Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your healthcare provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerin extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

    Slippery elm (Ulmus fulva) is a demulcent, a substance that protects irritated tissues and helps them heal. It may help soothe the digestive tract. Take 60 - 320 mg per day. One tsp. powder may be mixed with water and drunk three to four times a day.

  • Marshmallow (Althaea officinalis) is a demulcent and emollient, a substance that soothes mucous membranes like those found in the digestive tract. Drink one cup of tea three times per day. To make tea, steep 2 - 5 g of dried leaf or 5 g dried root in one cup boiling water. Strain and cool. Avoid marshmallow if you have diabetes. Marshmallow can interact with some medications, including lithium.

  • Garlic (Allium sativum), standardized extract, 400 mg two to three times daily, for antibacterial or antifungal and immune activity. Garlic can have blood-thinning properties and may increase the risk of bleeding. Talk to your doctor before taking garlic if you also take blood thinners such as warfarin (Coumadin) or aspirin, or if you have a clotting disorder.

  • Boswellia (Boswellia serrata, 1,200 mg three times per day for up to 8 weeks) has anti-inflammatory properties. A few small studies suggest that it may help in treating inflammatory bowel disease. It hasn't been studied specifically for proctitis. Boswellia may interact with several other drugs and supplements, so talk to your doctor before taking it.

Preventive Measures: You can take several steps to prevent proctitis:

    Practicing safe sex -- using condoms, having only one sex partner -- can prevent STDs that cause proctitis.

  • Eating a well-balanced diet and limiting caffeine, alcohol, and high-fat foods may help reduce symptoms of ulcerative colitis, which can cause proctitis.

  • Stress-reduction techniques such as tai chi, Yoga, and deep relaxation, may also lower the risk of inflammatory bowel disease, which can cause proctitis.

NOTE: The above information is processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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