What is chronic proctitis, how does it manifest and treatment methods?

Proctitis is an inflammation of the rectal mucosa. Proctitis should not be confused with paraproctitis, in which inflammation of the tissues located next to the rectum occurs.

Proctitis begins with simple redness and can progress to deep ulcers. The disease is quite delicate, so not every person immediately consults a doctor when the first symptoms appear. But in vain! Constant pain and itching in the anus, insomnia, and difficulty defecating can lead to nervous breakdowns and problems at work and in your personal life. In addition, proctitis can develop against the background of such serious diseases as hemorrhoids, microcracks of the anus and rectal cancer!

Classification

A disease in which the rectal mucosa becomes inflamed is called proctitis. The reasons that can lead to an inflammatory process developing in the colon can be very different. Depending on them, the following forms of the disease are distinguished:

• Alimentary proctitis. Occurs with systematic poor nutrition, consumption of too many hot spices and alcohol.
• Gonorrheal proctitis. The cause is microorganisms - gonococci. Inflammation develops when they enter the rectum and actively develop there.
• Parasitic proctitis develops “when the rectum is infected with dysenteric amoebas, trichomonas, and balantidia.
• Congestive proctitis develops “in parallel” with constipation with simultaneous venous stagnation of blood in the walls of the rectum. All this leads to damage to the colon mucosa.
• Radiation proctitis develops as a consequence of radiation therapy aimed at malignant neoplasms developing in the pelvic region.

In addition, the development of inflammatory processes in the rectum can be caused by a number of other factors: hypothermia, other intestinal diseases, hemorrhoids, rectal injuries, chronic inflammation of neighboring organs, anal fissure, prostatitis, vulvovaginitis, etc.

There are also acute and chronic proctitis.

Photo

In the photo below, you can see a significant difference between the normal mucous membrane of a healthy intestine and the one where proctitis is found. All manifestations of this disease in men and women are the same and are expressed by pain and burning in the anus, possible spotting in the form of drops of blood on the stool.

Upon careful examination, the rectal mucosa also undergoes changes depending on the form of the disease and its type. With catarrhal-hemorrhagic proctitis, the inflammatory process is accompanied by the release of pus and its accumulation on the mucous membrane; the catarrhal-mucosal form is characterized by the release of a large amount of mucus, and the walls of the rectum themselves look inflamed and swollen.

Causes

The main reasons for the development of proctitis include the following:

• Infectious – inflammation of the mucous membrane of varying degrees can be caused by bacteria, viruses, fungi, and protozoa.
• Parasitic infestations can also often significantly destroy the wall of the rectum, cause persistent constipation, and are not accompanied by the characteristic discharge of blood and mucus. Colonoscopy often reveals huge conglomerates of parasites localized in the cecum, sigmoid, and less often in the rectum. Even if the helminths are localized quite remotely from the rectum, catarrhal inflammation (catarrhal proctitis) occurs, which is associated with the impact of waste products of worms on its walls, as well as a violation of trophism.
• Traumatic - damage to the rectal mucosa can occur when inedible objects are ingested (fish bones, paper clips, cloves, etc.). Usually, accidentally (less often on purpose) swallowed objects cause erosive proctitis, less often ulcerative. Injuries can also be caused externally, through improper use of enemas, anal sex, or during medical procedures. Recently, traumatic proctitis is increasingly observed in men who massage the prostate, treat hemorrhoids, and masturbate with objects not intended for this purpose. It should be remembered that in this way you can not only introduce an infection into the intestinal cavity, but also pierce its wall, which will lead to fecal peritonitis and death.
• Vascular is one of the most dangerous causes of proctitis in adults (usually in the form of proctosigmoiditis). As a result of cessation of blood circulation in the inferior mesenteric artery, which supplies the large intestine, aseptic necrosis of its tissue develops. In this case, unbearable abdominal pain occurs, usually lasting 2-3 hours, vomiting and diarrhea appear. After 3 hours, the pain subsides - this is called the period of “imaginary well-being”, since at this moment necrosis develops. After 2-3 hours, the patient is in stupor or already in a coma, the body temperature rises, the pulse quickens, the pressure drops - diffuse peritonitis develops. Timely seeking medical help in the first two hours from the onset of the disease saves life. When contacted after 6 or more hours, the mortality rate is 90%. The only treatment for this pathology is surgery.
• Tumors are a fairly common cause of proctitis. Tumors of the large intestine in our country rank 2-3 in frequency, second only to breast and prostate cancer. Rectal cancer accounts for 25-30% of the total number of colon cancers. A tumor of even a small size disrupts trophism and patency in the rectum
• Endogenous causes are Crohn's disease and UC.

Treatment of acute proctitis

A combination of non-drug therapy along with medication is important. The first point implies limiting significant physical activity; bed rest is desirable. The patient is strongly recommended to follow a gentle diet until all symptoms of proctitis disappear. It implies an exception:

• mechanically irritating dishes and drinks (too hot/cold; optimal temperature 15-20°C);
• chemically irritating dishes (sour, salty, bitter, fried, etc.);
• products that can provoke the development of constipation and impaired motor skills (pomegranate, flour dishes, pasta).

It is important that meals are regular and fractional (small portions). You should not take long breaks between meals (more than 6 hours), as this can lead to disruption of the passage of the food bolus through the intestines.

In addition to diet, non-drug treatment of proctitis includes local anti-inflammatory procedures, such as:

• baths with potassium permanganate (potassium permanganate). They are recommended to be taken in a sitting position, no more than 4 times a day;
• enemas/finger application of sea buckthorn or olive oils to the walls of the rectum;
• To improve the general condition, mild sedative (calming) drugs are recommended - tinctures of valerian/motherwort. They can be used up to 4 times a day, dissolving 30-40 drops of tincture in 100 ml of water.

