What happens and what types are there?
With proctitis, the rectal mucosa becomes swollen, vulnerable and begins to secrete mucus. Due to irritation of the nerve endings, frequent urges occur, and superficial erosions produce blood on toilet paper and in the stool. According to duration, acute and chronic proctitis are distinguished; according to distribution, isolated damage to the rectum or proctosigmoiditis involving the sigmoid colon. Based on the nature of the changes, catarrhal, erosive, ulcerative and atrophic variants are distinguished, which the doctor sees during endoscopy.
- Acute proctitis - vivid symptoms, often infection or injury
- Chronic proctitis - wavy course
- Radiation proctitis - after irradiation of the pelvic organs
- Ulcerative proctitis is a variant of ulcerative colitis
- Ischemic proctitis - due to impaired blood supply
Causes and risk factors
Infectious proctitis is caused by intestinal bacteria and sexually transmitted pathogens - gonococcus, chlamydia, herpes simplex virus, treponema pallidum. A special group is radiation proctitis: it develops during or months and years after radiation therapy for cancer of the cervix, prostate, and rectum. Chronic proctitis is the first manifestation of ulcerative colitis or Crohn's disease. Less commonly, the cause is injury, foreign bodies, long-term use of certain medications, and blood flow disorders in the elderly.
- Intestinal infections and foodborne illnesses
- Sexually transmitted infections during anal sex
- Ulcerative colitis and Crohn's disease
- Radiation therapy of the pelvic organs
- Trauma, foreign body, consequences of operations
- Chronic constipation and enema abuse
- Atherosclerosis of pelvic vessels in the elderly
Symptoms
The most common complaint is a feeling of a full rectum and painful false urges, during which only mucus or a few drops of blood are released. The pain intensifies during and immediately after defecation, radiating to the perineum and sacrum. The stool becomes frequent and unformed, with mucus and streaks of blood visible in it. With an infectious nature, fever and general malaise are associated. Radiation proctitis often occurs with repeated bleeding with little pain.
- False urge to defecate
- Burning and pain in the anus
- Mucus and blood in stool
- Frequent loose stools
- Feeling of incomplete emptying
- Increased temperature due to infection
Diagnostics
The proctologist begins with an examination of the perianal area and a digital examination of the rectum. Then a sigmoidoscopy or anoscopy is performed, which allows you to see the mucous membrane directly. If there is blood in the stool, weight loss or age over 45 years, a colonoscopy with a biopsy is prescribed: it excludes a tumor and clarifies whether there is an inflammatory bowel disease. To find the cause, stool tests are taken for infections and fecal calprotectin; if sexually transmitted infections are suspected, appropriate smears are taken.
- Examination and digital rectal examination
- Sigmoidoscopy
- Colonoscopy with biopsy for warning signs
- Coprogram and stool culture
- Fecal calprotectin
- Screening for sexually transmitted infections
Treatment and prevention
The main rule: it is not proctitis in general that is treated, but its cause. For a bacterial infection, antibiotics are prescribed taking into account the pathogen, for ulcerative proctitis - local anti-inflammatory drugs in suppositories and enemas, for radiation - agents that protect the mucous membrane, and for persistent bleeding, endoscopic methods of stopping are used. Everyone benefits from soft stools, a sufficient amount of fluid and fiber, avoiding spicy foods and alcohol during an exacerbation, and warm sitz baths. Any medications are selected by the doctor.
- Elimination of the cause: antibiotics, treatment of the underlying disease
- Local anti-inflammatory drugs in suppositories and microenemas
- Diet with adequate fiber and fluids
- Normalization of stool, avoidance of straining
- Sitz baths and post-defecation hygiene
- Endoscopic control of bleeding in radiation proctitis