Proctitis

Proctitis is an inflammatory process in which the mucous membrane of the rectum is primarily affected. The disease can occur both in acute form and in chronic.

Proctitis is an inflammation of the mucous membrane of the rectum, which can be a consequence of infection, inflammatory bowel disease or radiation exposure. Symptoms of proctitis include a feeling of discomfort in the rectal area and bleeding. The diagnosis is established with sigmoidoscopy, usually with biopsy and bacterial culture. Proctitis treatment depends on the etiology.

Proctitis can be caused by sexually transmitted diseases, certain intestinal infections (eg, Campylobacter, Shigella, Salmonella ), inflammatory bowel disease, or radiation therapy; the disease can be associated with the previous use of antibiotics. Proctitis caused by infection during sexual intercourse is more characteristic of homosexuals. Patients with immunodeficiency have a certain risk of developing infection caused by herpes simplex and cytomegalovirus.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Proctitis causes

The cause of the proctitis can be various types of trauma (foreign bodies, frequent cleansing enemas, chemical and thermal burns), prolonged use of antibiotics and other medications. Secondary proctitis develops with certain diseases of the digestive system (calculous cholecystitis, gastritis, pancreatitis, intestinal tumors) and pathological processes in adjacent organs.

Proctitis Symptoms

As a rule, patients complain of secretion of mucus or blood from the rectum. Proctitis as a consequence of gonorrhea, herpes simplex or cytomegalovirus is accompanied by intense anorectal pain.

For diagnosis, proctoscopy or sigmoidoscopy is required, which allows visualization of the inflamed mucosa of the rectum. Small individual ulcers and vesicles suggest a herpetic infection. A smear with a mucous membrane should be examined for the culture of Neisseria gonorrhoeae, Chlamydia, a pathogenic intestinal microflora and a pathogenic viral infection. Serological tests for syphilis and stool testing for Clostridium difficile toxin should be performed . Sometimes a biopsy of the mucosa is necessary. Some patients may have an informative colonoscopy.

Acute proctitis

Acute proctitis is characterized by a sudden onset. Main clinical manifestations: tenesmus against constipation, fever, chills, sensation of heaviness and burning in the rectum.

[10], [11], [12], [13], [14], [15], [16]

Diagnosis of acute proctitis

Study in the acute period is difficult due to severe pain and spasm of the sphincter. However, the spasm of the sphincter is less pronounced than in anal fissures, and when the finger is heavily lubricated with petroleum jelly, finger research is usually performed. It reveals swelling of the mucous membrane. On the finger of the glove after the study, sometimes spotting bloody mucus.

Given that proctitis may be secondary and develop, for example, in tumors of the colon as a result of irritation of the mucous membrane of the rectum with necrotic masses of malignant formation, colonoscopy is mandatory, but more often 5-7 days after the onset of the disease, i.e., in the period of fading acute manifestations. The mucous membrane with acute proctitis is sharply hyperemic and has a color from bright red to crimson. Often it swells into the lumen of the intestine or even completely closes it. The vascular pattern can be dramatically enhanced or absent altogether. In the lumen of the intestine, mucus is observed with blood veins.

[17], [18], [19], [20], [21],

Treatment of acute proctitis

Treatment of acute proctitis is conservative. First of all, you need a diet with the exception of all irritating foods (spicy dishes, spices, spices) and alcohol. Zh. M. Yukhvidova recommends (1984) the following food regime:

• for breakfast - protein omelet, liquid semolina porridge on the water with a small piece of butter, cottage cheese;
• for lunch - meat broth or grated vegetable soup, boiled meat, passed through a meat grinder (you can also chicken steamed chops and boiled fish), liquid cranberry jelly; for dinner porridge rice on water with oil, steam cutlet, cottage cheese.

Antibiotics are prescribed in those cases of acute proctitis, when the disease is accompanied by a fever.

In connection with the fact that due to severe pain syndrome complete cleansing of the intestine does not occur, and multiple defecation aggravates the disease, the intestines should be cleansed daily with enemas from chamomile broth. Laxatives are not recommended, as they intensify the urge and pain. Before putting a cleansing enema, the tip is densely lubricated with petroleum jelly.

After a complete cleansing of the intestines for therapeutic purposes, 100.0 ml of warm chamomile infusion (temperature 37-38 ° C) is introduced into the intestine. At night put an ophthalmic enema (50-75 ml of warm - 37-38 ° C - vegetable oil). Starting from the second week of the disease, the morning therapeutic chamomile enemas are replaced by enemas with 0.3-0.5% solution of collargoll. The concentration of the solution is determined by the intensity of the inflammatory process in the gut. Oily evening microclysters continue for 14 days. General course of treatment 2 weeks. After a 10-day break, the course of treatment should be repeated to avoid relapse.

Chronic proctitis

Chronic proctitis, or proctosigmoiditis, may be a consequence of an untreated acute proctitis, or the disease from the very beginning takes a lingering course, manifesting itself for a long time with one or two unsharply expressed symptoms.

[22], [23], [24], [25], [26], [27]

Symptoms of chronic proctitis

Common symptoms of chronic proctitis are practically not observed. Periodically, there may be a feeling of discomfort in the rectum and a feeling of incomplete emptying of the intestine. When the process worsens, urge to defecate more often. A chair in the form of decorated lumps with an admixture of mucus and sometimes blood. Often, the disease is complicated by hemorrhoids, anal fissure. There is a moss in the anus, anal itching.

Diagnosis of chronic proctitis

First of all, it is necessary to exclude infectious and parasitic diseases. Finger research can detect changes in sphincter tone and tenderness in the area of the crypt.

Endoscopic examination reveals granularity and hyperemia of the mucous membrane, mucus on the walls and in the lumen of the intestine, contact bleeding.

[28], [29], [30]

Treatment of chronic proctitis

The same remedies are recommended as with acute proctitis, but the course of conservative therapy is longer. The best effect is provided by therapeutic microclysters from collargol.

Treatment of proctitis

Infectious proctitis requires antibiotic therapy. Homosexual men with nonspecific proctitis should be given empiric therapy with intramuscular injection of ceftriaxone 125 mg once (or ciprofloxacin 500 mg orally 2 times a day for 7 days) in a place with doxycycline 100 mg orally 2 times a day for 7 days. When proctitis associated with the use of antibiotics, is appointed metronidazole (250 mg orally 4 times a day) or vancomycin (125 mg orally 4 times a day) for 7-10 days.

With radiation proctitis, it is usually effective to use local formalin in the form of applications to the affected mucosa. Alternative therapies include topical administration of glucocorticoids in the form of a spray (hydrocortisone 90 mg) or enema (hydrocortisone 100 mg or methylprednisolone 40 mg) 2 times a day for 3 weeks or mesalamine (4 g) as an enema at bedtime for 3-6 weeks. Suppositories with mesalamine 500 mg 1 -2 times a day are also effective, mesalamine 800 mg orally 3 times a day or sulfasalazine 500-1000 mg orally 4 times a day for more than 3 weeks in the form of monotherapy or in combination with local treatment. If this form of treatment is unsuccessful, the effect can be achieved by the systemic application of glucocorticoids.