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

When irritating substances are introduced into the intestine or after mechanical trauma (minor)

For infectious inflammation of the rectum

First of all, it is necessary to eliminate the damaging factor - to destroy harmful bacteria in the rectal cavity. It should be noted that if the occurrence of proctitis is associated with intestinal infections (escherichiosis, dysentery, etc.), it is necessary to use drugs to sanitize the entire intestine.

Hormones (glucocorticosteroids) for topical use are not recommended for infectious inflammation, as they can promote the spread of bacteria and prevent their destruction.

The treatment regimen that can be used for infectious proctitis is as follows:

• Local antiseptic suppositories and ointments that are aimed at destroying bacteria. For example: Proctosan, Simetride;

How to use? It is recommended to administer the drug after defecation, twice a day. If you purchased the medicine in ointment form, it should only be administered using the applicator (which is included in the kit). After administering the ointment or rectal suppository, the drug should be kept in the intestinal cavity for at least 30 minutes. There is no need to specifically remove it. After the symptoms disappear, it is recommended to continue the course for another 7-9 days.

• Antibacterial drugs to sanitize the intestines from bacteria (only for intestinal infections). The best of them is Furazolidone - having a wide spectrum of action, it reaches its maximum concentration in the intestinal cavity and is absorbed into the blood by only 30%. Unfortunately, patients are often allergic to it. In this case, an alternative is antibiotics - Tetracyclines (Unidox, Doxycycline). They are contraindicated for pregnant women and children under 8 years of age. The safest poison for them is Josamycin, but only a doctor can choose the optimal antibiotic during an individual consultation.

How to restore normal bowel function? Since these drugs specifically destroy the intestinal microflora (both pathogenic and normal), after completing the course, problems with digesting food (especially dairy and plant products) may arise. To prevent this, you should “settle” beneficial bacteria with the help of medications such as Bifidum, Bifidumbacterin, Linex, etc. (see list of probiotics).

• NSAIDs/combined drugs (antispasmodics + NSAIDs);
• Laxatives (described above).

As a rule, the symptoms of infectious intestinal inflammation disappear within a few days (up to a week) if treatment was correctly prescribed and started in a timely manner.

With the introduction of a foreign body or inflammation of the peri-rectal tissue

Surgical intervention is indicated - removal of a foreign body from the intestinal cavity or a purulent focus in the tissue. After the operation, the surgeon determines further therapy, depending on the presence of complications, the degree of damage to the rectum and the patient’s condition. As a rule, it includes:

• Antibiotic;
• NSAIDs;
• Laxative.

Clinical fact. The human intestine is capable of not only performing peristalsis towards the rectum, but also moving objects in the opposite direction (if it is completely blocked). Therefore, foreign objects that patients insert into their rectum often end up much higher - in the sigmoid or even colon (30-50 cm higher). In this case, the surgeon cannot remove the object without making incisions, which is why he has to perform more traumatic operations.

For rectal tumors

In this case, the patient is sent for consultation to an oncologist. A repeat biopsy is performed and, if possible, a CT scan. Thanks to this, the extent of tumor spread, the presence of metastases and damage to the lymph nodes are determined. If the tumor is benign, only the tumor is removed. In case of a malignant tumor that has not had time to grow into neighboring organs and give metastases, the entire rectum is removed with a sigmostoma (extending the external opening of the intestine to the anterior abdominal wall). If the malignant tumor has spread beyond the rectum, radiation and chemotherapy are used.

A very approximate scheme of the oncologist’s actions is described, since the treatment of rectal tumors (especially cancer) is a complex step-by-step process that only a specialist can correctly carry out. Read more about treatment for colorectal cancer.

Symptoms of proctitis

In adults, the symptoms of proctitis (see photo) can be caused by damage to the rectum itself (local) or be associated with a systemic reaction of the whole body to inflammation (systemic).

Local symptoms include:

• stool disorders (with proctitis, there are both diarrhea caused by inflammation itself and discharge from erosions, ulcers, and constipation that appears due to spasm of the upper parts of the intestine or narrowing of the affected rectum);
• pain in the perineum or anus (because of this, some patients have a fear of the process of bowel movement - defecation);
• itching, weeping and discomfort in the anal area;
• false or urgent urge to defecate;
• fecal incontinence;
• pathological impurities or inclusions in stool (mucus, parasites or their fragments, blood, pus).

Systemic manifestations of proctitis, indicating the seriousness of the process, may include:

• fever;
• weight loss;
• decreased appetite;
• weakness;
• psycho-emotional disorders;
• rash;
• joint pain;
• lacrimation, redness of the eyes.

The last three symptoms are observed with allergic, immune or infectious damage. Sometimes they even precede local manifestations.

Symptoms

With an inflammatory process in the rectum, the following complaints are typical:

• pain in the anus that occurs during defecation, sometimes abdominal pain of varying intensity - characteristic symptoms of proctitis;
• diarrhea mixed with blood, mucus, and sometimes pus in the stool. With proctitis of parasitic etiology, whole or fragmented helminths can be seen in the feces.
• tenesmus - irritated intestinal mucosa causes a false urge to “go to the toilet.”
• at the beginning of acute proctitis, a spasm of the rectal sphincter occurs, and subsequently its full opening - a gaping anal hole (see photo above). In chronic forms, diarrhea can alternate with constipation, which is associated with a variety of causes, as well as alternating periods of remission and exacerbations.
• in moderate and severe cases of the disease, body temperature rises, symptoms of intoxication and fever appear.

Symptoms of chronic proctitis

In the presence of this form of the disease, periods of exacerbation always alternate with periods of remission. The main criterion for making a diagnosis is the duration of the disease for more than 6 months.

The clinical picture of the pathology outside the period of exacerbation in most cases is limited to a periodic feeling of discomfort in the rectal area. Since the cause of the development of chronic proctitis is most often the presence of another pathology, the symptoms primarily reflect the disease that caused the problem.

The clinical picture and treatment of proctitis during the period of exacerbation of the disease are no different from the acute form of the pathology.

