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
Entire Body System
- Fever
Herpes infections also typically produce fever and rectal ulcers. [britannica.com]
The most common side effects of CANASA include: dizziness, acne, inflammation of the large intestine (colitis), rectal pain, fever, and rash. Tell your doctor if you have any side effect that bothers you or does not go away. [canasa.com]
Symptoms Itching and/or burning around the anus Pus or mucous discharge in stools (shit) Mild to severe pain on bowel movements Occasional diarrhea or fever Some men have no symptoms at all How you get it Gonorrhea, chlamydia and herpes are passed on [hasslefreeclinic.org]
If you notice any of the below ulcerative colitis symptoms, contact one of our physicians at Gotham Gastroenterology for an evaluation: Abdominal pain Diarrhea Blood in stool Liver conditions Fever Cramping Decreased appetite/Weight loss Pain in the joints [gothamgastro.com]
You may have a change in bowel habits; a fever; and mucus, blood, or pus in your stools. Follow-up care is a key part of your treatment and safety. [myhealth.alberta.ca]
- Severe Pain
Symptoms Itching and/or burning around the anus Pus or mucous discharge in stools (shit) Mild to severe pain on bowel movements Occasional diarrhea or fever Some men have no symptoms at all How you get it Gonorrhea, chlamydia and herpes are passed on [hasslefreeclinic.org]
Inflammation and sores in the digestive tract can cause severe pain, malnutrition, intestinal scarring, bleeding, and weight loss. In some cases, removing the damaged area is the only effective treatment. [healthline.com]
If you have bleeding and mucus in a bowel movement, severe pain, or diarrhea, seek immediate treatment. Complications such as severe bleeding and anemia need immediate medical attention. As a result of severe diarrhea, you also may be dehydrated. [webmd.com]
In other cases, radiation proctitis can cause severe pain and bleeding that requires treatment. Your doctor may recommend treatments such as: Medications. [pharmacypedia.org]
If you have bleeding and mucus in a bowel movement, severe pain, and diarrhea, seek treatment at a hospital’s emergency department. Complications such as severe bleeding and anemia need immediate medical attention. [emedicinehealth.com]
- Unsafe Sexual Practices
[…] history of any STD Having a partner with an unknown sexual history Using drugs or alcohol (these may increase the likelihood of unsafe sexual practices) Having a partner who is an IV drug user Bisexual or homosexual partners Anal intercourse ( Anal sex [webmd.com]
[…] history of any STD Having a partner with an unknown sexual history Using drugs or alcohol (these may increase the likelihood of unsafe sexual practices) Having a partner who is an IV drug user Bisexual or homosexual partners Anal intercourse (Anal sex [emedicinehealth.com]
- Pallor
Mucosal features consistent with radiation injury include pallor with friability, and telangiectasias, which can be multiple, large, and serpiginous; these changes tend to be continuous. [aboutcancer.com]
Respiratoric
- Pharyngitis
Therefore, among MSM, even mild or ambiguous symptoms should prompt comprehensive testing, including urinary nucleic acid testing for gonorrhea and chlamydia and also rectal and pharyngeal culture and nucleic acid testing. [resident360.nejm.org]
Gastrointestinal
- Rectal Bleeding
A 35-year-old male was admitted to our hospital due to intermittent rectal bleeding associated with stools. [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 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. [ncbi.nlm.nih.gov]
Proctitis has several notable signs and symptoms, such as rectal pain and bleeding, diarrhea, tenesmus (constant feeling of having a bowel movement), increased secretion of mucus or painful bowel movements. [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]
Other common symptoms include but are not limited to: bloody bowel movements rectal bleeding a feeling of rectal fullness and incomplete evacuation anal or rectal pain soreness in your anal and rectal area severe cramps or pain during bowel movements [premiermedicalhv.com]
- Abdominal Pain
All patients subsequently complained of sudden abdominal pain, diarrhea, and bloody stools for several days. [synapse.koreamed.org]
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]
This can result in more frequent bowel movements, diarrhea, and abdominal pain. The inflammation associated with ulcerative colitis often affects the lower colon or rectum, but in some cases, it may affect the entire colon. [gothammedicine.com]
