What are the common symptoms of proctitis. How is proctitis diagnosed and treated. What are the potential complications of untreated proctitis. Who is at higher risk of developing proctitis.

Understanding Proctitis: An Overview of Rectal Inflammation

Proctitis is a condition characterized by inflammation of the rectal lining. The rectum, a muscular tube connected to the end of the colon, plays a crucial role in the digestive system by allowing stool to pass through before exiting the body. When this lining becomes inflamed, it can lead to a range of uncomfortable symptoms and potential complications if left untreated.

This condition can manifest as either acute or chronic, with symptoms varying in duration and severity. Proctitis is particularly common among individuals with inflammatory bowel diseases (IBD) such as Crohn’s disease or ulcerative colitis. However, it can also result from other factors, including sexually transmitted infections (STIs) and radiation therapy for certain cancers.

Recognizing the Signs and Symptoms of Proctitis

Identifying proctitis early is crucial for prompt treatment and prevention of complications. The symptoms of proctitis can vary from person to person, but some common signs include:

• A persistent feeling of needing to have a bowel movement
• Rectal bleeding
• Passage of mucus through the rectum
• Rectal pain or discomfort
• Pain on the left side of the abdomen
• A sensation of fullness in the rectum
• Diarrhea
• Pain during bowel movements

Is rectal bleeding always a sign of proctitis? While rectal bleeding can be a symptom of proctitis, it’s important to note that it can also indicate other conditions. Any unexplained rectal bleeding should be evaluated by a healthcare professional to determine the underlying cause.

Exploring the Various Causes of Proctitis

Proctitis can stem from several different sources, each requiring a unique approach to treatment. Understanding the underlying cause is essential for effective management of the condition. Some of the most common causes include:

1. Inflammatory Bowel Disease (IBD)

Approximately 30% of individuals with IBD experience rectal inflammation. Both Crohn’s disease and ulcerative colitis can lead to proctitis as part of their broader impact on the digestive system.

2. Sexually Transmitted Infections (STIs)

Various STIs can cause proctitis, particularly in individuals who engage in anal intercourse. Common culprits include gonorrhea, genital herpes, and chlamydia.

3. Radiation Therapy

Patients undergoing radiation therapy for cancers in the pelvic area, such as prostate or rectal cancer, may develop radiation proctitis. This can occur during treatment or even years after its completion.

4. Antibiotic Use

In some cases, antibiotics can disrupt the balance of bacteria in the bowels, allowing harmful bacteria like Clostridium difficile to flourish and cause inflammation.

5. Diversion Proctitis

This type of proctitis can occur in individuals who have undergone certain types of colon surgery where stool is diverted from the rectum to a surgically created opening (stoma).

6. Food Protein-Induced Proctitis

Infants may develop proctitis due to an allergic reaction to proteins in cow’s milk or soy-based formulas. Breastfed infants whose mothers consume dairy products can also be affected.

7. Eosinophilic Proctitis

This rare form of proctitis affects children under the age of two and is characterized by an accumulation of eosinophils (a type of white blood cell) in the rectal lining.

Identifying Risk Factors for Proctitis Development

While proctitis can affect anyone, certain factors may increase an individual’s risk of developing this condition. Understanding these risk factors can help in prevention and early detection. Key risk factors include:

• Engaging in unsafe sexual practices, particularly those that increase the risk of STIs
• Having multiple sexual partners
• Not using condoms during sexual activity
• Being diagnosed with an inflammatory bowel disease
• Undergoing radiation therapy for cancers in the pelvic region

Can lifestyle changes reduce the risk of developing proctitis? While not all cases of proctitis are preventable, adopting safe sex practices and maintaining good overall health can help reduce the risk of developing certain types of proctitis, particularly those caused by STIs.

Diagnostic Approaches for Proctitis

Accurate diagnosis of proctitis is crucial for determining the most appropriate treatment plan. Healthcare providers may use a combination of methods to diagnose proctitis and identify its underlying cause:

1. Medical history and physical examination
2. Rectal examination
3. Endoscopic procedures (e.g., sigmoidoscopy or colonoscopy)
4. Biopsy of rectal tissue
5. Stool sample analysis
6. Blood tests
7. Imaging studies (in some cases)

How does a healthcare provider distinguish between different types of proctitis? The combination of symptoms, physical examination findings, and diagnostic test results helps healthcare providers differentiate between various causes of proctitis. For example, the appearance of the rectal lining during an endoscopic procedure can provide clues about whether the inflammation is due to IBD, an infection, or radiation therapy.

Treatment Options for Managing Proctitis

The treatment of proctitis varies depending on its underlying cause and severity. The primary goals of treatment are to reduce inflammation, alleviate symptoms, and address any underlying conditions. Common treatment approaches include:

1. Medications

• Antibiotics for bacterial infections
• Antiviral drugs for viral infections
• Anti-inflammatory drugs (e.g., corticosteroids, mesalamine)
• Immunosuppressants for IBD-related proctitis

2. Dietary Modifications

In some cases, dietary changes may help manage symptoms. This might include avoiding certain trigger foods or following a specific diet recommended by a healthcare provider or dietitian.

3. Lifestyle Changes

Adopting healthier lifestyle habits, such as practicing safe sex and managing stress, can help prevent recurrence and improve overall well-being.

4. Supportive Therapies

Additional treatments may include:

• Stool softeners or fiber supplements to ease bowel movements
• Pain management strategies
• Probiotics to restore healthy gut bacteria

5. Specialized Treatments

For specific types of proctitis, such as radiation-induced proctitis, specialized treatments like hyperbaric oxygen therapy or laser therapy may be considered.

How long does it typically take for proctitis to respond to treatment? The response time can vary depending on the cause and severity of proctitis. Some cases may improve within a few days of starting treatment, while others may take several weeks or even months to fully resolve. Chronic cases may require ongoing management.