Proctitis - treatment with folk remedies

Some methods of treating proctitis with folk remedies help relieve the inflammatory process occurring in the rectal area. When treating proctitis with folk remedies, you need to take two tablespoons of calendula flowers and pour a glass of boiling water over them. All this must be heated in a water bath for 15-20 minutes (stirring constantly). The resulting infusion should be cooled and filtered. The infusion should be consumed daily three to four times a day, after diluting it with water.

This infusion can be used for intestinal lavage. To do this, pour one tablespoon of boric acid (3%) into one tablespoon of infusion. The resulting medicine is administered by enema every day before bedtime.

For proctitis, you can take half a tablespoon of lemon balm and oregano, mix and pour a glass of boiling water. Then place in a water bath for 25 minutes, then let the broth brew for an hour and a half. The resulting decoction can be used to produce retained enemas.

For a sitz bath, you can use an infusion of horsetail. To prepare the infusion, take half a glass of horsetail and pour one liter of boiling water over it. Let the broth sit for about ten minutes and strain. The resulting decoction can be used for a sitz bath.

For inflammation of the rectal mucosa, a mixture of oak bark, toadflax flowers and water pepper herb will help. All components must be taken in equal volumes, ground to a pulp in a mortar and poured with melted warm pork fat. After 12 hours, the resulting mixture should be slightly warmed and strained. Then take a little of the prepared mixture onto a gauze swab and insert it into the anus. Keep for at least five hours. The course of treatment should last approximately three weeks.

Symptoms of radiation proctitis

Radiation proctitis is a type of chronic form of the disease, but some clinicians classify it as a separate type. The main difference is the pronounced pain syndrome (“excruciating”), which accompanies the patient all the time. Unfortunately, to date no effective remedy has been developed for the pain relief of radiation proctitis, so it is very difficult to eliminate such a symptom.

In addition to local manifestations, radiation proctitis is characterized by the presence of general symptoms:

• immunosuppression, which increases the risk of developing respiratory and intestinal diseases;
• absence or significant decrease in appetite;
• weight loss.

The clinical picture of the pathology is not limited to this, since radiation sickness has a significant impact on other organs.

Classification of chronic paraproctitis: types and code according to ICD-10

According to the modern international classification of diseases, 10th revision (ICD-10), proctitis has code K 62.8.1. The modern classification is based on the reason for its development:

• infectious origin;
• parasitic disease;
• congestive or nutritional inflammation;
• pathology caused by chemical or mechanical irritation of the mucous membrane;
• radiation proctitis;
• chronic autoimmune inflammation.

Ulcerative proctitis is distinguished separately, which is characterized by the formation of ulcers and erosions of the mucous membrane. It predominantly develops against the background of Crohn's disease, ulcerative colitis and has code K 51.2.

Proctitis in children

Proctitis in children can manifest itself, especially before one year of age. The causes are intolerance to milk, protein, the presence of worms, constipation, intestinal infections, swallowing solid objects, poor diet, enema, violence. Proctitis manifests itself in discharge, mucous, bloody or purulent, on diapers, changes in skin color, weight loss, constipation and bloating, dermatitis.

If such symptoms appear, you should take the baby to a pediatrician, who will examine him and prescribe treatment: artificial nutrition, diet, taking antispasmodics, administering enemas and suppositories, UHF, ultrasound, etc.

Risk factors

The following factors can provoke the development of acute inflammation or exacerbation of chronic inflammation:

• sexual preferences: homosexuality; using rough or oversized dildos to irritate the anal ring in both sexes; the use of various foreign objects for the purpose of sexual gratification, leading to chronic trauma to the rectum;
• chronic intestinal diseases, especially Crohn's disease;
• systemic infections, especially syphilis and gonorrhea;
• inflammation of the walls of blood vessels or vasculitis;
• surgery on the pelvic organs for cancerous tumors followed by radiation;
• abuse of enemas;
• too frequent use of rectal suppositories;
• constant consumption of spicy, peppery foods;
• frequent consumption of strong alcoholic drinks.

Diagnostics

The final diagnosis is determined based on the results of all examinations and examinations of the patient. As an additional diagnostic method, an examination of the vagina in women or the urethra in men is performed to exclude a gonorrheal or trichomonas cause of the disease. If necessary, a test is carried out for the presence of intestinal tuberculosis.

Instrumental diagnostic methods are used as an examination to detect proctitis. Most often, specialists resort to sigmoidoscopy, which can be used to examine the mucous membrane lining the rectum from the inside and, in some situations, the final part of the sigmoid. Since this technique is considered one of the most accurate diagnostic methods, allowing for an objective assessment of more than 35 centimeters of intestine, the examination primarily pays attention to the following changes:

• condition of the intestinal walls;
• presence of structural changes;
• deviations from the color norm;
• existing pathological formations;
• discharge of purulent discharge or mucus;
• state of the vascular pattern.

The examination procedure is carried out with a special optical device - a sigmoidoscope, and in case of complex cases of proctitis with its erosive, polypous, catarrhal-purulent or ulcerative nature, an additional biopsy is performed followed by histology. During the examination, according to the doctor’s indications, a product containing antibiotics is applied, which accelerates the healing of damaged areas of the mucosa. In the form of additional diagnostic methods to determine the causes of inflammation in the rectum, they resort to colonoscopy or FGDS.

Tests and diagnostics

The diagnosis of “proctitis” is established based on the patient’s complaints, medical history, the results of a visual examination of the anus, a digital examination of the rectum, as well as data from stool tests (bacterial stool examination, coprogram, stool analysis for worm eggs) and instrumental research methods (sigmoidoscopy ). If necessary, PCR/ELISA diagnostics are performed for a specific infection ( syphilis , gonorrhea ). Proctitis is differentiated from paraproctitis , hemorrhoids , rectal fissure , polyposis .

Possible complications of the disease

1. Acute paraproctitis - acute inflammation of the tissues surrounding the rectum;
2. Significant decrease in immunity;
3. Sigmoiditis is inflammation of the sigmoid colon;
4. Malignant neoplasms in the rectal area.

As you can see, all possible complications are dangerous, so you really should be wary of them. So, for example, with the development of acute paraproctitis, it will be impossible to cope with the pathology without surgical intervention. To prevent the development of all these conditions, you should consult a proctologist when the very first signs of proctitis occur.

Complications

Proctitis causes unpleasant complications that can be prevented with timely treatment. Such complications may include holes in the skin caused by purulent and mucous masses. Inflammation of the pelvic peritoneum may appear as a complication.

Proctitis can also lead to inflammation of parts of the intestine that lie higher, such as the sigmoid colon. The disease also sometimes causes malignant tumors to appear in the rectal area.

Decreased immunity is quite common. It usually appears due to a viral infection. It is important that if you get proctitis, do not try to treat it at home, immediately contact a specialist to avoid complications.

Drug treatment

Typically, proctitis therapy is carried out on an outpatient basis. But in severe forms of inflammation, the patient is recommended to be treated in a hospital: firstly, this allows the patient to follow a diet, secondly, it helps to give up bad habits and lead a healthy lifestyle, and thirdly, it provides effective treatment under the supervision of specialists.

For proctitis, the patient may be prescribed the following medications:

1. Antibacterial and antiviral, depending on the results of bacteriological studies (metronidazole, chloramphenicol, penicillins, macrolides, etc.)
2. Antispasmodics (No-spa) - to relieve pain, eliminate spasms, and facilitate bowel movements.
3. Antiallergic drugs - relax the walls of the rectum.
4. Products that improve tissue regeneration (suppositories with methyluracil, sea buckthorn oil) help restore the mucous membrane, improve metabolic processes, and relieve symptoms of inflammation.
5. Hormonal drugs (dexamethasone, hydrocortisone) are prescribed for some types of proctitis.

As additional measures, cleansing enemas (to ensure bowel movements), enemas with medicinal solutions, herbs (chamomile, calendula, collargol) are recommended. Sitz baths with potassium permanganate have a local antiseptic effect.

How to treat proctitis

Treatment of proctitis in adults begins with drug therapy carried out in an outpatient setting and using symptomatic and etiopathogenetic methods.

Patients are prescribed bed rest and gentle nutrition, and are also advised not to sit for long periods of time. After the exacerbation of the disease is relieved, the patient should avoid overexertion during physical activity. If the disease is particularly severe, which is typical for the acute form of ulcerative or ulcerative-necrotic proctitis, then treatment begins with placing the patient in an inpatient setting under the supervision of a doctor.

Physical activity plays a significant role in the treatment of proctitis. Patients should not sit for long periods of time, as this posture and lack of dynamic movement weakens the pelvic muscles and causes congestion in the lower body. Even a severe illness and bed rest should not serve as a limitation for moderate physical activity and require the use of a special complex of physical therapy.

Medicines and enemas

The necessary medications for medical treatment are prescribed by the doctor based on individual indications and depending on the type of proctitis and the damage caused by it. Most often, medications with properties such as:

1. Antibiotics. A specific drug containing antibiotics is prescribed after a laboratory test, with the help of which the type of pathogen that caused the inflammatory process in the rectum is determined. The main action of antibacterial agents is intended to suppress the activity of these pathogenic microbes.
2. Antispasmodics. Products containing antispasmodics eliminate spasms and relieve pain, and in this way it is also possible to normalize bowel movements.
3. Antihistamines. This type of medication is intended to relax the intestinal muscle tissue and eliminate painful symptoms.
4. Enemas with therapeutic and cleansing effects. This type of treatment is often used to eliminate inflammation in the intestines. The use of medicines in the form of a solution and decoction of medicinal plants allows for cleansing and antiseptic treatment in the intestinal cavity.
5. Glucocorticoids. These medications are hormones produced by the adrenal glands and are prescribed for proctitis caused by ulcerative colitis.

It is not allowed to prescribe any medications for treatment on your own; the prescription of medications and their dosage should be determined only by a proctologist.

Proper nutrition

First you need to exclude from your menu all foods that irritate the intestines. It is worth limiting yourself to foods that are too fatty, too spicy and too sour. It would be correct to eat cottage cheese, scrambled eggs, and porridge boiled in water for breakfast. For lunch, you can eat low-fat broths, boiled meat, vegetable soups or chicken cutlets. Dinner should be porridge boiled in water, low-fat cutlets or cottage cheese.

Also, when fighting proctitis, you should stop drinking alcohol.

Physical activity regimen

A very important measure in the treatment of proctitis. To prevent blood stagnation in the pelvic muscles, you should not spend long periods of time sitting. It is necessary to create not very tiring physical activity for the patient. If the condition is severe and the doctor recommends bed rest, you should still take care of minimal stress.

Indications for surgery

If paraproctitis occurs, you must first surgically get rid of the epicenter of the suppuration. If a narrowing of the rectum has occurred, then an operation must be performed to restore its normal size. Surgical intervention is also necessary if proctitis cannot be cured by other methods for a long time or if rectal tumors appear.

Diet

If you have proctitis, you need to exclude from your diet all foods that irritate the rectum: spicy, salty, sour, fatty, spices. During acute proctitis and exacerbation of chronic proctitis, you should temporarily avoid vegetables, fruits, berries, and any sweets.

Sample diet for proctitis:

Treatment

Patients faced with proctitis have a logical question: how to treat the disease and get rid of discomfort as soon as possible? If the pathology proceeds without complications , therapy is possible at home.

Doctors most often prescribe topical remedies to help cope with inflammation and reduce pain and itching. The most common are Proctosedyl and Anuzol suppositories.

In addition to these drugs , sea buckthorn oil (can be in the form of suppositories), microenemas with potassium permanganate, oak bark or chamomile , warm baths with immortelle infusion, regenerating ointments (Proctosan, Bezornil) are prescribed. Antibiotics for proctitis are prescribed only if bacteria are the cause of the disease.

Surgical treatment is indicated if conservative methods do not give a positive result, as well as in the presence of a benign or malignant tumor that interferes with the patient’s normal life.

In addition to the main therapy, alternative medicine can be used Microenemas with calendula infusion are effective. To prepare them, take dried or fresh leaves of the plant, pour a glass of boiling water and leave for about two hours in a dark place. The strained concentrate is diluted in water in a ratio of 1 tbsp. spoon per 100 ml. You can supplement the infusion with chamomile.

As tea, decoctions of string, tansy, raspberries, and plantain are taken orally, 1-2 tbsp. spoons 3-4 times a day.

Warm sitz baths are great for itching and discomfort : sage, knotweed, eucalyptus, and chamomile are used for this.

Attention! Self-treatment is unacceptable. The use of traditional medicine recipes is possible only after consultation with a doctor.

A proper diet is of great importance during therapy. It is necessary to reconsider your diet and completely abandon the following foods :

• fatty, fried, spicy, salty;
• smoked meats and preservatives;
• sweets and chocolate;
• sweet carbonated drinks;
• foods rich in fiber (fruits, vegetables, cereals).

It is worth paying attention to your diet . It should be fractional, at least five times a day, but in small portions - this reduces the load on the digestive organs. It is healthy to eat fermented milk products (cottage cheese, unsweetened yogurt, fermented baked milk, kefir), boiled or steamed meat, poultry and lean fish, light meat and vegetable soups. You are allowed to eat baked apples.

The prognosis of the disease is favorable, especially if treatment was started in a timely manner . The chronic form of proctitis can cause exacerbations, which can be reduced with diet and a healthy lifestyle.

Treatment of chronic proctitis

In this form, all the doctor’s efforts are aimed at detecting and eliminating the manifestations of the underlying disease (due to which inflammation of the rectum has developed). Its successful therapy is the only way to get rid of chronic proctitis. Treatment regimens for possible causes are very complex, so we will describe only the fundamental points:

Structure of the rectum

The rectum is the final section of the intestine, it begins in the sigmoid colon and ends in the anus. The lining of the rectum is made up of muscle and has a large amount of mucus, which helps push down leftover food.

Two muscle rings (anal sphincters) contract and retain feces. And during their relaxation, defecation occurs. In men, the rectum is connected to the prostate and bladder, in women - to the vagina and uterus.

When the rectum functions properly, all processes go unnoticed, but if there is any malfunction, inflammation of the rectum can develop. More than 30% of people with inflammatory bowel disease have inflammation of the rectum. One of the most common diseases is proctitis.

1 Consultation with a proctologist

2 Consultation with a proctologist

3 Consultation with a proctologist

Treatment of radiation proctitis

Pain syndrome comes to the fore with radiation proctitis. It is so pronounced that patients cannot find any relief from the pain. Therefore, it can be removed with any pharmacological drug that is effective for the patient. It is possible to prescribe narcotic analgesics, NSAIDs, antispasmodics, and so on.

In addition, it is imperative to carry out therapy aimed at reducing the damaging effects of radiation. For this purpose, antioxidants are used (ascorbic acid; tocopherol, etc.). To reduce inflammation, local hormonal agents (Ultraproct, Doloproct) are used.

This is only an approximate treatment regimen for radiation proctitis; adequate treatment can only be prescribed individually, directly when contacting a radiologist.

Currently, proctitis is not a dangerous disease. Effective methods have been developed to treat various forms of the disease, which allows one to achieve either complete recovery or stable remission. The main thing that the patient must do for this is to promptly seek advice from a doctor, since prolonged self-medication can lead to the development of complications and aggravation of the severity of the disease.

Local therapy for proctitis

In addition to the main treatment, microenemas with oils and herbs and sitz baths with a solution of potassium permanganate (a faint pink solution of potassium permanganate) are prescribed.

Suppositories with Belladonna, Methyluracil, Proctosan, suppositories with Prednisolone, Relief - Ultra, Ultraproct help relieve the condition of inflammation of the rectum.

Action of suppositories:

• • Healing of microcracks, erosions, ulcerative defects. • Drying. • Anti-inflammatory. • Laxative. • Antipruritic. • Relieving pain symptoms.

Chronic proctitis is well corrected with proper nutrition and spa therapy. Mineral waters, which have a good effect on the entire gastrointestinal tract as a whole and on the lower intestines, can be drunk in Truskavets, Essentuki and other famous health resorts.

What to do at home?

Any uncomplicated proctitis with a mild course can be treated at home. But still, at home you should follow the recommendations of the proctologist, and not self-medicate, since it is imperative to diagnose the disease and differentiate it from many other pathologies of the rectum. After all, all the symptoms are similar to such a terrible and widespread disease in modern times as rectal cancer, in which self-medication means deterioration of the condition and loss of precious time.

Principles of treating proctitis at home:

1. A diet excluding spicy, salty, fatty, fried foods, as well as raw foods of plant origin.
2. Light physical exercise, avoid prolonged sitting.
3. Hygiene of intimate places.
4. Avoiding anal sex during illness.
5. Quitting bad habits, especially any alcohol.
6. Drug treatment of proctitis: tablets (less often injections), administration of medications in the form of enemas, suppositories.
7. Warm sitz baths.
8. Traditional methods of treatment should be combined with traditional ones, and not replace them. It must be remembered that improper treatment of acute proctitis leads to chronic proctitis, that is, the patient dooms himself to the disease for life.
9. If there are complications of proctitis, you should urgently consult a doctor; surgery may be necessary.

The most effective methods of traditional medicine for the treatment of proctitis:

Acute proctitis is completely curable with adequate and timely treatment. But if the disease has become chronic, then no treatment methods lead to complete recovery. But with proper therapy and diet, you can achieve long-term remission of the disease and prevent the development of complications.

Treatment of intestinal proctitis

When treating proctitis, both during the period of exacerbation and in the acute form, you should adhere to a mechanically and chemically gentle diet. If flatulence is present, limit the consumption of carbohydrates and dairy products.

If you are prone to constipation, you should eat more fruits, vegetables, and bran bread.

When treating infectious proctitis and colitis, it is preferable to use antiseptics:

• Intetrix - take 2 tablets 2 times a day for 10 days;
• Ersefuril (analogs Enterofuril, Stopdiar, Ecofuril ) is a very effective drug in the treatment of infections of the large intestine, which is highly active against E. coli, salmonella, clostridia, shigella and staphylococci. The drug should not be used under the age of 3 years or during pregnancy. Take the medicine 4 times a day, 1 capsule, for a course of 5-7 days.

For abdominal pain and flatulence, antispasmodics provide good relief:

• Spasmomen is a drug that causes relaxation of the smooth muscles of the intestine. Use 1 tablet 2 times a day for 2-3 weeks. The drug has no contraindications or side effects.
• Dicetel is a drug similar in effect to the previous one, but it cannot be used during pregnancy, childhood, or severe intestinal damage, as it can cause smooth muscle atony.

For persistent diarrhea, astringents (black tea, sage infusion, bird cherry fruits, oak bark), enveloping drugs ( Almagel, Phosphalugel, Maalox ), and sorbents (activated carbon) are prescribed. Enveloping and astringent drugs are especially necessary for erosive proctitis to protect the damaged areas from further destruction.

Imodium (lopreamide) is recognized as the drug of choice for the treatment of diarrhea. The drug Imodiup Plus has also proven itself very well , which includes simethicone, which absorbs intestinal gases, which is very necessary for diarrhea and flatulence.

For constipation, osmotic laxatives are usually prescribed:

• Forlax – take 2 sachets 2 times a day with meals.
• Duphalac is an effective drug that can be used by children from birth, as well as during pregnancy. Dosage for children is 5-15 ml depending on age. In adults, 15-40 ml - for the treatment of infectious proctitis, 20 ml 3 times a day for 10 days.

espumizan is successfully used, 1-2 capsules orally 3 times a day.

For proctitis of any etiology, it is prohibited to take non-steroidal anti-inflammatory drugs and painkillers. These medications may “mask” serious symptoms and treatment may not be started on time.

Prevention

Measures aimed at preventing proctitis and its relapses include maintaining general and local health:

• timely treatment of gastrointestinal diseases;
• elimination of inflammation in neighboring organs;
• proper nutrition (limit fried, fatty, spicy);
• giving up alcohol and smoking;
• maintaining careful hygiene of the anus and genitals;
• use of barrier contraceptives to prevent transmission of infection during sexual intercourse.

Prognosis and prevention

The prognosis for proctitis, in particular in its chronic form, is favorable . If the treatment regimen is drawn up correctly and treatment is carried out in a timely manner, rapid recovery and stable remission can be achieved.

Prevention consists of eliminating negative factors that can affect the development of the pathological process. It is important to maintain hygiene, promptly treat inflammation of the pelvic organs and genitourinary system, lead a healthy lifestyle, and use a condom when practicing anal sex.

Forecast

Depending on the factors that caused the inflammatory lesion of the rectum and the timely initiation of the rehabilitation course, the prognosis may be different. For example, if proctitis is provoked by an infection, and therapy is started when the initial symptoms appear at the catarrhal stage, recovery occurs after 10 days.

The prognosis will be questionable and even unfavorable if the rectum is affected by tuberculosis, Crohn's disease, and cancer.

Rectal cancer Rectal fistula Hemorrhoids Colon cancer Colitis of the intestine Ulcerative colitis of the intestine

Disease severity

According to severity, proctitis is usually classified into the following options:

1. Mild degree – pain is not intense, bleeding is minor, body temperature is not elevated, diarrhea up to 5 times a day.
2. Moderate severity – severe pain during defecation, severe bleeding (even in the absence of feces during defecation), temperature increased to 38°C, diarrhea up to 10 times a day.
3. Severe severity - the patient is in serious condition, body temperature is above 38°C, the anus is gaping, bleeding is pronounced from the rectum, hemodialysis is required. Such conditions develop with acute intestinal obstruction, cancer, necrosis of the large intestine, and Crohn's disease.

Classification of the disease

According to the nature of the damage to the mucous membrane, proctitis is divided into:

• catarrhal,
• ulcerative

With the flow:

• spicy,
• subacute,
• chronic.

Catarrhal proctitis is divided into:

• catarrhal mucous,
• catarrhal-hemorrhagic,
• catarrhal-purulent.

Ulcerative proctitis is divided into:

• erosive,
• ulcerative-necrotic,
• purulent-fibrinous.

There are 2 forms of chronic proctitis:

• atrophic,
• hypertrophic.

Rice. 5. The photo shows proctitis.

Causes

Proctitis (proctitis; Greek proktos anus, rectum + -itis) is inflammation of the mucous membrane of the rectum. Proctitis is one of the most common diseases of the rectum, often combined with inflammation in the final part of the large intestine - the sigmoid colon (proctosigmoiditis), inflammation of the inner lining of the large intestine (colitis), with hemorrhoids or anal fissures (see photo below)

The main causes of proctitis:

• unbalanced nutrition, constant violation of the diet, which includes abuse of spicy food, dishes seasoned with hot spices, “love” for alcoholic beverages - the causes of alimentary (food) proctitis;
• congestive usually occurs in patients prone to prolonged constipation caused by stagnation of venous blood flow and the formation of areas of blockage of small vessels in the rectum;
• radiation is a “side effect” of radiation therapy for oncopathologies of the pelvic organs, both in women and men;
• the cause of gonorrhea is the flow into the anus of discharge from the patient’s genital organs containing the pathogen;
• parasitic - damage to the mucous membrane of Trichomonas, dysenteric amoeba.

It is customary to classify the causes that can lead to an inflammatory process in the rectum into two groups.

1. The first group consists of local damaging factors that directly affect the mucous membrane of the organ.
2. The second group consists of general factors that affect not only the final sections of the intestine, but also the entire body in particular.

Local damaging factors

Rectal administration (through the anus) of any irritating substances:

• Any essential oils (eucalyptus, clove, peppermint, etc.);
• Alcohol and purified turpentine;
• Tinctures on capsicum, mustard.

Most often, they are used by patients as an alternative treatment for proctitis, which only leads to worsening symptoms.

Causes of general proctitis

• Infectious causes: dysentery, salmonellosis, escherichiosis (especially the hemorrhagic form).
• Autoimmune diseases affecting the intestines: Nonspecific ulcerative colitis (UC), Whipple's disease, Crohn's disease.
• Parasitic diseases, for example: amoebiasis, giardiasis, ascariasis, enterobiasis.

Factors that are not the direct cause of proctitis, but contribute to its development:

• hypothermia;
• frequent infections;
• decreased immunity;
• inflammatory diseases of neighboring organs: bladder (cystitis), internal female genital organs (vaginitis - inflammation of the vagina, vulvovaginitis - inflammation of the vagina and external genital organs, oophoritis - inflammation of the ovary);
• any stool disorders.

Therapy of the disease and its varieties

Proctitis must be treated under the strict supervision of a doctor. Treatment of chronic proctitis - therapy with antibiotics or antibacterial agents:

1. Penicillins.
2. Cephalosporins.
3. Macrolides.
4. Aminoglycosides.
5. Tetracyclines.
6. Levomycetin.
7. Metronidazole.

Antibiotics - tablets, suspensions, capsules - are suitable only if the cause of the disease is bacteria. However, if the disease is the result of uncontrolled use of these drugs or their overdose, then drug treatment of proctitis with antibiotics will not only not help, but will also worsen the situation. In this case, the doctor may prescribe Vancomycin or Trichopolum. For herpes and cytomegalovirus infections, antiviral and antiallergic drugs are used - Nalkrom, Bicromat, Vividrin, Intal. Sulfasalazine is prescribed for oral administration. Treatment of the chronic version of the disease can be done on an outpatient basis; the ulcerative type of the disease requires immediate hospitalization. No-Shpa is very often used as an antispasmodic that relieves major pain sensations.

If the disease requires local treatment (extensive ulcers, nodes and rashes in the rectum), suppositories and enemas are used. For the post-radiation type of the disease, Hydrocortisone or Mesalazine is used. These drugs are administered through the anus. Cortisol is produced in the form of foam, specially designed for insertion into the anus. A special device is provided for this. Local antimicrobial drugs include Colibacterin. The same applies to ordinary potassium permanganate, which is diluted in a certain proportion with water and injected directly into the rectum using an enema. If the disease manifests itself during pregnancy or a child suffers from it, then treatment with microenemas and glycerin suppositories is used.

Relief rectal suppositories are very effective for proctitis. They are used to eliminate swelling, itching and burning, and severe inflammation. Relief reduces blood loss, and in case of regularly occurring hemorrhoids, it helps to straighten the node without surgery. Relief is used in the morning and evening, as well as after each act of defecation during a particularly acute period of the disease.

As an additional therapy, many doctors prescribe spa procedures - subaqueous baths, mud, intestinal douching with alkaline mineral waters, therapeutic massage and physical exercise. For severe cicatricial narrowing of the anus, surgical intervention is used. If you follow all the doctor’s recommendations and the treatment regimen, the prognosis for the outcome of the disease is favorable. Only a competent doctor can cure proctitis without health consequences.

Candles

The introduction of suppositories is considered an additional, alternative method in the treatment of proctitis. In some cases, with the help of this form of drugs it is possible to achieve a faster recovery, in other situations this method is contraindicated.

The specific type of suppositories is prescribed depending on the patient’s condition, the symptoms that torment him, and the nature of the ongoing process. If there are symptoms of acute proctitis, then rectal remedies can be used only in mild forms - to relieve the manifestations of the disease and more effective treatment.

Today, the following suppositories are used to treat proctitis: based on methyluracil, sea buckthorn, Ultraproct, Proctosan. In severe forms of inflammation of the rectum (ulcerative), the doctor may prescribe suppositories based on Prednisolone or Sulfasalazine.

Suppositories are not the only method of treating proctitis. Treatment of this disease includes the use of antibiotics or antivirals (depending on the causative agent of the infection), antispasmodics, antihistamines, enemas, and diet. If complications occur, surgery may be required.

Allowed and prohibited during the diet

Proper dietary nutrition for proctitis is a paramount component of the entire recovery process. It makes recovery extremely easy.

With proctitis, accompanied by frequent constipation, intestinal motility is greatly weakened. In this case, foods containing fiber are included in the menu. They stimulate the gastrointestinal tract and the movement of fecal matter. In addition, the diet for proctitis should contain a maximum of vitamins and microelements. The main components in the patient's diet should be as follows:

1. Coarsely ground black bread or with a high bran content.
2. Fruits - dried fruits, oranges, tangerines, berries, apples.
3. Vegetables - cabbage, including sauerkraut, beets in raw and boiled forms, pumpkin - puree, soups, as well as turnips, watercress.

With your doctor's permission, you can supplement your diet with fruit drinks and herbs. It is recommended in the morning (on an empty stomach) to drink 200 ml of tap water with a drop of lemon and 2 tsp. Sahara.

Foods that increase the secretion of the digestive organs are prohibited. These include:

• White bread, bakery products and baked goods made from premium flour.
• Strong tea and coffee.
• Spices and hot seasonings.
• Smoked and dried dishes.
• Chocolate and chocolate-containing products.
• Cereal porridges - rice, semolina, buckwheat.
• Garlic, radish and pepper.
• Fatty meats and broths made from it, fried meat and fish.

Especially if you have proctitis, you should not eat canned or pickled products, sausages and sausages.

Prevention of proctitis is a set of simple norms and standards of human life, which are very easy to observe. For example, a healthy lifestyle - normal physical activity, giving up tobacco and alcohol, proper diet and daily routine. A prerequisite is an orderly sex life and strict adherence to the rules of personal hygiene. In case of doubtful sexual intercourse, a condom must be used. If an adult or child exhibits 2 or more symptoms of proctitis, you should immediately consult a doctor. During prevention and treatment, it is very important to give moderate physical activity to the body. Prolonged sitting in a sitting position negatively affects the pelvic muscles, thereby disrupting the normal process of bowel movements.

If the patient consults a doctor in a timely manner, serious consequences can be avoided. If the disease has already acquired a chronic form, a complete cure is impossible, only the elimination of painful symptoms. The patient should not treat himself or use medications without the advice of a doctor. Only the attending physician can accurately diagnose and determine which treatment methods will be most effective in this case.

Causes of the disease

Proctitis according to the mechanism of development is divided into:

• Infectious.
• Traumatic.
• Stagnant.
• Radiation.

The causes of infectious proctitis are:

• Causative agents of sexually transmitted infections: gonococci, chlamydia, spirochete pallidum, etc. The disease is most common in men who have sex with men. In women with gonococcal proctitis, pathogens enter the rectum from the vagina.
• Of the nonspecific flora, streptococci and staphylococci are often found, as well as representatives of the intestinal flora - Escherichia coli, etc.
• Proctitis can be caused by pathogens of intestinal infections such as shigellosis, salmonellosis, and campylobacteriosis.
• With irrational use of antibiotics, clostridiosis and intestinal candidiasis can develop, which in turn affect the rectum.
• In patients with immunodeficiency, viral proctitis occurs, caused by herpes viruses and cytomegaloviruses.
• Tuberculous proctitis is rare nowadays.
• Parasitic proctitis occurs when the intestines are damaged by pinworms, roundworms, tapeworms, and whipworms. as well as dysenteric amoebas and ciliates - balantidia.

Radiation proctitis

The disease develops as a result of exposure to radiation used to treat tumors of the pelvic region.

Traumatic proctitis

This type of disease is based on injuries to the rectum caused by penetration of inedible objects from the upper intestines. Injuries to the rectum caused by medical manipulation, as well as during anal sex, are more common.

Congestive proctitis

The cause of the disease is venous congestion in the pelvic area, which is manifested by the development of varicose veins and thrombophlebitis.

Malignant tumors

Malignant tumors of the rectum often cause the development of proctitis. They account for up to 1/3 of all colon tumors. The cause of inflammation is toxins produced by the malignant tumor.

Diseases of the digestive system

Proctitis often develops against the background of diseases of the digestive system such as:

• Liver diseases: viral and toxic hepatitis, cirrhosis, cholecystitis.
• Pancreatitis.
• Gastritis.
• Diseases of the stomach and duodenum: gastritis and peptic ulcer.
• Dysbacteriosis.
• Autoimmune diseases: Crohn's disease.

Effect of toxic substances

Proctitis often develops due to poisoning with salts of heavy metals, including lead.

Rice. 2. The photo shows proctitis.

Types and forms of the disease

Classification of proctitis depending on the course of the disease:

1. Acute proctitis
2. Chronic proctitis

Acute proctitis

Acute proctitis is an inflammatory process, the symptoms of which began to appear suddenly. Treatment of acute proctitis should begin immediately when the first signs appear, so that later it does not develop into a chronic form.

The fundamental symptom of acute proctitis is pain in the rectal cavity. They are very strong in nature and intensify during the act of defecation. Painful sensations may also appear in the perineal area, between the anus and genitals. Women experience pain in the labia and vagina, and men experience pain in the scrotum and penis. Some patients experience pain in the lumbar region. Constantly accompanied by a painful urge to defecate.

Depending on the nature of the changes in the intestinal mucosa, acute proctitis is divided into:

• Erosive - superficial lesions - erosions - appear on the intestinal tissues.
• Ulcerative - the intestinal mucosa becomes covered with deeper lesions - ulcers.
• Ulcerative-necrotic - ulcers are present on the intestinal tissues; in some areas, necrosis of the mucous membrane and its rejection occur.
• Catarrhal-hemorrhagic - the mucous membrane is bright red, swollen, and many small hemorrhages are visible on it.
• Catarrhal-mucous - the tissues become bright red, swell, and begin to secrete a lot of mucus.
• Catarrhal-purulent - the tissues look swollen, there is pus on them.
• Purulent-fibrous - the intestinal tissue is covered with a thin film - purulent-fibrous plaque.
• Polypous - growths appear on the mucous membrane that look like polyps.

The most severe is catarrhal-purulent, polypous, erosive and ulcerative proctitis.

Chronic form

The symptoms of chronic proctitis are much less pronounced, but the aching and dull pain does not go away for a long period of time. The course of the disease is wave-like: regular deterioration of the patient’s condition is replaced by frequent remissions.

In most people, chronic proctitis is caused by the presence in the body of infectious and autoimmune diseases, benign or malignant tumors, existing pathology in the blood vessels, genetic predisposition, etc.

The chronic form is divided into:

• Hypertrophic - the mucous membrane is thickened, the folds are swollen, their depth is increased; focal growths of the mucous membrane (false polyps) are detected.
• Atrophic - the mucosa is pale, thinned, the depth of the folds is reduced. Vessels located in the submucosal layer are visible through the mucosa.
• Normotrophic - a color change due to chronic inflammation is detected. The thickness and relief of the mucosa are unchanged.

Atrophic and hypertrophic changes in the mucous membrane make it more vulnerable.

The following forms of the disease are distinguished:

1. Erosive proctitis is an inflammatory lesion of the rectum, in which surface defects (erosions) are formed on the mucous membrane, which subsequently heal without scarring.
2. Catarrhal proctitis is an acute inflammatory process in the rectum that occurs in isolation or as a complication of other diseases of the gastrointestinal tract.
3. Ulcerative proctitis is a form of nonspecific ulcerative colitis, which is characterized by the development of an inflammatory process and the formation of ulcers on the rectal mucosa. Ulcerative proctitis has stages of exacerbation and symptoms depending on the course of the disease.