Proctitis

GENERAL INFORMATION:

What is proctitis? Proctitis is inflammation (redness and swelling) of the lining of your rectum. The rectum is the last part of your large intestine (bowel) that ends at your anus. Your anus is the opening where your stool (bowel movement or BM) passes out. Inflammation of the rectum that reaches the colon is called proctocolitis. Proctitis may be an acute (short-term) or chronic (long-term) condition.

What causes proctitis?

• Bowel diseases: Ulcerative colitis and Crohn's disease are autoimmune conditions that cause swelling in the bowels. Autoimmune means your body’s immune (defense) system attacks your own cells or body tissues.
  
  
• Food allergies: These may easily upset any part of your bowel, causing proctocolitis.
  
  
• Infections: Germs, such as bacteria, viruses, and parasites (small living creatures) may infect the bowels. Germs that are often found in the small bowels may cause your condition. Your condition may also be caused by the following:
  
  
  • Sexually transmitted infections: These are also called STIs and are spread by having sex with an infected partner. Having unprotected anal sex increases your risk of having proctitis caused by these infections.
    
    
  
  
• Medicines: Your bowel may become inflamed with the use of certain medicines. These medicines include non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, and medicine used to clear out your bowel contents. Chemotherapy medicines used to treat cancers may also cause proctitis.
  
  
• Radiation treatment: This is a treatment that uses x-rays or gamma rays to treat cancer. Having this done on your pelvic (hip) area may damage your rectal tissues and blood vessels, causing proctitis. Proctitis caused by radiation may occur for a period of three months after your treatment. Chronic radiation proctitis (CRP) may occur months or years after your treatment.
  
  
• Trauma: Putting objects in your rectum may cause this condition.

What are the signs and symptoms of proctitis? You may have any of the following:

• Anal and rectal problems:
  
  
  • Anal discharge of pus, mucus, or blood.
    
    
  • Itching of the skin around the anus.
    
    
  • Open rectal sores (ulcers)
    
    
  • Rectal and anal pain, bleeding, or redness.
  
  
• BM problems:
  
  
  • Change in BM habits, such as diarrhea (loose, frequent BM's) or constipation (dry, hard stools).
    
    
  • Feeling that your rectum is not empty after having a BM, or straining to move your bowels.
    
    
  • Mucus or blood-streaked stool.
    
    
  • Needing to have a BM right away, and you may not be able to control it.
  
  
• Other:
  
  
  • Abdominal (stomach) pain and bloating (swelling).
    
    
  • Fever.
    
    
  • Swollen groin and rectal lymph nodes. Lymph nodes are small bean shaped lumps that store special cells of your immune system.

How is proctitis diagnosed? Your caregiver will take your health history, including information about your past travels or activities. This also includes exposures and contacts, diseases, or treatments you may have had. Your caregiver will check your groin and abdomen to look and feel for swollen lymph nodes (glands). Your caregiver may also check your rectum by inserting a gloved finger into your anus. You may need any of the following tests:

• Allergy testing: This may be done if your caregiver thinks your proctitis is caused by a food allergy. Your caregiver may do a skin prick test or a formal food challenge. Allergy testing will help you and your caregiver learn what foods you should avoid. Ask your caregiver for more information about allergy testing.
  
  
• Anoscopy: This test lets caregivers look inside your anus and rectum. During this test, a clear jelly-like lotion is put onto a short plastic or metal tube. The tube is then gently put into your anus and up the rectum. Your caregiver may also take samples of BM to be sent to a lab for tests. This may help caregivers find the cause of your problem.
  
  
• Endoscopy: This test is done to look for changes or abnormal tissue inside your bowel. This test may also help find the cause of your bleeding or pain. A long, thin tube with a tiny camera on the end is put into your anus. Caregivers will look for problems in your rectum and colon. A small amount of tissue may be taken from your bowel wall and sent for tests. Bleeding may also be treated during this test.
  
  
• Lab tests: These include tests to check what germ is causing your proctitis. A sample of your blood, stool, or fluid discharge may be taken. A sample may also be taken by rubbing a cotton swab over your ulcer. The sample will be sent to a lab for tests.

How is proctitis treated? Your treatment will depend on what caused your condition. Before using any over-the-counter (OTC) treatments, see your caregiver. Some treatments may make your condition worse. If you have an STI, your sex partner may also need treatment. Do not have sex again until your caregiver says it is OK. Mild proctitis (little bleeding with no other problems) caused by radiation may resolve without treatment. In other cases, treatment may include any of the following:

• Diet changes: You may need to change your diet if you have a food allergy that is causing your condition.
  