Potential Complications of Untreated Proctitis

If left untreated or inadequately managed, proctitis can lead to several complications that can significantly impact a person’s quality of life and overall health. Some potential complications include:

1. Anemia

Chronic bleeding from the rectum can result in anemia, a condition characterized by a lack of healthy red blood cells. Symptoms of anemia may include fatigue, dizziness, shortness of breath, headaches, pale skin, and irritability.

2. Rectal Ulcers

Persistent inflammation in the rectum can lead to the formation of open sores or ulcers on the rectal lining. These ulcers can cause additional pain and bleeding.

3. Fistulas

In severe cases, ulcers may extend through the entire intestinal wall, creating abnormal connections (fistulas) between different parts of the intestine or between the intestine and other organs, such as the bladder or vagina.

4. Strictures

Chronic inflammation can lead to the formation of scar tissue, potentially causing narrowing (strictures) of the rectum or anal canal. This can result in difficulty passing stool and increased pain during bowel movements.

5. Increased Risk of Colorectal Cancer

Long-standing, chronic inflammation of the rectum may increase the risk of developing colorectal cancer, particularly in individuals with IBD-related proctitis.

Can complications of proctitis be reversed? Many complications of proctitis can be effectively treated or managed, especially if caught early. However, some complications, such as extensive scarring or fistulas, may require surgical intervention. Regular follow-up with a healthcare provider is crucial for monitoring and preventing potential complications.

Living with Proctitis: Coping Strategies and Long-term Outlook

While dealing with proctitis can be challenging, there are various strategies that can help individuals manage their symptoms and improve their quality of life:

• Adhering to prescribed treatment plans
• Maintaining open communication with healthcare providers
• Joining support groups or seeking counseling to address the emotional impact of chronic illness
• Practicing stress-reduction techniques, such as meditation or yoga
• Making dietary adjustments as recommended by healthcare providers
• Staying informed about new developments in proctitis treatment

What is the long-term outlook for individuals with proctitis? The prognosis for proctitis varies depending on its cause and how well it responds to treatment. Many cases of acute proctitis, especially those caused by infections, can be successfully treated with a full recovery. Chronic forms of proctitis, such as those associated with IBD, may require ongoing management but can often be controlled with appropriate treatment. Regular follow-up care is essential for monitoring the condition and adjusting treatment as needed.

In conclusion, proctitis is a manageable condition that requires prompt diagnosis and appropriate treatment. By understanding its causes, recognizing symptoms early, and working closely with healthcare providers, individuals with proctitis can effectively manage their condition and minimize its impact on their daily lives. Ongoing research continues to improve our understanding of proctitis and may lead to new, more effective treatment options in the future.

Proctitis – Symptoms and causes

Overview

Proctitis is inflammation of the lining of the rectum. The rectum is a muscular tube that’s connected to the end of your colon. Stool passes through the rectum on its way out of the body.

Proctitis can cause rectal pain, diarrhea, bleeding and discharge, as well as the continuous feeling that you need to have a bowel movement. Proctitis symptoms can be short-lived, or they can become chronic.

Proctitis is common in people who have inflammatory bowel disease (Crohn’s disease or ulcerative colitis). Sexually transmitted infections are another frequent cause. Proctitis also can be a side effect of radiation therapy for certain cancers.

Symptoms

Proctitis signs and symptoms may include:

• A frequent or continuous feeling that you need to have a bowel movement
• Rectal bleeding
• Passing mucus through your rectum
• Rectal pain
• Pain on the left side of your abdomen
• A feeling of fullness in your rectum
• Diarrhea
• Pain with bowel movements

When to see a doctor

Make an appointment with your doctor if you have any signs or symptoms of proctitis.

Causes

Several diseases and conditions can cause inflammation of the rectal lining. They include:

• Inflammatory bowel disease. About 30% of people with inflammatory bowel disease (Crohn’s disease or ulcerative colitis) have inflammation of the rectum.
• Infections. Sexually transmitted infections, spread particularly by people who engage in anal intercourse, can result in proctitis. Sexually transmitted infections that can cause proctitis include gonorrhea, genital herpes and chlamydia. Infections associated with foodborne illness, such as salmonella, shigella and campylobacter infections, also can cause proctitis.
• Radiation therapy for cancer. Radiation therapy directed at your rectum or nearby areas, such as the prostate, can cause rectal inflammation. Radiation proctitis can begin during radiation treatment and last for a few months after treatment. Or it can occur years after treatment.
• Antibiotics. Sometimes antibiotics used to treat an infection can kill helpful bacteria in the bowels, allowing the harmful Clostridium difficile bacteria to grow in the rectum.
• Diversion proctitis. Proctitis can occur in people following some types of colon surgery in which the passage of stool is diverted from the rectum to a surgically created opening (stoma).
• Food protein-induced proctitis. This can occur in infants who drink either cow’s milk- or soy-based formula. Infants breast-fed by mothers who eat dairy products also may develop proctitis.
• Eosinophilic proctitis. This condition occurs when a type of white blood cell (eosinophil) builds up in the lining of the rectum. Eosinophilic proctitis affects only children younger than 2.

Risk factors

Risk factors for proctitis include:

• Unsafe sex. Practices that increase your risk of a sexually transmitted infection (STI) can increase your risk of proctitis. Your risk of contracting an STI increases if you have multiple sex partners, don’t use condoms and have sex with a partner who has an STI.
• Inflammatory bowel diseases. Having an inflammatory bowel disease (Crohn’s disease or ulcerative colitis ) increases your risk of proctitis.
• Radiation therapy for cancer. Radiation therapy directed at or near your rectum (such as for rectal, ovarian or prostate cancer) increases your risk of proctitis.

