Proctitis is inflammation of the lining of the rectum, called the rectal mucosa.
Proctitis can be short term
(acute) or long term (chronic). Proctitis involves an inflammatory change of the rectum (within 15 cm of the dentate line). Proctitis is similar to proctosigmoiditis but is not necessarily associated with proximal extension of disease into the colon and usually does not evolve into ulcerative colitis. If proximal extension does occur, it usually does so within the first 2 years of initial diagnosis. Proctitis has many causes. It may be a side effect of medical treatments like radiation therapy or antibiotics. Proctitis caused by sexually transmitted diseases (STDs) is transmitted through receptive anal intercourse and is most commonly due to gonorrhea and chlamydia, or less commonly lymphogranuloma venereum or herpes virus. Nonsexually transmitted causes include autoimmune disease of the colon, such as Crohn disease and ulcerative colitis, celiac disease, chemicals, rectal instrumentation, and trauma to the anorectal area. It may also occur as idiopathic proctitis. For more information on Crohn disease and ulcerative colitis, see Medscape'sInflammatory Bowel Disease Resource Center.
Proctitis involves mucosal cell loss, acute inflammation of the lamina propria, eosinophilic crypt abscess, and endothelial edema of the arterioles. These may improve or in turn progress with subsequent fibrosis of connective tissue and endarteritis of the arterioles, resulting in rectal tissue ischemia and leading to mucosal friability, bleeding, ulcers, strictures, and fistula formation.
Frequency United States Frequencies of proctitis are associated with their individual etiologies. Radiation therapy accounts for 5-20% of patients with acute proctitis, usually within 6 months of treatment with a total dose of greater than 50 Gy. Chronic radiation proctitis has a more delayed onset from 9-14 months after initial radiation exposure but can occur any time up to 30 years post irradiation. [1]
Race Incidence is higher in Jewish persons. Sex Males are affected more often than females. Age Proctitis occurs predominantly in adults.
History General symptoms Feeling of rectal fullness Anal and rectal pain Diarrhea, usually frequent, small amounts Frequent or continuous urge to have a bowel movement Pain in the lower left abdomen Passing mucus through the rectum Rectal bleeding Idiopathic proctitis Passage of blood and mucus per rectum Tenesmus Occasionally, passage of loose stool, with or without lower abdominal pain or rectal cramping Infectious proctitis Pruritus Rectal and anal pain (may become severe) Avoidance of defecation due to pain Most common causes - Neisseria gonorrhoeae, Chlamydia trachomatis,herpes simplex virus (HSV) types 1 and 2 Indolent and extensive HSV types 1 and 2 infections: Symptoms may include the following: tenesmus, rectal pain, discharge, and hematochezia. The disease may run its natural course of exacerbations and remissions but is usually more prolonged and severe in patients with immunodeficiency disorders. Presentations may resemble dermatitis or decubitus ulcers in debilitated, bedridden patients. A secondary bacterial infection may be present. Radiation-induced proctitis Early symptoms include tenesmus and diarrhea that resolve shortly after the radiation treatment period. Later symptoms of proctitis (occurring months to years after the completion of radiation therapy) include tenesmus, bleeding, low-volume diarrhea, and rectal pain. Symptoms of radiation-induced proctitis are associated with low-grade obstruction or fistulous tracts into adjacent organs.
Physical examination findings may include the following: Mucosal erythema Mucosal friability Groups of vesicles eroding into circular superficial ulcers enlarged Tender inguinal lymph nodes (HSV) Painless chancres Hemoccult positive stools Telangiectasias Elevated fecal calprotectin and fecal lactoferrin [2]
Causes of proctitis may include the following: N gonorrhoeae C trachomatis HSV 1 (10%) and HSV 2 (90%) Radiation therapy Immunodeficiency disorders Crohn disease Syphilis (usually secondary) Papillomavirus Amebiasis Lymphogranuloma venereum Ischemia Toxins (eg, hydrogen peroxide enemas) Vasculitis Cytomegalovirus (CMV) Clostridium difficile Campylobacter species
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