There is a group of diseases that are not dangerous for the life of the patient, but significantly reduce its quality. Proctitis is one of such socially significant pathologies. Obsessive discomfort in the rectal area and a number of other symptoms of intestinal disorders arising from inflammation, do not allow the patient to follow the usual routine.
To prevent this, it is necessary to identify the disease in a timely manner and immediately begin its treatment. There is a chronic and acute form of rectal proctitis, each of which develops for specific reasons. Finding them in the past in a patient can greatly facilitate diagnosis.
Classification of causes
It is customary to distinguish two groups of causes leading to inflammation of the rectum. The first is local damaging factors that directly affect the mucous membrane of this organ. The second group includes common causes that affect the entire body and, in particular, the end sections of the intestine.
Local damaging factors
- Any essential oils (eucalyptus, clove, peppermint, etc.);
- Alcohol and purified turpentine;
- Tinctures on paprika, mustard.
Most often, they are used by patients as a popular treatment for proctitis, which only leads to exacerbation of symptoms.
Various infections of the intestinal tract, with a protracted course. The development of anal proctitis can be associated not only with the ingress of a microorganism on the rectal mucosa, but also with the action of mechanical factors (diarrhea, toxin release, the release of undigested food, etc.).
Common infectious causes:
- Ulcerative colitis of non-specific character (NUC);
- Whipple’s disease;
- Crohn’s disease;
- Chagas disease (you should pay attention to this factor if the patient traveled to tropical countries in the near past).
- Irritable bowel syndrome;
- Colon dyskinesia;
- As a complication of stem vagotomy (after surgical treatment of peptic ulcer).
Radiation sickness (intestinal form) that occurs when a dose of about 10 Gray is irradiated.
Proctitis can also develop after radiation therapy or radon baths.
It should be noted that the causes of a general nature often provoke the development of chronic proctitis. The acute form in 83% of cases is the result of exposure to a local damaging factor (with the exception of gastrointestinal infections).
Symptoms of acute proctitis
As a rule, signs of the acute form occur immediately or several hours after the action of the damaging factor (except for the tumor). Patients are concerned with two main symptoms:
- Pain – pulling character, of medium or low intensity, which intensifies during bowel movements. Patients often cannot name the exact location of pain and indicate the lower abdomen or lower back. However, with active questioning, it turns out that the discomfort is located in the region of the sacrum or the anus. They do not pass during the day, which leads to anxiety and increased irritability of the patient. Pain syndrome is somewhat reduced after taking anti-inflammatory (Ketorolac, Ibuprofen, Nimesulide) or combination drugs (Baralgin, Spazmalgon);
- Violation of the act of defecation – the patient constantly pulls into the toilet (false urges). The stool, due to an increase in defecation, acquires a mucous character, only mucus (a small amount) with blood admixture can stand out. Perhaps the development of constipation, because of the psychological block – the patient is afraid to go to the toilet, as this provokes increased pain.
Symptoms of acute proctitis can be complemented by a decrease in appetite, a short-term increase in temperature (not more than 37.6 o C), discomfort in the abdomen (due to impaired motility).
Symptoms of chronic proctitis
When this form of exacerbation alternate with periods of remission. The main criterion for diagnosis is the course of the disease for more than 6 months.
The clinical picture without exacerbation is erased – most often, it is limited to recurrent feelings of discomfort in the rectum. Since chronic proctitis often occurs on the background of another disease, the symptoms associated with this pathology come to the fore for the patient.
Symptoms and treatment of proctitis during an exacerbation are similar to the acute form.
Symptoms of radiation proctitis
Radial proctitis refers to the chronic form of the disease, but clinicians distinguish it as a separate species. The main difference is the pronounced, “painful” pain syndrome that constantly accompanies the patient. Unfortunately, effective pain relief of radiation proctitis has not been developed, therefore, it is extremely difficult to alleviate its symptoms.
In addition to local manifestations, the pathology is accompanied by a number of other symptoms:
- weight loss;
- decrease / lack of appetite;
- depression of immunity, which is why a person is prone to the development of respiratory and intestinal diseases.
The clinical picture is not limited to this, since radiation sickness influences a number of other organs.
To correctly diagnose proctitis, it is necessary to conduct a comprehensive examination. It should begin with the usual examination of the anal and perianal areas.
What can be detected during the inspection
In acute proctitis (or in exacerbation of the chronic form), the following changes are observed:
- redness of the skin around the anus (perianal region);
- the appearance of fistulous canals. They manifest themselves in the form of small “protrusions” of the skin, painful to the touch, from which pus or blood is released;
- the wall of the anal canal is saturated red. Sometimes, it can detect cracks with the naked eye.
In children, damage to the anus often bleeds, which makes it possible to suspect acute proctitis. With long-term proctitis in adults, hemorrhoidal nodules are often detected, which look like limited thickening of a dark color. When viewed, they may protrude from the rectal cavity, or within it.
