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Proctitis
Proctitis is an acute or chronic inflammation of the rectal mucosa. The prognosis is good unless massive bleeding occurs.
Proctitis affects mainly adolescents and adults. It is most common in men around age 30. Proctitis is caused by several different sexually transmitted diseases . Male homosexuals and people who practice anal intercourse are more likely to suffer from proctitis. Patients who have AIDS or who are immunocompromised are also more at risk.
Causes
Contributing factors include chronic constipation, habitual laxative use, emotional upset, radiation (especially for cancer of the cervix and of the uterus), endocrine dysfunction, rectal injury, rectal medications, bacterial infections, allergies (especially to milk), vasomotor disturbance that interferes with normal muscle control, and food poisoning.
Signs and symptoms
Common symptoms of proctitis include:
- Anal or rectal pain and discomfort, such as itching
- Urgent desire to defecate
- Discharge of mucus, pus, or blood
- Change in bowel habits, such as constipation or diarrhea
- Rectal bleeding
- Fever
Diagnosis
In acute proctitis, sigmoidoscopy shows edematous, bright red or pink rectal mucosa that's thick, shiny, friable, and possibly ulcerated. In chronic proctitis, sigmoidoscopy shows thickened mucosa,
loss of vascular patten, and stricture of the rectal lumen. Other supportive tests include biopsy to rule out carcinoma and a bacteriologic examination. A detailed patient history is essential.
Treatment
Primary treatment eliminates the underlying cause (fecal impaction, laxatives, or other medications). Soothing enemas or steroid (hydrocortisone) suppositories or enemas may be helpful if proctitis is due to radiation. Tranquilizers may be appropriate for the patient with emotional stress.
Prevention
- Safer sexual practices, such as monogamous sex and condom use, help protect against STDs that can cause proctitis.
- A reduction in caffeine, dairy foods, high-fat foods, and artificial sweeteners may lower the risk of proctitis. Studies suggest a link between ulcerative colitis and diets high in these foods.
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