Proctitis Disease

DESCRIPTION

An acute or chronic inflammation of the rectal mucosa

System(s) affected: Gastrointestinal
Genetics: Higher incidence in Jews
Incidence/Prevalence in USA: 0.5-3/100,000 (ulcerative proctitis)/10-30/100,000 (ulcerative proctitis)
Predominant age: Adult
Predominant sex: Male > Female

SIGNS AND SYMPTOMS

Rectal and/or perianal discomfort
Rectal bleeding and/or mucous discharge
Diarrhea
Tenesmus
Urgency
Constipation
Fever
Weight loss

CAUSES

Idiopathic
Rectal gonorrhea
Crohn's disease
Syphilis (usually secondary)
Nonspecific sexually transmitted infection
Herpes simplex
Chlamydia
Papillomavirus
Amebiasis
Lymphogranuloma venereum
Ischemia
Radiation therapy
Toxins (e.g., hydrogen peroxide enemas)
Vasculitis

RISK FACTORS

Rectal intercourse
Radiation
Rectal injury
Rectal medications
Jewish heritage

LABORATORY

Serological tests for syphilis, ameba
Smear, culture from rectal wall
Stool cultures

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Inflammation of rectal mucosa
Ulceration
Disruption of crypts

SPECIAL TESTS

N/A

IMAGING

N/A

DIAGNOSTIC PROCEDURES

Flexible sigmoidoscopy
Biopsy for histology, culture, viral studies, chlamydia culture
Colonoscopy to exclude more proximal involvement

APPROPRIATE HEALTH CARE

Outpatient, unless severe and refractory to usual measures

GENERAL MEASURES

Treatment depends upon the cause
Rectal gram stains have significant false-negative rate and if clinician has strong suspicion of gonorrheal proctitis, empiric treatment warranted while culture results pending
Avoidance of causative factors
Sitz baths may provide some relief

SURGICAL MEASURES

N/A

ACTIVITY

No restrictions

DIET

No special diet

PATIENT EDUCATION

Counseling regarding HIV infection risk

PREVENTION/AVOIDANCE

Safe sex, if sexually transmitted

POSSIBLE COMPLICATIONS

Chronic ulcerative colitis
Fistulae/abscess formation
Treatment failure (may be as much as 35% in gonorrhea proctitis)
Perforation

EXPECTED COURSE AND PROGNOSIS

Satisfactory cure or control with appropriate treatment

ASSOCIATED CONDITIONS

Syphilis
Gonorrhea
Other sexually transmitted disease
Prostate cancer (radiation therapy)

AGE-RELATED FACTORS

Pediatric:

Not common, but if found, is more apt to spread to full-blown disease in more proximal areas of the colon
Consider sexual abuse, if gonorrheal infection

Geriatric: Slower to heal, consider ischemia
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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