The patient must be in the knee-elbow position in order to have optimal visual access. To inspect the anal ring and end sections of the rectum it is necessary that the patient relax as much as possible. For a more thorough examination, an anoscope is used (a specialized device for proctological examination).
Conducting a finger study
This is one of the oldest diagnostic methods for which special tools are not required. With it, the doctor is able to suspect not only the presence of inflammation of the rectum, but also a possible cause of proctitis (tumor, foreign object, mechanical injury).
No preparation is required from the patient. The optimal position for the study – the knee-elbow. If the patient’s condition does not allow him to take this position, the position on the left side with the legs brought to the stomach is recommended.
During the examination, the doctor evaluates:
- the integrity of the rectum and the condition of its walls;
- the presence of any formations on the wall (tumor, fistulous passage, abscess);
- the nature of the discharge (which remained on the glove).
Before the procedure, the doctor must lubricate the glove with liquid paraffin oil, so the finger test is painless for the patient.
The best way to diagnose this disease is instrumental examination. The diagnosis “proctitis” cannot be made if the patient has not been examined by a proctologist. Currently, the following methods are used:
- Anoscopy is performed using a proctologic (rectal) mirror, which is lubricated with vaseline oil and inserted into the anus, slightly widening it. Thanks to this tool a better view is opened than with a regular inspection. It does not require special training of the patient. Conducted in the same positions as the finger study.
- sigmoidoscopy is an endoscopic method, during which a detailed examination of the rectal walls (up to 30 cm) is performed. To do this, use the sigmoidoscope – elastic tube with a camera and a light source, which is introduced through the anus. Analyzing mucosal changes, can determine the form of the disease:
- catarrhal proctitis – most often occurs after the action of irritating substances on the rectum. It is characterized by the appearance of pronounced edema and enhancement of the “vascular pattern”;
- purulent proctitis – the presence of pus in the rectal cavity and infiltration of the wall by immune cells (leukocytes) indicates this form. Develops due to the action of microorganisms;
- erosive proctitis – with this form, thinning of the surface layer of the intestine occurs, which is often observed during a long-term current process;
- ulcerative proctitis is characterized by the formation of deep defects, with damage to the muscle layer. Is a sign of NLA;
- mixed forms – occur when a combination of various pathogenic factors.
The form does not have a significant impact on the tactics of treatment, but it helps to suggest the cause of the development of proctitis.
How to prepare for sigmoidoscopy
It is necessary to completely clear the rectum of feces so that nothing prevents the inspection. Preparation includes the following steps:
- A diet excluding foods rich in fiber (any vegetables, berries, fruits; rye bread; corn and pearl barley, etc.);
- In the evening, on the eve of the sigmoidoscopy, the patient can eat a light dinner (not containing the products listed above);
- After 50 minutes, the patient is given an enema every hour until the washings are “clean”;
- Rectoromanoscopy is performed on an empty stomach, therefore it is not recommended to have breakfast for the patient;
- In the morning, re-apply enemas, to obtain clean wash water;
- Immediately before sigmoidoscopy, a digital examination is performed to prepare the anus for the advancement of the endoscope and reduce the risk of injury.
This term refers to the taking of rectal tissue for examination under a microscope. Biopsy is performed during rectoromanoscopy with endoscopic forceps. Local anesthesia is not indicated in this procedure, so for the patient it is somewhat unpleasant. However, biopsy is necessary to rule out the presence of a tumor on the wall of the rectum.
Laboratory diagnostics (general blood, urine, and feces) can be used as additional methods. However, they are informative only in the presence of chronic proctitis, to identify the underlying disease.
The tactics of treatment is significantly different, with different types of proctitis, so the first stage to successfully getting rid of the disease is a qualitative diagnosis. To conduct it and prescribe the appropriate therapy can only be qualified by a doctor (the best option is a proctologist).
Treatment of acute proctitis
It is important to combine non-drug therapy with medication. The first paragraph implies the restriction of significant physical exertion, bed rest is desirable. The patient is strongly advised to follow a sparing diet until all symptoms of proctitis disappear. It implies an exception:
- mechanically-irritating foods and drinks (too hot / cold; optimal temperature is 15-20 o C);
- chemically irritating foods (sour, salty, bitter, fried, and so on);
- products that can trigger the development of constipation and dysmotility (pomegranate, flour dishes, pasta).
It is important that food is regular and fractional (in small portions). You should not make long breaks between meals (more than 6 hours), as this can lead to disruption of the passage of the food bolus through the intestines.
In addition to diet, non-pharmacological treatment of proctitis includes local anti-inflammatory procedures, such as:
- baths with potassium permanganate (potassium permanganate). They are recommended to be taken in a sitting position, no more than 4 times a day;
- enemas / finger application of sea buckthorn or olive oil on the walls of the rectum;
- To improve the general condition, light sedatives (sedatives) are recommended – valerian / motherwort tinctures. They can be used up to 4 times a day, dissolving 30-40 drops of tincture in 100 ml of water.