Complications

Proctitis that isn’t treated or that doesn’t respond to treatment may lead to complications, including:

• Anemia. Chronic bleeding from your rectum can cause anemia. With anemia, you don’t have enough red blood cells to carry adequate oxygen to your tissues. Anemia causes you to feel tired, and you may also experience dizziness, shortness of breath, headache, pale skin and irritability.
• Ulcers. Chronic inflammation in the rectum can lead to open sores (ulcers) on the inside lining of the rectum.
• Fistulas. Sometimes ulcers extend completely through the intestinal wall, creating a fistula, an abnormal connection that can occur between different parts of your intestine, between your intestine and skin, or between your intestine and other organs, such as the bladder and vagina.

Prevention

To reduce your risk of proctitis, take steps to protect yourself from sexually transmitted infections (STIs). The surest way to prevent an STI is to abstain from sex, especially anal sex. If you choose to have sex, reduce your risk of an STI by:

• Limiting your number of sex partners
• Using a latex condom during each sexual contact
• Not having sex with anyone who has any unusual sores or discharge in the genital area

If you’re diagnosed with a sexually transmitted infection, stop having sex until after you’ve completed treatment. Ask your doctor when it’s safe to have sex again.

June 16, 2020

Show references

1. Proctitis. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/proctitis/all-content. Accessed April 27, 2020.
2. Proctitis. Merck Manual Professional Version. https://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/proctitis#. Accessed April 27, 2020.
3. Walls RM, et al., eds. Disorders of the anorectum. In: Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Elsevier; 2018. https://www.clinicalkey.com. Accessed April 27, 2020.
4. Gajendran M, et al. A comprehensive review and update on ulcerative colitis. Disease-a-Month. 2019; doi:10.1016/j.disamonth.2019.02.004.
5. McCarty TR, et al. Efficacy and safety of radiofrequency ablation for treatment of chronic radiation proctitis: A systematic review and meta-analysis. Journal of Gastroenterology and Hepatology. 2019; doi:10.1111/jgh.14729.
6. What is anemia? National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/anemia. Accessed April 27, 2020.
7. Friedman LS. Clinical manifestations, diagnosis, and treatment of radiation proctitis. https://www.uptodate.com/contents/search. Accessed April 27, 2020.
8. Tominaga K, et al. Diversion colitis and pouchitis: A mini-review. World Journal of Gastroenterology. 2018; doi:10.3748/wjg.v24.i16.1734.

Tenesmus: The Troubling Symptom You Can’t Ignore

Symptoms of Tenesmus

Both ulcerative colitis and Crohn’s disease can cause inflammation of the rectum that gives people the “false sensation, or urge, of having to move their bowels even when there isn’t stool in the rectum,” says Paul R. Sturrock, MD, a colon and rectal surgeon at UMass Memorial Medical Center in Worcester, Massachusetts. Tenesmus can also be associated with abdominal cramps and rectal pain.

RELATED: What Is Abdominal Pain?

“Often patients will describe having multiple small bowel movements over the course of the day as they repeatedly go to the bathroom to try and evacuate and relieve the urge they are feeling,” says Dr. Sturrock.

As an inflamed rectum expands and contracts, even a little amount of stool, or even gas, can create the sensation of needing to have a bowel movement, says Dr. Ehrlich. People often feel like they’re going to have an accident if they don’t make it to the bathroom immediately. When they get there, “not much of anything comes out, and [the effort] is sometimes uncomfortable.” People may also experience mucous discharge from the anus.

Inflammation Causes Tenesmus

Anything that causes rectal inflammation can lead to tenesmus. For example, some sexually transmitted diseases, such as chlamydia, can cause the rectum to become inflamed, says Ehrlich. Men who have received radiation therapy to the rectal area for prostate cancer may also experience tenesmus, he says. Hemorrhoids are another cause.

Tenesmus is especially common in people with ulcerative colitis. “By definition, ulcerative colitis starts in the rectum and moves up the digestive tract,” explains Ehrlich. “So nearly all patients with colitis and an inflamed rectum are at risk of tenesmus as a symptom if they have not yet been treated for their IBD.”

In people with Crohn’s disease, the most common area of inflammation is the ileum, or the lowest part of the small intestine, so they are less likely to experience tenesmus, says Ehrlich.

RELATED: Crohn’s Disease Management Guide

Managing Tenesmus

If you stay on top of your disease and use a good maintenance medication regimen prescribed by your gastroenterologist, you may prevent rectal inflammation from becoming severe enough to cause tenesmus, says Sturrock.

If the symptom does develop, doctors may prescribe topical therapies that patients can insert as a suppository into the rectum, says Ehrlich. These include aminosalicylate (5-ASA) drugs, most commonly mesalamine. Mesalamine can also be given through a self-administered enema.

Gastroenterologists may also prescribe steroid suppositories, such as hydrocortisone in a foam that can be inserted into the rectum to reduce inflammation. A newer medicine called budesonide MMX is also available in a suppository foam, and can reduce rectal inflammation and is effective for patients who did find success with mesalamine, according to a review published in July 2019 in Expert Reviews of Gastroenterology and Hepatology.

In addition, doctors may recommend oral 5-ASAs to manage your overall IBD, which can help to relieve tenesmus, says Ehrlich. People who have more severe disease may benefit from biologic therapies like Remicade (infliximab).

While doctors may recommend surgery for people with severe IBD affecting the rectum and potentially more of the colon, surgery on its own is not used to manage tenesmus, says Sturrock. However, patients who have their rectum removed typically do find relief from the symptoms of tenesmus.

Additional reporting by Jordan Davidson.

What Is Rectal Prolapse? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Treatment for rectal prolapse depends on the severity of your symptoms. Sometimes prolapses resolve on their own. Initially your healthcare provider might work with you to manage the constipation that might be causing the prolapse through adding fiber to your diet and keeping hydrated. Your doctor might work with you to avoid straining during bowel movements. Kegel exercises to strengthen the pelvic muscles might also be advised.

If none of these strategies help, surgery is usually required — especially if you’re experiencing recurrent episodes.

Surgery can keep rectal prolapse from happening again. Two types of surgical procedures are typically used to treat rectal prolapse:

• Abdominal repair Surgery to fix rectal prolapse is usually done through the belly. Abdominal surgery for rectal prolapse usually involves making a small cut in the lower abdomen. The surgeon will then pull the rectum upward and attach it to a small bone in the lower back so that it can’t slip out again.
• Rectal repair In this type of surgery, the surgeon works through the anus rather than making an incision in the abdomen. This surgery is often performed on older patients or those with more medical problems.

The two most common rectal procedures are:

• Altemeier procedure In this procedure, the surgeon cuts off or removes a portion of the rectum that extends outside the anus. The remaining rectum is pushed back inside the body and attached to the inside of the anus.
• Delorme procedure In this procedure, the inner lining of the fallen rectum is removed. The outer lining is then folded and sewn back so that it no longer protrudes.

Prevention of Rectal Prolapse

To prevent rectal prolapse, avoid straining during bowel movements.

The following tips can help you avoid constipation, which leads to straining:

• Drink plenty of water
• Eat fruits, vegetables, and other foods that are high in fiber
• Exercise regularly
• Use laxatives but only as directed by your healthcare provider because of the potential risks of chronic use
• Consider bowel training, which involves having a bowel movement at the same time each day

Rectal Descent and Rectal Prolapse | MUSC Health

What is rectal descent?

Some people have great difficulty emptying their rectum due to what is called rectal descent. Rectal descent is a problem that appears to be related to childbirth. When a women gives birth, the normal attachments of the rectum to the lower backbone may get stretched or torn. This tearing allows the rectum to fall into the pelvis where it assumes a horizontal position. The front of the rectum can fall into the top of the anal canal and block the anal opening.

How does the rectum work?

The normal rectum lies against the sacrum (lower backbone) in a gentle curve down to the anal opening. When a person moves his bowels, the muscles of the pelvic floor relax and the rectum swings down and straightens so it is almost straight up and down (vertical) over the anal opening. In this way the rectal contents can move straight out.

When a person pushes to move his bowels, it increases the abdominal pressure. If the rectum is attached to the sacrum properly, the increased abdominal pressure squeezes the rectal contents out like toothpaste from a tube. The rectum is a soft pliable tube. If it is not firmly supported by the lower backbone, it slides down in the pelvis and blocks the anal opening.

Let us compare the rectum to a sock. If you support the sock with one hand on either side of the top open end, then it is easy to put your foot into it and slide it all the way inside. If, however, the sock is lying on the floor not supported or held in place, then it will be very hard to put your foot into it, much less get your foot all of the way in. The same is true of the rectum. The hands supporting the sock are represented by the attachments of the top of the rectum to the backbone.

What are the symptoms of rectal descent?

Knowing this, you can predict the complaints that people with rectal descent have. If they don’t have colonic inertia, they will have the usual amounts of stool getting down to the rectum daily. They will feel the urge to move their bowels; but, even with straining, the rectum will not empty. This differs from someone with colonic inertia. Someone with colonic inertia may not feel the need to move his bowels for a week or more at a time. Someone with rectal descent without colonic inertia will feel the need to move his bowels every day.

Patients with rectal descent take a long time to have a bowel movement. Even after they move their bowels, it may feel as if their rectum is still not empty.

They may feel as if their rectum is dropping out of their pelvis. They may feel a weight down on the bottom of their pelvis. A woman may feel a mass pushing against her vagina.

People with rectal descent have difficulty emptying their rectum. They must strain to move their bowels. They may have to put their fingers into their rectum or (in the case of a woman) vagina, or push on their pelvic area, to get their bowels to move.

During surgery, sometimes physicians will notice that the rectum has fallen down and is just lying flat on the floor of the pelvis.

Before talking about how to correct rectal descent let us discuss some other forms of rectal descent. The first is solitary rectal ulcer.

Solitary Rectal Ulcer

Sometimes rectal descent causes the front wall of the rectum to flop into the anal canal. Straining causes pressure on the front wall of the rectum and a pressure sore develops. This sore is called a solitary rectal ulcer. It has a white base and sharp distinct edges. When we see it, we can be certain that rectal descent is present. This solitary rectal ulcer can cause pain and bleeding.

Rectocele

Rectocele is a bulge of the lower rectum into, over or behind the vagina. Rectoceles trap stool and may not empty. Rectoceles are probably more common in women whom have had a hysterectomy. The rectum falls into the place of the uterus. The woman with a rectocele may need to put her finger into the vagina to push the stool out. Defecography demonstrates the rectum bulging forward.

Stool softeners and fiber may help. If they do not, surgery may be needed.

Rectoceles can only occur if the attachments between the rectum and the vagina are weakened, and if extra rectum is dragged down or stretched out to form the pouch

If the rectocele causes difficult rectal emptying, the associated rectal descent should be corrected. The surgery recommended for a symptomatic rectocele is the same operation done for rectal descent.

A type of rectocele repair can be done through the vagina, but this does not correct rectal descent. It often does not correct the rectal emptying problems associated with rectoceles.

We can usually confirm that a woman has rectal descent by talking to her and examining her. We must confirm the diagnosis with defecography. Defecography uses video X-rays to look at the shape and position of the rectum as it empties.

What is Rectal Prolapse?

Another form of rectal descent is rectal prolapse. When the rectum falls down in the pelvis it can drop so far that it actually drops through the anal opening as a pink fleshy round lump. This is called rectal prolapse.

Rectal prolapse can result in constipation, as it can cause a blockage of the anal opening. The prolapse can stretch the anal sphincter muscles and cause anal leakage (fecal incontinence).

Rectal prolapse is not a cancer and it will not turn into a cancer. Therefore, treatment is necessary only if it is causing a problem.

Symptoms of prolapse which might indicate the need for surgery include persistent bleeding, chronic constipation, difficulty with rectal emptying, straining to move the bowels, mucous drainage, protruding lump, inability to control solid, liquid, or gas bowel movements, or progressive weakening of the anal sphincter muscles.

The aim of the surgery is to remove the extra rectal length and re-suspend the rectum from the lower backbone.

Prolapse can be repaired by either anal surgery or abdominal surgery. In the abdominal surgery, the sigmoid colon is removed and the rectum is sewn to the sacrum (just like the surgery for rectal descent).

Another way to accomplish bowel shortening and re-suspension is to remove the extra rectal length through the anus. Then, the bowel ends are hooked together just above the anus. Removing all the excess bowel leaves the shortened rectum hanging from the inside of the abdomen on the left, by the spleen and ribs. This operation does not require an incision on the front of the abdomen and there is no risk of damage to the nerves of the penis in men.

If a person has rectal prolapse and fecal incontinence (the inability to control bowel movements), fixing the rectal prolapse also corrects the fecal incontinence about 50% of the time. However, if the sphincter muscles are very weak, fixing the prolapse will not correct the incontinence. Additional surgery may be needed to tighten the anal sphincter muscles.

Symptoms & Causes of Proctitis

What are the symptoms of proctitis?

The most common symptom of proctitis is tenesmus—an uncomfortable, frequent urge to have a bowel movement. Other symptoms of proctitis may include

• discharge of mucus or pus from your rectum
• a feeling of fullness in your rectum
• pain in your anus or rectum
• pain during bowel movements
• cramping in your abdomen
• pain on the left side of your abdomen
• bleeding from your rectum
• bloody bowel movements
• diarrhea
• constipation
• swollen lymph nodes in your groin

If you are HIV-positive and have proctitis caused by genital herpes, your symptoms may be worse.

Seek help right away

If you have the following symptoms, you should see a doctor right away:

• bleeding from your rectum
• discharge of mucus or pus from your rectum
• severe pain in your abdomen

See a doctor right away if you have bleeding from your rectum, discharge of mucus or pus from your rectum, or severe pain in your abdomen.

What causes proctitis?

A number of things may cause proctitis.

Infections

Sexually transmitted diseases (STDs) can cause proctitis if you have had anal sex with a person infected with an STD. Common STD infections that can cause proctitis include

Infections associated with foodborne illness, such as Salmonella, Shigella, and Campylobacter infections, can also cause proctitis.

Children with strep throat may sometimes get proctitis. They may infect the skin around their anus while cleaning the area after using the toilet or by scratching with hands that have strep bacteria from their mouth or nose. The bacteria may cause inflammation of the anus. Strep bacteria that get into the rectum may cause proctitis.

Inflammatory bowel disease

Two types of inflammatory bowel disease—ulcerative colitis and Crohn’s disease—may cause proctitis. Ulcerative colitis causes inflammation and ulcers in the large intestine. Crohn’s disease causes inflammation and irritation of any part of the digestive tract—most often in the end of the small intestine. However, ulcerative colitis and Crohn’s disease can also affect the rectum and cause proctitis.

Radiation therapy

If you have had radiation therapy in your pelvic area or lower abdomen due to certain cancers, you may develop a condition that is similar to proctitis, called radiation proctopathy or radiation proctitis. This condition is different because the intestinal lining does not become inflamed. Up to 75 percent of patients develop radiation proctitis following pelvic radiation therapy.²

Injury to the anus or rectum

Injury to your anus or rectum from anal sex or from putting objects or substances—including enemas—into your anus or rectum can cause proctitis.

Certain antibiotics

Use of certain antibiotics can lead to an infection that can cause proctitis in some people. Antibiotics are medicines that kill bacteria. Even though antibiotics are meant to kill infection-causing bacteria, some antibiotics can kill good bacteria that normally live in your digestive tract. The loss of good bacteria may let a harmful bacterium called Clostridioides difficile, or C. difficile, grow in the colon and rectum. C. difficile causes proctitis when it infects the lining of the rectum. Antibiotics that can kill good bacteria, leading to C. difficile infection, include

References

[2] Grodsky MB, Sidani SM. Radiation proctopathy. Clinics in Colon and Rectal Surgery. 2015;28(2):103–111.

Rectal Prolapse – Symptoms, Causes, Diagnosis and Treatment

Rectal prolapse causes a lump to stick out of your back passage (anus) and this can become quite painful. Although the lump can pop in and out at first, later on it can stay out all the time, especially when you stand up. This can cause problems with daily activities that involve walking or standing for any length of time.

What causes rectal prolapse?

• Anything that increases the pressure inside your tummy (abdomen) can make you more likely to develop a rectal prolapse. This can include:
• Constipation.
• Diarrhoea.
• Straining to pass urine due to a swollen prostate gland.
• Pregnancy.
• Persistent cough.

• Damage to the back passage (anus) or pelvis from previous surgery.
• Damage to the muscle on the floor of the pelvis.
• Infections of the bowel with certain types of microbes called parasites (such as amoebiasis and schistosomiasis).
• Diseases of the nervous system such as multiple sclerosis.
• Damage to the nerves from back surgery, a slipped disc, or an accident injuring the pelvic nerves.
• Mental health conditions associated with constipation, such as:
• Depression.
• Anxiety (as in irritable bowel syndrome).
• A side-effect of medicines used to treat psychiatric disorders.

In children, rectal prolapse can occur in:

• Cystic fibrosis.
• Ehlers-Danlos syndrome.
• Hirschsprung’s disease (a rare condition that can cause poo to become stuck in the bowel).
• Malnutrition (not having enough food, not eating the right food, or not being able to absorb the nourishment from food).
• Rectal polyps.

Click on the links for more information about the highlighted conditions.

Prolapse of the bladder or womb (uterus) doesn’t cause rectal prolapse but is sometimes associated with it.

Who gets rectal prolapse?

No-one knows how common rectal prolapse is because people often have it without reporting it to their doctor. However, it is known to happen most frequently in the elderly. Women seem to be more prone to it than men.

It is occasionally seen in children, especially from the ages of 1 to 3 years.

What are the symptoms of rectal prolapse?

A lump

• The first thing you will notice is a lump sticking out of your back passage (anus). In the early stages this will only appear after you’ve had a poo or strained to pass a motion. It tends to disappear when you stand up.
• Later on, you may notice the lump in other circumstances that involve straining, like coughing or sneezing.
• Eventually, the lump may be noticeable most of the time and interfere with day-to-day activities such as walking.
• You may have to push the lump back with your hand.
• A doctor examining the prolapse will see a lump sticking out which has concentric rings around it. An ulcer on the prolapse may also be seen.

Full rectal vs mucosal prolapse

Dr Hassan Mahmud, via SlideShare.net

Other symptoms

• You may notice pain, constipation and bleeding from the last part of your bowel (the rectum).
• The muscles around the anus (anal sphincter) may become weak, allowing a little bit of poo to escape (faecal incontinence). This can also happen with slime (mucus) produced by the bowel wall.

What else looks like rectal prolapse?

A prolapsed intussusception

An intussusception occurs when a section of bowel folds into the next section, a bit like the way a telescope folds up. Sometimes the folded bowel pokes outside the back passage (anus) and looks like a rectal prolapse.

A rectal polyp

A rectal polyp is a thickening of the lining (mucosa) of the bowel that comes to resemble a finger-like structure growing out of the side wall of the gut. If it pokes outside the anus it can resemble a rectal prolapse.

A haemorrhoid

What we know as a pile is a large vein that usually develops from straining whilst going to the loo. This is yet another condition that can look like a rectal prolapse if it pokes outside the anus.

Difference between rectal prolapse and haemorrhoids

Dr Hassan Mahmud, via SlideShare.net

Do I need any tests for rectal prolapse?

• It’s usually easy to tell if you have piles (haemorrhoids) rather than a rectal prolapse because a prolapse has concentric rings around the outside, whereas piles don’t.
• You may need a barium enema (an X-ray exam of the lower bowel) to check that you haven’t got any other bowel conditions. Instead of, or as well as this, you may be offered a colonoscopy (an examination in which a colonoscope – a thin flexible tube containing fibre-optic channels) is passed through your anus and into the lower part of your bowel (the colon).
• A proctosigmoidoscopy (an examination using a non-flexible scope) is used to check the rectum and anus for ulcers which sometimes occur with rectal prolapse.
• Anal physiology tests – these sound complicated but are basically ways of examining how your bowel works. They include X-ray pictures while your bowel is emptying (defecography), a test to check the pressure inside your bowel (manometry) and checks to test how well the muscles and nerves of the area are working. All this information is useful, especially if you are going to have surgical treatment.
• Other tests may be suggested, depending on what conditions the doctor wants to rule out. For example, a sample of your poo may need checking for infection or your child may need a sweat test to rule out cystic fibrosis.

What are the treatment options for rectal prolapse?

Treatment without surgery

• A prolapse which is small and/or has only recently occurred can sometimes be pushed back using pressure from your hand. If doing this is painful, a doctor may be required to do this after giving you a sedative and a local anaesthetic injection to numb the area.
• Make sure you sort out any underlying cause such as constipation or diarrhoea.
• If the prolapse cannot be pushed back you will need the attention of a surgeon.
• A partial prolapse (in which it’s only the lining of the bowel that pops out) can usually be treated without surgery although sometimes the extra tissue needs to be trimmed off.
• In children, the prolapse can usually be gently pushed back using a lubricant gel. You need to make sure your child has a high-fibre diet and doesn’t strain when they go to the loo. Sometimes a laxative is required. Very occasionally an injection that shrinks tissue (a sclerosant) has to be given.
• Most elderly people can cope by pushing the prolapse back themselves. However, sometimes a rubber ring is inserted under the skin to keep the prolapse in place. This is not very successful as it is often too tight (causing constipation) or too loose (causing the prolapse to poke out again).

Surgical treatment

Surgery for adults

• If your prolapse can’t be pushed back and the blood supply has been cut off you will need emergency surgery. This involves removing the prolapse and part of the lower bowel (a rectosigmoidectomy).
• A prolapse involving just the lining (mucosa) of the bowel is treated by removing the excess mucosa. This is basically identical to surgery for a pile (haemorrhoidectomy). Staples are sometimes used instead of conventional cutting with a scalpel.
• Abdominal surgery involving opening the tummy. The basic procedure is called a rectopexy, which involves placing the lower part of the bowel (the rectum) back into its original position and fixing it so it doesn’t slip down again. Various methods are used to prevent slippage, including sutures, staples, slings and shortening the stretched bowel. Surgeons are starting to use a laparoscope – a thin telescope with a light source – for some of these procedures. The instrument is passed through a small hole in the tummy, resulting in a smaller scar than you would get with conventional surgery.
• Perineal procedures – these involve surgery in the area of the perineum which is located between the anus and testicles in men or the anus and lower part of the vagina in women. Variations include:
• Circling the anus with wire (Thiersch’s wiring procedure).
• Stripping some of the lining of the bowel off the prolapse, bunching up the bowel muscles with stitches, then replacing the lining (Delorme’s mucosal sleeve resection).

Surgery for children

• This is usually reserved for children aged under 4 years who have failed to respond to non-surgical treatment for more than a year.
• Surgery may also be used where the prolapse keeps coming back, becomes painful or where ulcers or bleeding develop.
• Lots of different methods are used including:
• Injections to cause scarring around the rectum.
• Insertion of a sling to support the rectum.
• Use of mesh gauze to pack around the rectum and the use of a hot probe called a cautery.
• Opening the tummy (abdomen) to reposition the rectum.
• Placing a suture inside the rectum so that scar tissue sticks it to the tail bone (the sacrum).
• As with adult surgery, some of these techniques are now being done through a laparoscope.

What is the best treatment for me?

Studies suggest that there is no difference in success rate whichever surgical procedure is used. Your surgeon will discuss the best option, taking on board your age, general health, previous experience with anaesthetics and how long you have had your prolapse. In general, young fit people are better off having a procedure through the tummy (abdomen). Older people may be more suited to perineal operations which can be done under local anaesthetic. There’s more of a chance of the prolapse coming back but less risk to your health if you’re a bit frail.

What are the complications of rectal prolapse?

Complications include:

• Ulcers in the lining (mucosa) of the lower part of the bowel (the rectum).
• Death of tissue (necrosis) of the wall of the rectum.
• Bleeding and breakdown (dehiscence) of tissue where two bits of bowel have been stitched together. These are the most common complications after surgery.

What is the outlook for rectal surgery?

The outlook (prognosis) will depend on your age, on whether you have any untreatable causes for the prolapse and on the state of your general health.

About 1 in 10 children who have a rectal prolapse will continue to have it when they grow up, especially if they are aged over 4 years when they first develop it.

Swollen Anus & Swollen Rectum Causes, Treatment, and More

Inflammatory causes

Proctitis is any condition that involves inflammation of the lining of the rectum. Proctitis often involves symptoms of pain and problems with defecation that can lead to swelling of the rectum.

• Infection: Infections of this area, in the form of sexually transmitted infections and foodborne illness, are a frequent cause of proctitis. If these infections involve the glands of the anal canal, abscesses (areas filled with pus) can develop, leading to swelling and increased pain in the anorectal area.
• Inflammatory medical conditions: Inflammatory bowel disease (Crohn’s disease or ulcerative colitis) often involve the rectum. These conditions can lead to chronic irritation that results in anal abscesses that cause pain and swelling.

Anatomical causes

Anatomical causes may lead to a swollen rectum, such as the following.

• Fistula: Rarely, an abnormal anatomical communication, or fistula, can form between the anus or rectum and the skin around the anus. An anal fistula is often a result of an anal abscess that did not heal, leading to breaks in the surface of the skin.
• Prolapse: Increased pressure in combination with a weakening of the muscles of the anal canal can lead to a condition in which the rectum “slides” through the anus and protrudes through the opening. This is called a rectal prolapse. The prolapse can often look and feel like a swollen lump, as in this image.

Cancerous causes

A malignant mass in the anal canal can grow and swell leading to associated symptoms of pain,bleeding and/or itching in the anorectal area. Anal cancer rarely metastasizes (spreads) to other parts of the body.

3 swollen rectum conditions

The list below shows results from the use of our quiz by Buoy users who experienced swollen rectum. This list does not constitute medical advice and may not accurately represent what you have.

Hemorrhoids

Hemorrhoids, also known as piles, are swollen veins in your anus and lower rectum that can cause pain, itching, and rectal bleeding. Hemorrhoids may be seen or felt on the outside of the anus (external) or may be hidden from view inside of the rectum.

Hemorrhoids are common occurring in 10 million Am..

Chronic or recurrent hemorrhoids

Chronic, or recurrent, hemorrhoids are swollen veins in the anus and rectum that never really resolve and may be symptomatic more or less constantly.

Hemorrhoids are caused by anything that puts pressure on the anus from the inside, such as straining during bowel movements; constipation; pregnancy; or anal intercourse.

Most susceptible are pregnant women and older people, though anyone can be affected.

Symptoms include a small amount of bleeding during or after a bowel movement, as well as discomfort, itching, or swelling around the anus.

A medical provider can suggest treatment to ease the symptoms of chronic hemorrhoids, as well as make certain of the diagnosis since other, more serious conditions can have symptoms similar to hemorrhoids.

Diagnosis is made through patient history and physical examination.

Treatment most often involves simple lifestyle changes such as drinking more water; adding fiber-rich foods to the diet; using fiber supplements and stool softeners; not delaying, or straining, to pass a bowel movement; and using topical medications. Surgical procedures to remove the hemorrhoid can be used in some cases.

Rarity: Common

Top Symptoms: rectal bleeding, rectal pain, pain when passing stools, anal itching, painless rectal bleeding

Symptoms that never occur with chronic or recurrent hemorrhoids: unintentional weight loss

Urgency: Self-treatment

Cellulitis

Cellulitis is a bacterial infection of the deep layers of the skin. It can appear anywhere on the body but is most common on the feet, lower legs, and face.

The condition can develop if Staphylococcus bacteria enter broken skin through a cut, scrape, or existing skin infection such as impetigo or eczema.

Most susceptible are those with a weakened immune system, as from corticosteroids or chemotherapy, or with impaired circulation from diabetes or any vascular disease.

Symptoms arise somewhat gradually and include sore, reddened skin.

If not treated, the infection can become severe, form pus, and destroy the tissue around it. In rare cases, the infection can cause blood poisoning or meningitis.

Symptom of severe pain, fever, cold sweats, and fast heartbeat should be seen immediately by a medical provider.

Diagnosis is made through physical examination.

Treatment consists of antibiotics, keeping the wound clean, and sometimes surgery to remove any dead tissue. Cellulitis often recurs, so it is important to treat any underlying conditions and improve the immune system with rest and good nutrition.

Rarity: Uncommon

Top Symptoms: fever, chills, facial redness, swollen face, face pain

Symptoms that always occur with cellulitis: facial redness, area of skin redness

Urgency: Primary care doctor

Paraproctitis – rectal fistula

Paraproctitis – anal fistula (rectal fistula)

Acute or chronic purulent “fusion” of tissues in the anal area, leading to the formation of a fistulous canal and, accordingly, a fistulous opening.
The main diagnostic signs of this serious disease are complaints of pain in the anus, the presence of a fistulous opening and discharge from it, including a purulent nature, and perineal edema.

A diagnosis by a proctologist is not difficult.

To clarify the nature and location of the fistulous tract, an instrumental examination is carried out – anoscopy or retroromanoscopy, ultrasound or MRI.

Treatment of paraproctitis

The main method of treatment is surgery. The surgeon-proctologist performs excision of the fistulous tract and eliminates the opening of the fistula. This operation belongs to the category of emergency and does not require special preparation.

The only contraindication is the severe general condition of the patient.

Anesthesia – under general anesthesia.

Rehabilitation after surgery for paraproctitis

After the operation, lasting up to one hour, the first 5 days must be spent in a hospital.

Antibiotics and pain relief are prescribed. Operations are performed daily.

It is important to follow your diet during this period.It should not be coarse – it is rice or semolina porridge, steamed fish, omelet.

It is strictly forbidden to use spicy and salty foods, alcohol, carbonated drinks.

It is advisable to give up smoking for this period. A good reason to quit smoking altogether.

It is important to drink abundantly at least 2.5 – 3 liters of plain, filtered water or non-carbonated mineral water in agreement with a dietitian.

In the absence of problems, for 2-3 days, the patient is allowed to go home, where he can independently carry out hygienic treatment of the perineum, wash the postoperative wound with an antiseptic according to the recommendations of the attending physician.

Disability and some limited physical activity take 8-10 days after discharge. Full recovery usually occurs within a month.

Pay attention!

Paraproctitis is a serious, dangerous disease. Don’t try to self-medicate. Do not hesitate to consult a proctologist.

You will not find anywhere more delicate doctors who understand everything and know everything.

90,000 Rectal atresia in newborns

Information about the disease

Congenital pathologies of the gastrointestinal tract are diverse and include the incomplete development of any organ or part of the gastrointestinal tract, or its absence. Such disorders include atresia (underdevelopment) of the anus, duodenum, esophagus, stomach and pylorus, stenosis (narrowing) of these organs, the membrane of the colon, and others.

Anus atresia is a congenital anomaly in which the newborn has no anal (anal) opening.In some cases, atresia of the anus is detected in utero, but more often it is detected immediately after birth. Highly qualified doctors of the Department of Pediatric Surgery of the Rambam Clinic have at their disposal modern equipment, with the help of which they quickly and effectively eliminate the mistakes made by nature by surgery.

Methods of diagnosis and treatment

Atresia of the anus can take various forms, any of which requires surgical treatment in the first days from the moment of birth.The mildest degree is the membrane of the anus, in which the anus is covered with a film, but there are no other deviations in the structure of the intestine. In this case, proctoplasty is performed almost painlessly. A more severe form of atresia is cloacal: the urethra, rectum and vagina exit into a closed dead-end cloaca. When atresia is complicated by a fistula, feces can enter the urethra or genital slit (in girls).

In addition to visual signs, atresia of the anus is manifested from the first hours of life by the child’s anxiety, profuse regurgitation, including bile and meconium.The baby’s abdomen swells up, shortness of breath appears, signs of dehydration and intoxication. To determine the severity of anus atresia, radiography, puncture (to determine the depth of the anomaly), urethrocystography (to detect fistulas), and ultrasound are used. In especially difficult cases, a laparoscopic examination of the internal organs is performed.

Pediatric surgeons at the Rambam State Hospital, in close collaboration with neonatologists, prepare a newborn for surgery while still in the maternity ward.Elimination of anus atresia is performed using minimally invasive endoscopic surgery methods. All manipulations are performed through three tiny holes, no more than 5 mm in diameter.

This method reduces trauma and pain syndrome, shortens the recovery period after surgery. Doctors restore intestinal patency by abdominal-perineal proctoplasty. In severe cases of atresia, a colostomy is applied with the withdrawal of the rectum through the abdominal wall, and at the age of 3-4 months, when the child’s weight exceeds 5-7 kg, a full-fledged anus is formed with the elimination of the colostomy as the second stage of the reconstructive operation.

In the “Rambam” medical center, foreign patients can receive detailed consultations by phone from the staff of the international department, who will tell you about the types, methods and cost of treatment, its timing, and the necessary documents. Upon arrival for treatment, foreign patients and their parents are immediately provided with the services of an interpreter and, if necessary, accompaniment.

90,000 Rectal cancer diagnostics in Kazan, how to find out the symptoms? – “Golden glow”

The complexity of the diagnosis of rectal cancer – in the nonspecificity of symptoms.Any of the symptoms of bowel cancer can be a sign of some other gastrointestinal disease or simply a manifestation of an inaccurate diet.

Unfortunately, rectal cancer is often detected in the late stages of the disease, which means, as a rule, a poor prognosis.

Rectal cancer symptoms

discharge or presence of mucus, pus, blood in the feces

alternating diarrhea and constipation

pain during bowel movements, false desires

foreign body sensation in the intestine

pain in the perineum, sacrum, lower back

weakness, sudden weight loss, pale, sallow complexion

!!! One or more of these symptoms is a reason to visit a doctor without delay.

Diagnostics

In most cases, cancer is not confirmed, but since there is always a risk, the doctor must make sure that there is no malignant tumor in the rectum.

Initial examination by a proctologist can reveal the presence or absence of neoplasms in the rectum at a distance of up to 15-20 cm from the anus.

Additional examinations that may be assigned:

analysis of feces for the presence of occult blood in it

endoscopic examination (colonoscopy)

Colonoscopy is the most reliable and effective diagnostic method today, during which a specialist can establish the exact location of a neoplasm, take tissue samples for histological examination, remove small formations (polyps), which are also sent for histology.

!!! Pay attention ! After the age of 40, routine examinations by a proctologist are necessary, even BEFORE any symptoms or complaints appear.

INSPECTION BY A DOCTOR

Do not rely on chance, get examined by a specialist. Make an appointment with a proctologist without delaying until tomorrow.

Any symptoms indicating the presence of problems in the gastrointestinal tract (GIT) require examination and timely treatment.Launched gastrointestinal diseases are risk factors for the development of oncology.

Medical Center “ Golden Glow ” specializes in the treatment of diseases of the gastrointestinal tract. Modern equipment allows you to accurately diagnose existing diseases.

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