  
• Medicines to treat infection:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Antiviral medicine: Antiviral medicine may be given to fight an infection caused by a germ called a virus.
  
  
• Other medicines: Medicines to treat proctitis may be taken by mouth, or put into your rectum.
  
  
  • Anti-inflammatory medicine: This medicine will help prevent your body from releasing special chemicals that can cause swelling. Common anti-inflammatory medicines used to treat proctitis include aminosalicylates (5-ASA). This medicine may also be applied to a skin area with an ulcer.
    
    
  • Antiulcer medicine: Antiulcer medicine will coat your bowel to help prevent further damage to your tissues. It may also help with tissue healing.
    
    
  • Steroids: Steroid medicine may be given to decrease swelling. This medicine may help ease your symptoms but may also have side effects. Be sure you understand why you need steroids. Do not stop taking this medicine without your caregivers OK. Stopping on your own can cause a bad response.
    
    
  • Short chain fatty acids: Short chain fatty acids (SCFA) will help repair your bowel tissues faster. SCFA treatment is usually done with radiation proctitis.
  
  
• Procedures to stop bleeding:
  
  
  • Formalin: Formalin is a chemical solution that may be used to control bleeding. Treatment is done by applying the solution on the walls of your rectum using a swab stick. Your bowels may then be rinsed with a saline solution. This treatment may be used for radiation proctitis.
    
    
  • Heat therapy: This treatment uses heat to control bleeding and diarrhea caused by radiation. Heat therapy includes laser therapy or argon plasma coagulation (APC). Ask your caregiver for more information on heat therapy.
    
    
  • Hyperbaric oxygen therapy: This is also called HBOT. It is used to increase the oxygen in your body. HBOT may help promote healing of tissues damaged by radiation.
  
  
• Surgery: Surgery may be needed if other treatments have failed. Surgery to remove the damaged part of your bowel may be done.

What problems may happen if I have proctitis? If proctitis is left untreated, more serious problems may occur. You may have large amounts of bleeding, and tissues in your rectum may breakdown, causing ulcers or scars. Germs may enter the tissues and cause an abscess (collection of pus). When scar tissue forms, narrowing of your rectum may occur. A fistula (abnormal connection) may form, which connects your anus or rectum to your skin or another organ. If you are female, a fistula may connect your rectum to your vagina.

How can I help treat or prevent proctitis?

• Ask your caregiver about medicines that may help ease your symptoms. If you are having constipation, ask about using fiber supplements. If you are having trouble controlling your BM, ask about stool forming medicines. Ask your caregiver about a good skin care product to use if your anal skin is irritated.
  
  
• If you will have radiation therapy of your pelvic area, ask your caregiver about disease-preventing medicines. These medicines may help prevent you from having proctitis after your therapy.
  
  
• Practice safe sex. Do not have sex with someone who has an STI. This includes having oral or anal sex. Do not have sex while you or your partner is being treated for a STI. Use a latex condom every time you have sex and make sure the condom is worn correctly. Use a new condom or proper barrier (blocking) device with each new sexual act.
  
  
• Regularly see your caregiver for check-ups. If you often change sexual partners, have a regular sexual health check.
  
  
• Wash your hands often with soap and warm water. Always wash your hands after using the toilet, when working with food, and before and after having sex. Germ-killing hand lotion or gel may also be used to clean your hands when there is no water available. Clean your toilet seats, water taps, and door handles often.

When should I call my caregiver? Call your caregiver if:

• You have a rash, itching, or swelling after taking your medicine.
  
  
• You have bleeding or pain during or after sex.
  
  
• You have signs and symptoms that are new, do not improve, or are getting worse.
  
  
• You have questions or concerns about your condition, treatment, or care.

When should I seek immediate help? Seek care immediately or call 911 if:

• You have very bad abdominal or rectal pain that does not go away.
  
  
• You have blood, pus, or a bad smelling discharge coming from your anus or rectum.
  
  
• You have joint pain, swollen lymph nodes, or night sweats.
  
  
• You have genital swelling or pain, or unusual bleeding.
  
  
• Your stools are black or have blood on them.

Where can I find more information? Contact the following for more information:

• Division of STD Prevention, Centers for Disease Control and Prevention
  1600 Clifton Rd.
  Atlanta, GA 30333
  Phone: 1-800-227-8922
  Phone: 1-800-232-4636
  Web Address: http://www.cdc.gov/std
  

• National Digestive Diseases Information Clearinghouse (NDDIC)
  2 Information Way
  Bethesda, MD 20892-3570
  Phone: 1-800-8915389
  Web Address: www.digestive.niddk.nih.gov
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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