Drug therapy depends on the cause of acute proctitis. We give the most common treatment regimens:
With the introduction of irritating substances into the intestine or after mechanical injury (minor)
- Ketorol and so on.
Alternative – combined drugs (antispasmodics + NSAIDs):
- Reduce pain;
- Gradually normalize the condition of the mucous membrane (reducing its swelling and other inflammatory phenomena);
- Relax the walls of the rectum, which somewhat reduces the feeling of discomfort (only combined drugs).
Pills inside (after meals) or intramuscular injections. No more than 4 times a day.
With prolonged use (more than a week), it is recommended to take these drugs together with IPP (proton pump inhibitors). This will prevent such a side effect as the development of a peptic ulcer. Preparations: Omeprazole, OMEZ, Rabeprazole and so on.
- Suppressing inflammation, almost completely eliminate the symptoms of acute proctitis;
- Eliminate pain and discomfort in the distal intestine (due to lidocaine).
In infectious inflammation of the rectum
First of all, it is necessary to eliminate the damaging factor – to destroy the harmful bacteria in the rectal cavity. It should be noted that if the occurrence of proctitis is associated with intestinal infections (escherichiosis, dysentery, etc.), it is necessary to use preparations for the rehabilitation of the entire intestine.
Hormones (glucocorticosteroids) for topical use are not recommended for infectious inflammation, since they can promote the spread of bacteria and prevent their destruction.
The treatment regimen that can be used for infectious proctitis is as follows:
- Local antiseptic candles and ointments, which are aimed at the destruction of bacteria. For example: Proktozan, Simetrid;
How to apply? It is recommended to administer the drug after defecation, twice a day. If you purchased the medicine in the form of an ointment, it should be injected only with an applicator (which is included). After the introduction of ointment or rectal suppository, the drug should be kept in the intestinal cavity for at least 30 minutes. Specially delete it is not necessary. After the symptoms disappear, the course is recommended to continue for another 7-9 days.
- Antibacterial drugs, for the rehabilitation of the intestines from bacteria (only for intestinal infections). The best of them is Furazolidone – with a broad spectrum of action, it reaches the maximum concentration in the intestinal cavity and is absorbed into the blood by only 30%. Unfortunately, he is often allergic to patients. In this case, the alternative is antibiotics – Tetracyclines (Unidox, Doxycycline). Pregnant women, children under 8 years old are contraindicated. Josamycin is the safest reason for them, but only a doctor can select the optimal antibiotic during an individual consultation.
How to restore normal bowel function? Since these drugs purposefully destroy the intestinal microflora (both pathogenic and normal), after the course is over, there may be problems with the digestion of food (especially dairy and herbal products). To prevent this, “bacteria” should be “settled” with the help of drugs such as Bifidum, Bifidumbacterin, Linex and
- NSAIDs / combination drugs (antispasmodics + NSAIDs);
- Laxatives (described above).
As a rule, symptoms of infectious inflammation of the intestine disappear within a few days (up to a week) if the treatment has been correctly administered and started in a timely manner.
With the introduction of a foreign body or inflammation of the peri-rectal tissue
It is shown surgery – removal of a foreign body from the intestinal cavity or purulent focus in the fiber. After surgery, the surgeon determines further therapy, depending on the presence of complications, the degree of rectal lesion and the patient’s condition. As a rule, it includes:
Clinical fact. The human intestine is able not only to carry out peristalsis to the rectum, but also to promote objects in the opposite direction (with its complete blockage). Therefore, foreign objects that patients inject themselves into the rectum are often significantly higher — in the sigmoid or even the large intestine (30–50 cm higher). In this case, the surgeon can not get the object without incisions, because of what he has to perform more traumatic operations.
For rectal tumors
In this case, the patient is sent for consultation to the oncologist. Repeated biopsy and, if possible, CT scan is performed. This determines the degree of spread of the tumor, the presence of metastases and lymph nodes. If the tumor is benign, only the tumor is removed. In a malignant tumor that did not grow into neighboring organs and give metastases, remove the entire rectum with the imposition of a sigmoidoma (by removing the external opening of the intestine on the anterior abdominal wall). If a malignant neoplasm has spread beyond the rectum, resort to methods of radiotherapy and chemotherapy.
A very approximate scheme of oncologist’s actions is described, since the treatment of rectal tumors (especially cancer) is a complex step-by-step process that only a specialist can correctly conduct. Read more about the treatment of rectal cancer.
Treatment of chronic proctitis
In this form, all the efforts of the doctor are aimed at detecting and eliminating the manifestations of a background disease (because of which the inflammation of the rectum has developed). His successful therapy is the only way to get rid of chronic proctitis. The treatment schemes for possible causes are very complex, therefore we will describe only the fundamental points: