Proctitis : Symptoms and Treatment , Diagnosis , Causes

Contents:

  • Classification reasons
  • Symptoms of acute proctitis
  • Symptoms of chronic proctitis
  • symptoms of radiation proctitis
  • Diagnostics
    • What can be detected during the inspection
    • Carrying digital examination
    • Toolbiopsy techniques
    • Treatment Treatment of acute proctitis
    • Treatment of chronic proctitis
    • treatment of radiation proctitis

There is a group of diseases that are not dangerous for the patient's life, but significantly reduce its quality.Proctitis - one of these socially important pathologies.Compulsive discomfort in the rectal area and a number of other symptoms of intestinal disorders resulting from inflammation, do not allow the patient to follow the usual daily routine.

To avoid this, you need to quickly identify the disease and to proceed immediately to its treatment.There is a chronic and acute forms of proctitis rectum, each of which is developed for certain reasons.Finding them in the past, the patient can greatly facilitate diagnosis.

Classification reasons

accepted to allocate two groups of causes that lead to inflammation of the rectum.The first - the local damaging factors that impact directly on the mucous membrane of the body.The second group of reasons of a general nature, acting on the whole body and, in particular, on the final sections of the intestine.

Local damaging factors

Common causes

Rectal administration (through the anus) of any irritants:
  • Camphor;
  • Any essential oils (eucalyptus, clove, peppermint, etc.);
  • alcohol and turpentine;
  • tinctures on peppers, mustard.

Most often, they are used by patients as a folk treatment of proctitis, which only leads to worsening of symptoms.

various infections of the intestinal tract, with a prolonged duration.The development of anal proctitis may be associated not only with the entry of microorganisms on the mucosa of the rectum, but also with the effect of mechanical factors (diarrhea, discharge of toxins, excretion of undigested food, and so on).

Common infectious causes:

  • Dysentery;
  • Salmonellosis;
  • ehsherihioza (especially hemorrhagic form);
  • viruses ECHO (enteroviruses).
Mechanical injury after self-massage the anal ring, rectum or prostate. Autoimmune diseases affecting the intestines.The most common:
  • Ulcerative colitis nonspecific nature (UC);
  • Whipple's disease;
  • Crohn's disease;
  • Amyloidosis.
Improper prostate massage. Parasitic diseases such as:
  • amebiasis;
  • Giardiasis;
  • Ascariasis;
  • Enterobiasis;
  • Chagas disease (should pay attention to this factor, if the patient is in the near past, traveling to tropical countries).
introduction of any foreign body into the cavity of the rectum.Proctitis may develop after treatment with enemas / micro enema or rectal suppositories. STI (diseases that are transmitted through sexual contact), capable of hitting the mucous membrane of the rectum:
  • Syphilis;
  • Gonorrhea.
Transition infection with the surrounding tissue (fat okolopryamokishechnoy bladder in men, uterus or vagina in women). Any dysmotility or innervation of the colon.It may develop spontaneously or after certain operations.Main damaging factor - chronic constipation.The most common violations:
  • Irritable bowel syndrome;
  • Dyskinesia of the colon;
  • as a complication of stem vagotomy (after surgical treatment of peptic ulcer disease).
tumor as the rectum and surrounding tissue (if it is a significant increase).

Radiation sickness (intestinal form) that occurs during irradiation dose of about 10 Gray.

Proctitis may also develop after radiation therapy or taking radon baths.

It should be noted that the general causes often provoke the development of chronic proctitis.The acute form in 83% of cases is the result of the impact of local damaging factor (exception - gastrointestinal infections).

Symptoms of acute proctitis

Typically, the symptoms of acute forms occur immediately or within a few hours after exposure to damaging factor (exception - the tumor).Patients concerned about two main symptoms:

  • Pain - pulling character, medium or low intensity, which increases during a bowel movement.Patients often can not tell the exact location of pain and point to the lower abdomen or lower back.However, with active questioning, it turns out that the discomfort located in the sacrum, or the anus.They are not tested during the day, which leads to anxiety and irritability patient.Pain is somewhat reduced after taking the anti-inflammatory (ketorolac, ibuprofen, nimesulide) or combined drugs (Baralgin, Spazmalgon);
  • Act Violation defecation - patient constantly "pulling the toilet" (false desires).Chair, due to increased frequency of defecation becomes slimy character, can be allocated only to the mucus (a small amount) mixed with blood.Perhaps the development of constipation, because of the psychological block - the patient is afraid to go to the toilet, as it provokes increased pain.

Symptoms of acute proctitis may be supplemented by a decrease in appetite, a short-term rise in temperature (no more than 37,6oS), discomfort in the abdomen (due to the motility disorders).


Symptoms of chronic proctitis

In this form of exacerbation alternating with periods of remission.The main criterion for diagnosis - the disease for more than 6 months.

clinical picture is worsening erased - most often it is limited to periodically there is a feeling of discomfort in the rectum.Since chronic proctitis often occurs against the backdrop of another disease to the forefront for the patient out the symptoms associated with this disease.

Symptoms and treatment during acute proctitis similar to the acute form.

symptoms of radiation proctitis

radiation proctitis refers to a chronic form of the disease, but clinicians distinguish it as a separate species.The main difference - it is pronounced, "excruciating" pain, which constantly accompanies the patient.Unfortunately, not developed effective analgesia radiation proctitis, so ease its symptoms is extremely difficult.

addition to local manifestations, pathology is accompanied by a number of other symptoms:

  • weight loss;
  • reduction / loss of appetite;
  • immunosuppression, due to which a person is exposed to the development of respiratory and intestinal diseases.

clinical picture is not so limited, as radiation disease affects a number of other bodies.

Diagnostics

To properly diagnose "proctitis", it is necessary to conduct a comprehensive survey.Post it should be a normal examination of the anal and perianal areas.

What can be detected during the inspection

In acute proctitis (or exacerbation of chronic forms) the following changes:

  • redness of the skin around the anus (perianal area);
  • may cause sinus openings channels.They appear in the form of small "protrusion" of the skin, painful to the touch, from which pus or blood;
  • wall of the anal canal deep red.Sometimes, it is possible to detect cracks with the naked eye.

Children anal lesions often bleed, allowing suspected acute proctitis.At long current proctitis often found in adults hemorrhoidal nodules that look like a limited thickening dark.They can act when viewed from the cavity of the rectum, or located within it

inspection technique

The patient must be in a knee-elbow position, so that was the best visual access.For inspection of the anal ring and the end of the rectum is necessary that the patient is the most relaxed.For a more thorough inspection using an anoscope (a specialized device for proctology examination).

Carrying digital examination

It is one the oldest methods of diagnosis, which does not require special tools.With it, the doctor is able not only to suspect the presence of colon inflammation, but also a possible cause of proctitis (tumor, a foreign object, mechanical injury).

From patient preparation is not required.Optimum position for research - Bozeman.If the patient's condition does not allow him to take this position, it is recommended the position on the left side with those given to the abdomen legs.

The survey assesses the doctor:

  • integrity of the rectum and the condition of its walls;
  • presence of any structures on the wall (tumor, fistulous, abscess);
  • character selections (which remained on the glove).

Before the procedure, the doctor is required to lubricate the glove liquid paraffin oil, so the digital examination is painless for the patient.

Instrumental methods

The best way to diagnose this disease - instrumental examination.Diagnosis "proctitis" can not be made if the patient was not examined by a doctor-proctologist.Currently, the following methods:

  • anoscopy - carried out with the help of proctology (rectal) mirror, which is lubricated by mineral oil and inserted into the anus, some expanding it.Thanks to this tool offers a better view than the usual examination.It does not require special preparation of the patient.Held in the same positions as the digital examination.
  • sigmoidoscopy - this is the endoscopic method, in which conducted a detailed examination of the walls of the rectum (30 cm).For this purpose, rectoromanoscope - elastic tube with a camera and a light source that is inserted through the anus.By analyzing changes in the mucous can determine the shape of disease:
    • catarrhal proctitis - often occurs after exposure to irritants in the rectum.It is characterized by the appearance of pronounced edema and increased "vascular pattern";
    • purulent proctitis - the presence of pus in the cavity of the rectum and the infiltration of immune cells wall (leukocytes) indicates this form.Developed due to the action of micro-organisms;
    • erosive proctitis - in this form there is a thinning of the surface layer of the intestine that is often seen in a long ongoing process;
    • ulcerative proctitis - characterized by the formation of deep defects, with damage to the muscle layer.It is a sign of NYaKa;
    • mixed forms - occur when a combination of a variety of pathogenic factors.

form has no significant influence on the tactics of treatment, but it helps to assume the cause of proctitis.

How to prepare for sigmoidoscopy

necessary to fully cleanse your colon of stool, that nothing prevented the inspection.Training includes the following steps:

  • 3 days prior to the study recommended a diet that excludes foods rich in fiber (any vegetables, berries, fruit, rye bread, corn and barley grains and so on);
  • evening before sigmoidoscopy, the patient can eat a light dinner (not containing the above products);
  • After 50 minutes, the patient begins to put enema every hour, until the washings are "clean";
  • sigmoidoscopy is performed on an empty stomach, so breakfast is not recommended to the patient;
  • morning again put an enema, to obtain "clean" rinsing water;
  • Just before sigmoidoscopy conduct manual research to prepare the anus to the advancement of the endoscope and reduce the risk of injury.

biopsy

This term refers to the taking of rectal tissue for examination under a microscope.A biopsy is performed during sigmoidoscopy using endoscopic forceps.Local anesthesia is not indicated in this procedure, so the patient is more unpleasant.However, biopsy is necessary to exclude the presence of tumor in the wall of the rectum.

as an additional method you can use the laboratory diagnostics (general blood tests, urine and stool).However, they are informative only with chronic proctitis, to identify the underlying disease.

Treatment

Tactics of treatment is significantly different, with different types of proctitis, so the first step to successfully get rid of the disease - quality diagnostics.Carry it and assign appropriate therapy can only qualified physician (the best option - it's a proctologist).

Treatment of acute proctitis

important combination of non-pharmacological treatment with medication.The first item involves significant limitation of physical activity, bed rest is desirable.The patient strongly recommend sparing diet, until all symptoms of proctitis.It involves exclusion:


  • mechanically irritating food and drinks (too hot / cold; the optimum temperature 15-20oS);
  • chemically irritating foods (sour, salty, bitter, fried, and so on);
  • products that can trigger constipation development and dysmotility (grenades, flour dishes, pasta).

It is important that the food was regular and fractional (small volume batches).You should not make long breaks between meals (more than 6 hours), as this may lead to a breach of the bolus passage through the intestines.

addition to diet, non-pharmacological treatment of proctitis includes local anti-inflammatory treatments such as:

  • baths with "potassium permanganate" (potassium permanganate).It is recommended to take in a sitting position, not more than 4 times a day;
  • enema / finger drawing of sea buckthorn oil or olive oil on the colon wall;
  • to improve the general condition, recommend a mild sedative (calming) drugs - valerian tincture / Leonurus.They can be applied up to 4 times a day, tincture by dissolving 30-40 drops per 100 mL of water.

Drug therapy depends on the cause of acute proctitis.Here are the most common treatment regimens:

With the introduction of irritating substances in the intestine or after mechanical injury (minor)

drugs Group + examples What are they doing? How to apply?
NSAIDs (non-hormonal anti-inflammatory drugs):
  • Ibuprofen;
  • Nimesulide;
  • Ketorol and so on.

alternative - a combination of drugs (antispasmodics + NSAIDs):

  • Spazmalgon;
  • Baralgin.
  1. Reduce pain;
  2. gradually normalize the condition of the mucous (reducing its swelling and other inflammatory phenomena);
  3. Relax rectal wall, which somewhat reduces the discomfort (only combination drugs).

tablets inside (after eating) or intramuscular injection.Not more than 4 times per day.

Chronic administration (over a week) is recommended to take these drugs with proton pump inhibitors ( "proton pump inhibitors").This will help prevent side effects such as the development of peptic ulcer disease.Drugs: Omeprazole, OMEZ, rabeprazole, and so on.