If you notice any of the below ulcerative colitis symptoms, contact one of our physicians at Gotham Gastroenterology for an evaluation: Abdominal pain Diarrhea Blood in stool Liver conditions Fever Cramping Decreased appetite/Weight loss Pain in the joints [gothamgastro.com]
It may result in rectal bleeding or discharge, urgency, painful defecation, tenesmus, and crampy lower abdominal pain. [us.bestpractice.bmj.com]
- Rectal Discharge
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]
Inflammation - rectum; Rectal inflammation Proctitis is an inflammation of the rectum. It can cause discomfort, bleeding, and the discharge of mucus or pus. [mountsinai.org]
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]
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]
[…] form of cramping Rectal 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]
- Dyschezia
A: Proctitis typically causes symptoms such as dyschezia, as well as urgency, tenesmus, and anal discharge. Proctitis is distinct from colitis, which is inflammation of the colon proximal to the rectum. [resident360.nejm.org]
A 22-year-old male was admitted to our hospiral with dyschezia and hemotochezia. Barium enema and colonoscopy revealed protruding lesions 7 cm above the anal verge. [ci.nii.ac.jp]
Neurologic
- Dizziness
Anemia can cause you to have pale skin, irritability, weakness, dizziness, brittle nails, and shortness of breath. [emedicinehealth.com]
The most common side effects of CANASA include: dizziness, acne, inflammation of the large intestine (colitis), rectal pain, fever, and rash. Tell your doctor if you have any side effect that bothers you or does not go away. [canasa.com]
If there is severe bleeding, anemia can result, showing symptoms such as pale skin, irritability, weakness, dizziness, brittle nails, and shortness of breath. [en.wikipedia.org]
Anemia causes you to feel tired, and you may also experience dizziness, shortness of breath, headache, pale skin and irritability. Ulcers. Chronic inflammation in the rectum can lead to open sores (ulcers) on the inside lining of the rectum. [mayoclinic.org]
- Headache
Stop using CANASA and tell your doctor right away if you get any of these symptoms: cramps, stomach (abdominal) pain, bloody diarrhea, chest pain, decrease in the amount of urine, fever, headache, rash, shortness of breath, or fatigue. [canasa.com]
The effects of bisacodyl can include abdominal pain, diarrhea, and enteritis, and occasional nausea and headache have been reported [ 4, 5, 6 ]. [synapse.koreamed.org]
Anemia causes you to feel tired, and you may also experience dizziness, shortness of breath, headache, pale skin and irritability. Ulcers. Chronic inflammation in the rectum can lead to open sores (ulcers) on the inside lining of the rectum. [mayoclinic.org]
Symptoms indicating severe disease include weakness, dizziness, irritability, shortness of breath, and headaches. Exams and Tests for Proctitis The diagnosis of proctitis is based on the suspected cause. [webmd.com]
Possible side effects of oral administration of sulfasalazine- or mesalamine containing medications include nausea, vomiting, heartburn, diarrhea, and headache. [my.clevelandclinic.org]
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.
Microbiology
- Chlamydia
Lymphogranuloma venereum (LGV) is a condition caused by invasive serovars of Chlamydia trachomatis. [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]
A positive chlamydia result alone will not distinguish between LGV and non-LGV chlamydia. Serology for syphilis and HIV should also be performed. [mshc.org.au]
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.
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
- Babb RR. Radiation proctitis: a review. Am J Gastroenterol. Jul 1996;91(7):1309-11.
- Baxter NN, Tepper JE, Durham SB, et al. Increased risk of rectal cancer after prostate radiation: a population-based study. Gastroenterology 2005; 128:819.
- Tagkalidis PP, Tjandra JJ. Chronic radiation proctitis. ANZ J Surg 2001; 71:230.
- Nostrant TT. Diagnosis and treatment of chronic radiation proctitis. October 7, 2009. Accessed. March 14, 2010.
- Manojlovic N, Babic D. Radiation-induced rectal ulcer--prognostic factors and medical treatment. Hepatogastroenterology 2004; 51:447.
- 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
- Regueiro MD. Diagnosis and treatment of ulcerative proctitis. J Clin Gastroenterol. Oct 2004;38(9):733-40
- 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.
- 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.
- Marks G, Mohiudden M. The surgical management of the radiation-injured intestine. Surg Clin North Am 1983; 63:81.