Purulent proctitis symptoms and treatment. Manifestation of proctitis and effective methods of treatment. Treatment of chronic proctitis in remission
is a chronic inflammation of the rectal mucosa. Often combined with sigmoiditis (proctosigmoiditis). Accompanied by tenesmus, discomfort, itching, burning and mild pain in the area of the rectum. Traces of mucus, blood and pus are found in the feces. During the period of exacerbation, the symptoms become more pronounced, it is possible to increase the temperature to subfebrile figures. It is diagnosed taking into account complaints, anamnesis of the disease, examination of the anal area, rectal examination, rectoscopy, biopsy, stool tests and other methods. Treatment - diet, drug therapy, non-drug methods.
ICD-10
K62.8 Other specified diseases of the anus and rectum
General information
Chronic proctitis is a chronic inflammatory process in the area of the rectal mucosa that has arisen as a result of specific and non-specific infections, chronic diseases of the overlying gastrointestinal tract, helminthiases, eating disorders, fecal stagnation, chemical, mechanical and radiation exposure and other factors. Usually, inflammation is not limited to the rectum, but spreads to the overlying intestine with the development of proctosigmoiditis. It is also possible to involve pararectal tissue with the development of paraproctitis. Chronic proctitis is more common than acute inflammation of this organ. Men and women are equally affected.
Causes
Classification
Taking into account the causes of occurrence in clinical proctology, the following types of chronic proctitis are distinguished:
In addition, chronic proctitis can develop with local disorders of blood supply and innervation, with the decay of neoplasms of the rectum and neighboring organs. Taking into account the characteristic changes in the mucosa, atrophic and hypertrophic chronic proctitis are distinguished. In the atrophic form, thinning and smoothing of the mucosal folds are observed. With hypertrophic proctitis, the mucosa is loose, its folds are thickened.
Symptoms of proctitis
Chronic proctitis can be the outcome of acute proctitis or develop without previous acute manifestations. Characteristic symptoms are discomfort, burning, itching, slight soreness, tenesmus, a feeling of incomplete emptying of the bowels, and pathological impurities in the feces. During remission, chronic proctitis may be asymptomatic or manifest with one or two mild symptoms. Often the only symptom of the disease is a slight or moderate admixture of mucus in the feces. During the period of exacerbation, the symptoms of chronic proctitis become more pronounced. There is an increase in body temperature to subfebrile figures, combined with pain, severe burning and false urges.
Complications
With a long course, chronic proctitis is often complicated by anal fissure, hemorrhoids or chronic paraproctitis. Eczematous changes appear on the skin of the pararectal region. Itching in the anus becomes so pronounced that it begins to have a negative impact on the quality of life of the patient. The ability to work decreases, sleep disturbances occur. The patient becomes irritable.
Diagnostics
The diagnosis of chronic proctitis is established taking into account complaints, medical history, data from a rectal examination, examination of the perianal region, rectoscopy, biopsy, laboratory tests of feces and other methods of laboratory and instrumental diagnostics. When examining the perianal region, pay attention to the condition of the anus and surrounding tissues. Characterized by hypertrophy of the skin folds. In some cases, signs of maceration, traces of feces, mucus and blood on the skin are revealed. When conducting a digital examination, proctologists evaluate the state of the sphincter, detect pain in the crypt area, hypertrophy of the papillae and swelling of the intestinal wall.
Rectoscopy in chronic proctitis indicates an increase or smoothness of the vascular pattern, the presence of individual petechial hemorrhages and mucus patches on the intestinal wall. During an endoscopic examination, the doctor performs a biopsy. The material is sent for histological examination to clarify the nature and causes of inflammation. In addition, to determine the causes of chronic proctitis, a fecal analysis for worm eggs, bacteriological examination of feces and other tests are prescribed.
Treatment of chronic proctitis
Treatment is conservative, long-term, carried out on an outpatient basis. The patient is prescribed a special diet that excludes the use of alcohol, carbonated drinks, fatty, fried, spicy and spicy foods. A patient with chronic proctitis is recommended to limit the use of foods containing a large amount of coarse fiber, which cause increased gas formation and irritate the intestinal wall (vegetables, fruits, legumes, etc.). The basis of the menu is soups and lean meat, steamed.
The patient is explained the importance of strict adherence to the diet. To improve the psycho-emotional state, reduce irritability, normalize sleep and create a favorable psychological environment conducive to diet and follow the doctor's recommendations, patients with chronic proctitis are prescribed sedatives. When choosing medicines, the use of drugs that irritate the intestinal mucosa is avoided.
During the period of exacerbation of chronic proctitis, antibiotic therapy is carried out, patients are prescribed microclysters with a decoction of chamomile and collargol. To eliminate spasms, reduce pain and facilitate the act of defecation, antispasmodics are used. Local remedies (ointments, suppositories) are used to help eliminate inflammation and activate regenerative processes. In some cases, ointments with glucocorticosteroids are prescribed.
After stopping acute events, a patient with chronic proctitis is recommended to sit baths with potassium permanganate, oil microclysters and perineal showers. During the period of remission, patients with chronic proctitis are referred for sanatorium treatment. In case of stenosis of the rectum, conservative therapy is carried out (expansion with Gegar bougies, physiotherapy), in case of ineffectiveness, surgical interventions are performed.
Forecast and prevention
The prognosis for chronic proctitis is quite favorable. With adequate therapy, compliance with the technique of using local remedies (suppositories, microclysters) and following the doctor's recommendations, a stable long-term remission is possible. Preventive measures include exclusion of exposure to harmful factors, timely diagnosis and treatment of acute diseases of the rectum.
Update: December 2018
There is a group of diseases that are not dangerous for the patient's life, but significantly reduce its quality. Proctitis is one of such socially significant pathologies. Obsessive discomfort in the rectal area and a number of other symptoms of intestinal disorders arising from inflammation prevent the patient from following the usual daily routine.
To prevent this from happening, it is necessary to identify the disease in a timely manner and immediately begin its treatment. There are chronic and acute forms of rectal proctitis, each of which develops for certain reasons. Finding them in the past in a patient can greatly facilitate diagnosis.
Cause classification
It is customary to distinguish two groups of causes leading to inflammation of the rectum. The first is local damaging factors that directly affect the mucous membrane of this organ. The second group includes causes of a general nature, acting on the whole organism and, in particular, on the final sections of the intestine.
Local damaging factors |
Common Causes |
Rectal administration (through the anus) of any irritant:
Most often, they are used by patients as an alternative treatment for proctitis, which only aggravates the symptoms. |
Various infections of the intestinal tract, with a protracted course. The development of anal proctitis can be associated not only with the ingestion of a microorganism on the rectal mucosa, but also with the action of mechanical factors (diarrhea, release of toxins, release of undigested food, and so on). Radiation sickness (intestinal form) resulting from irradiation with a dose of about 10 Gray. Proctitis can also develop after radiation therapy or. |
It should be noted that the causes of a general nature often provoke the development of chronic proctitis. The acute form in 83% of cases is the result of exposure to a local damaging factor (an exception is gastrointestinal infections).
Symptoms of acute proctitis
As a rule, signs of an acute form occur immediately or several hours after the action of a damaging factor (an exception is tumors). Patients are concerned about two main symptoms:
- Pain is of a pulling nature, of medium or low intensity, which intensifies during bowel movements. Patients often cannot name the exact localization of pain and point to the lower abdomen or lower back. However, with active questioning, it turns out that the discomfort is located in the sacrum or anus. They do not pass during the day, which leads to anxiety and increased irritability of the patient. The pain syndrome decreases somewhat after taking anti-inflammatory drugs (Ketorolac, Nimesulide) or combined drugs (Baralgin, Spasmalgon);
- Violation of the act of defecation- the patient constantly "pulls to the toilet" (false urges). The stool, due to the increased frequency of defecation, acquires a mucous character, only mucus (a small amount) with an admixture of blood can be excreted. It is possible to develop constipation, due to a psychological block - the patient is afraid to go to the toilet, as this provokes increased pain.
Symptoms of acute proctitis can be supplemented by a decrease in appetite, a short-term increase in temperature (no more than 37.6 ° C), discomfort in the abdomen (due to impaired motor skills).
Symptoms of chronic proctitis
In this form, exacerbations alternate with periods of remission. The main criterion for making a diagnosis is the course of the disease for more than 6 months.
The clinical picture without exacerbation is erased - most often, it is limited to a recurring feeling of discomfort in the rectum. Since chronic proctitis often occurs against the background of another disease, the symptoms associated with this pathology come to the fore for the patient.
Symptoms and treatment of proctitis during an exacerbation are similar to the acute form.
Symptoms of radiation proctitis
Radiation proctitis refers to the chronic form of the disease, however, clinicians distinguish it as a separate species. The main difference is a pronounced, “excruciating” pain syndrome that constantly accompanies the patient. Unfortunately, effective pain relief for radiation proctitis has not been developed, so it is extremely difficult to alleviate its symptoms.
In addition to local manifestations, the pathology is accompanied by a number of other symptoms:
- weight loss;
- decrease/lack of appetite;
- depression of the immune system, because of which a person is prone to the development of respiratory and intestinal diseases.
The clinical picture is not limited to this, since radiation sickness also affects a number of other organs.
Diagnostics
To correctly diagnose "proctitis", it is necessary to conduct a comprehensive examination. It should begin with a routine examination of the anal and perianal regions.
What can be found on inspection
In acute proctitis (or exacerbation of the chronic form), the following changes are observed:
- redness of the skin around the anus (perianal area);
- fistulous canals may appear. They appear as small "protrusions" of the skin, painful to the touch, from which pus or blood is released;
- the wall of the anal canal is saturated red. Sometimes, cracks can be found on it with the naked eye.
In children, anal lesions often bleed, suggesting acute proctitis. With long-term proctitis in adults, hemorrhoidal nodules are often found, which look like limited thickenings of a dark color. They may, on examination, protrude from the rectal cavity, or are located within it.
Inspection technique
The patient should be in the knee-elbow position in order to have optimal visual access. To examine the anal ring and the final sections of the rectum, it is necessary for the patient to relax as much as possible. For a more thorough examination, an anoscope (a specialized device for proctological examination) is used.
Carrying out a finger examination
This is one of the oldest diagnostic methods that does not require special tools. With the help of it, the doctor is able to suspect not only the presence of inflammation of the rectum, but also the possible cause of proctitis (tumor, foreign object, mechanical injury).
The patient does not need any preparation. The optimal position for the study is knee-elbow. If the patient's condition does not allow him to take this position, the position on the left side with the legs brought to the stomach is recommended.
During the examination, the doctor evaluates:
- the integrity of the rectum and the condition of its walls;
- the presence of any formations on the wall (tumor, fistula, abscess);
- the nature of the discharge (which remained on the glove).
Before the procedure, the doctor must lubricate the glove with liquid vaseline oil, so the digital examination is painless for the patient.
Instrumental Methods
The best way to diagnose this disease is an instrumental examination. The diagnosis of "proctitis" cannot be made if the patient has not been examined by a proctologist. Currently, the following methods are used:
- anoscopy - carried out using a proctological (rectal) mirror, which is lubricated with vaseline oil and inserted into the anus, slightly expanding it. Thanks to this tool, a better view is opened than with a normal examination. It does not require special preparation of the patient. It is carried out in the same positions as the digital examination.
- sigmoidoscopy- This is an endoscopic method, during which a detailed examination of the walls of the rectum (up to 30 cm) is carried out. For this, a sigmoidoscope is used - an elastic tube with a camera and a light source, which is inserted through the anus. Analyzing changes in the mucosa, they can determine the form of the disease:
- catarrhal proctitis- often occurs after the action of irritating substances on the rectum. It is characterized by the appearance of pronounced edema and increased "vascular pattern";
- purulent proctitis - the presence of pus in the cavity of the rectum and infiltration of the wall with immune cells (leukocytes) indicates this form. Develops due to the action of microorganisms;
- erosive proctitis- with this form, thinning of the surface layer of the intestine occurs, which is often observed during a long-term process;
- ulcerative proctitis- characterized by the formation of deep defects, with damage to the muscle layer. Is a sign of UC;
- mixed forms - occur when a combination of various pathogenic factors.
The form does not significantly affect the treatment tactics, but it helps to suggest the cause of the development of proctitis.
How to prepare for sigmoidoscopy
It is necessary to completely clean the rectum from feces so that nothing interferes with the examination. Preparation includes the following steps:
- 3 days before the study, a diet is recommended that excludes foods rich in fiber (any vegetables, berries, fruits; rye bread; corn and pearl barley, and so on);
- In the evening, on the eve of sigmoidoscopy, the patient can eat a light dinner (not containing the above products);
- After 50 minutes, the patient is given enemas every hour until the wash water is "clean";
- Sigmoidoscopy is performed on an empty stomach, so the patient is not recommended to have breakfast;
- In the morning, enemas are repeated until “clean” washings are obtained;
- Immediately before sigmoidoscopy, a digital examination is performed to prepare the anus for the advancement of the endoscope and reduce the risk of injury.
Biopsy
This term refers to the taking of rectal tissue for examination under a microscope. A biopsy is performed during sigmoidoscopy using endoscopic forceps. Local anesthesia is not indicated for this procedure, so it is somewhat unpleasant for the patient. However, a biopsy is needed to rule out a tumor on the rectal wall.
As additional methods, laboratory diagnostics (urine and feces) can be used. However, they are informative only in the presence of chronic proctitis, to identify the underlying disease.
Treatment
The tactics of treatment differ significantly, with different types of proctitis, so the first step to successfully getting rid of the disease is a high-quality diagnosis. Only a qualified doctor can conduct it and prescribe appropriate therapy (the best option is a proctologist).
Treatment of acute proctitis
It is important to combine non-drug therapy with medication. The first point implies the limitation of significant physical exertion, bed rest is desirable. The patient is strongly advised to follow a sparing diet until all symptoms of proctitis disappear. It implies an exception:
- mechanically irritating foods and drinks (too hot/cold; optimum temperature is 15-20 o C);
- chemically irritating foods (sour, salty, bitter, fried, and so on);
- 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 or olive oil on the walls of the rectum;
- to improve the general condition, light sedative (calming) drugs are recommended - tinctures of valerian / motherwort. They can be used up to 4 times a day by 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:
With the introduction of irritating substances into the intestine or after a mechanical injury (minor)
| Group of drugs + examples | What are they doing? | How to apply? |
NSAIDs (non-hormonal anti-inflammatory drugs):
Alternative - combined drugs (antispasmodics + NSAIDs):
|
|
Tablets inside (after meals) or intramuscular injections. No more than 4 times a day. |
Local glucocorticosteroids (hormones):
|
|
Only in the form of rectal suppositories or ointments. It is recommended to apply/inject into the rectum 4 times a day. |
Laxatives (weak):
|
For the prevention of constipation, as they can provoke an exacerbation of symptoms | Tablets for oral administration, 1 time per day. Guttasil and Guttalax are recommended to be taken at bedtime, as stool relief occurs only after 12 hours. |
With 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, and so on), 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 scheme of therapy that can be used for infectious proctitis is as follows:
- Local antiseptic suppositories and ointments that are designed to kill bacteria. For example: Proctosan, Simetride;
How to apply? It is recommended to administer the drug after defecation, twice a day. If you purchased the medicine in the form of an ointment, it should only be administered with the applicator (which is included). After the introduction of an ointment or rectal suppository, the drug should be kept in the intestinal cavity for at least 30 minutes. You don't need to specifically remove it. After the disappearance of symptoms, the course is recommended to continue for another 7-9 days.
- Antibacterial drugs, for intestinal sanitation from bacteria (only for intestinal infections). The best of them is - having a wide spectrum of action, it reaches its maximum concentration in the intestinal cavity and is absorbed into the blood only by 30%. Unfortunately, patients are often allergic to it. In this case, antibiotics are an alternative - Tetracyclines (Unidox, Doxycycline). Pregnant women, children under 8 years of age, they are contraindicated. Josamycin is the safest for them, but only a doctor can choose the optimal antibiotic during an individual consultation.
How to restore normal bowel function? Since these drugs purposefully destroy the intestinal microflora (both pathogenic and normal), after the end of the course, there may be problems with the digestion of food (especially dairy and vegetable products). To prevent this, you should "settle" beneficial bacteria with the help of drugs such as Bifidum, Bifidumbacterin, etc. (cm. ).
- NSAIDs/combinations(antispasmodics + NSAIDs);
- Laxatives (described above).
As a rule, the symptoms of infectious inflammation of the intestine disappear within a few days (up to a week), if the treatment was correctly prescribed and started in a timely manner.
With the introduction of a foreign body or inflammation of the perirectal tissue
Surgery is indicated - removal of a foreign body from the intestinal cavity or a purulent focus in the fiber. 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 able not only to carry out peristalsis to the rectum, but also to move objects in the opposite direction (with its complete blockage). Therefore, foreign objects that patients insert into their rectum often turn out to be much higher - in the sigmoid or even the colon (30-50 cm higher). In this case, the surgeon cannot get the object without incisions, which is why he has to perform more traumatic operations.
For tumors of the rectum
In this case, the patient is referred for a consultation with an oncologist. A second biopsy is performed and, if possible, a CT scan. This determines the degree of spread of the tumor, the presence of metastases and lesions of the lymph nodes. If the tumor is benign, only the neoplasm is removed. In case of a malignant tumor that did not have time to germinate into neighboring organs and give metastases, the entire rectum is removed with the imposition of a sigmostoma (exposing the external opening of the intestine to the anterior abdominal wall). If the malignant neoplasm has spread beyond the rectum, they resort to radiation and chemotherapy methods.
Treatment of chronic proctitis
With this form, all the efforts of the doctor 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. The treatment regimens for possible causes are very complex, so we will describe only the fundamental points:
Treatment of radiation proctitis
Pain comes to the fore with radiation proctitis. It is so pronounced that patients do not find a place for themselves from pain. Therefore, it can be removed with any pharmacological drug that is effective for the patient. Perhaps the appointment of narcotic analgesics, NSAIDs, antispasmodics, and so on.
In addition, be sure to carry out therapy aimed at reducing the damaging effects of radiation. For this purpose, antioxidants are used (ascorbic acid; tocopherol, and so on). To reduce inflammation, local hormonal agents are used (Ultraproct, Doloproct).
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 for the treatment of various forms of the disease, which makes it possible to achieve either a complete recovery or a stable remission. The main thing that the patient should do for this is to consult a doctor in a timely manner, since prolonged self-medication can lead to the development of complications and aggravation of the severity of the disease.
An inflammatory disease of the rectal mucosa is called proctitis. As a rule, inflammation of the rectum becomes the result of diseases of the large intestine already existing in the patient, acute intestinal infections, sexually transmitted diseases, and operations on the rectum.
Manifestations of proctitis
Proctitis can be in acute or chronic forms, which determine the features of the clinical picture of the disease. Acute proctitis begins suddenly, the patient's body temperature rises, chills and a feverish state occur. Despite constipation, quite often there are false urges to defecate, heaviness in the rectum. The acute form of this disease occurs infrequently. Much more common is chronic proctitis. It occurs gradually, almost without any clinical picture. Attention is drawn to the sensation of itching or burning in the anus, a slight weeping. For some time, these symptoms are quite successfully stopped by home remedies, which allows the patient to postpone a visit to the doctor. However, it is worth breaking the diet, eating spicy food or alcohol, as the patient immediately feels an increase in burning sensation in the rectal area, mucous secretions appear, sometimes with an admixture of pus. The sooner you undergo an examination and appropriate treatment, the higher the chances of a full recovery.
Diagnosis and treatment of proctitis
To confirm the diagnosis of proctitis, the doctor conducts not only a digital examination of the rectum, but also prescribes endoscopic diagnostics. Very informative are rectoscopy, biopsy of the rectal mucosa, bacteriological seeding of a smear from the intestine for microflora. Treatment of proctitis is a very difficult task. First of all, the patient's diet is corrected. For the period of treatment of proctitis, spicy, salty and sour foods, alcohol, plant foods, juices, and sweet dishes are excluded. Subsequently, the diet may be slightly expanded, but some caution should be exercised, since the likelihood of developing relapses of the disease is high. Be sure to adhere to the drinking regimen. Treatment of proctitis in the acute phase is to eliminate inflammation, gently cleanse the intestines. Medical microclysters, ointments and suppositories are used. Usually, the treatment of proctitis takes a rather long period, but subject to all the recommendations, the chance for a full recovery is high.
Treatment of proctitis with medications: suppositories, antibiotics. Usually, proctitis therapy is carried out on an outpatient basis. Severe forms of proctitis treatment with suppositories. For the treatment of ulcerative proctitis, suppositories with sulfasalazine or prednisol are used. If the patient does not go to the doctor, but begins to be treated at home with suppositories, ointments or tablets, treatment of proctitis is effective only under medical supervision. Medical treatment of proctitis. With inflammation of the rectum, treatment includes suppositories with methyluracil, sea buckthorn oil will accelerate the regeneration of damaged tissues. Methods of treatment. If the diagnosis of proctitis is confirmed, treatment must also be prescribed, and the doctor may prescribe topical preparations of suppositories or ointments for proctitis in them. Treatment of proctitis with the use of drugs, enemas. Proctitis causes, symptoms, diagnosis. Paraproctitis candles with sea buckthorn with hemorrhoids. Candles betiol, anuzol with painkillers. Treatment of chronic proctitis elimination of causative factors, sparing diet.
Proctitis treatment. Questions and answers. Ask a Question. Question: Can paraproctitis be cured with ultraproct suppositories? the bump seemed to disappear. Proctitis - symptoms and treatment of proctitis. Proctitis is an inflammation of the rectum. Corticosteroid suppositories and ointments such as hydrocortisone are used to reduce. Methods for the treatment of proctitis. There are several directions in the treatment of any form of proctitis.
Candles can be used with methyluracil, antiseptics and anesthetics, depending. Proctitis treatment. Antibiotic corticosteroid suppositories or mesalamine suppositories or oral tablets may be prescribed to treat bacterial infections. Topical treatment of chronic proctitis is essentially the same as for acute proctitis. I was advised proctazan, suppositories. It helped, it did not hurt to go to the toilet. Proctitis with its symptoms is no exception. If there is no adequate and timely treatment during pregnancy, then treatment with microclysters, glycerin suppositories is used. Candles and aerosols containing sea buckthorn oil complement regeneration therapy. Proctitis caused by autoimmune non-specific ulcerative colitis requires treatment. Conclusion. We talked about how and how hemorrhoids, proctitis, eczema of the anus are treated - treatment of doloproct suppositories, cream, instructions for its use are also considered.
Treatment of proctitis: what can a doctor do? No-x-sha candles. Drugs affecting the digestive system and metabolic processes. In the treatment of chronic proctitis, special suppositories and ointments are used, but not in all cases the use of suppositories is allowed. But the symptoms and treatment of ulcerative proctitis are very different from those of colitis. These include methyluracil suppositories, it is recommended to administer a suppository three times. Proctitis treatment. Idiopathic proctitis. Usually prescribed enemas or suppositories with mesalazine or enemas with glucocorticoids once a day for.
Proctitis
Acute proctitis with proper treatment ends in recovery. In chronic proctitis, the prognosis is aggravated by more or less frequent exacerbations, discomfort and itching in the anus.
What can a doctor do?
The doctor establishes the diagnosis based on the history, examination data, rectal examination and rectoscopy. To determine the degree and nature of inflammatory changes, a cytological examination of the intestinal contents, sowing of feces in order to determine the composition of the intestinal microflora, and a biopsy of the mucous membrane are carried out.
In severe forms of acute proctitis, treatment is carried out in a hospital. Showing bed rest, a diet with a limited amount of fiber, the exclusion of spicy, fried foods, spices and alcohol. Anti-inflammatory therapy is prescribed taking into account the results of stool culture and the sensitivity of the microflora to drugs. Locally apply microclysters with collargol, chamomile infusion. When the phenomena of acute inflammation subside, oil microclysters, sitz baths with 0.01% potassium permanganate are prescribed. perineal warm shower. In severe forms of nonspecific ulcerative proctitis, the use of corticosteroids has a beneficial effect.
Treatment of chronic proctitis can be carried out on an outpatient basis, using the same means as for the treatment of acute proctitis. Spa treatment is advisable. Assign mud therapy, intestinal lavage with warm alkaline water such as Borjomi, Essentuki, which contribute to the rejection of mucus and activate the motor function of the colon. They use a complex of therapeutic measures aimed at combating constipation, but laxatives should not be used. Treatment of complications of the disease is operative.
If you feel any discomfort, burning sensation or itching in the anus, you should not self-medicate or turn a blind eye to it and think that everything will go away on its own. During this time, the process can only get worse and lead to complications. And, of course, it is necessary to treat the underlying disease that led to proctitis.
Proctitis - treatment
Proctitis is an inflammation of the rectal mucosa. This disease brings the patient a lot of inconvenience, but timely and qualified treatment will help to quickly defeat this disease.
Treatment of proctitis depends on the form of this disease and its severity, but each patient should follow a special strict diet. It provides:
Drug treatment of proctitis is carried out mainly with the help of antibiotics. They are necessary to suppress infection. Together with them, the patient is always prescribed antibacterial drugs. If a patient is diagnosed with radiation proctitis, treatment should be carried out using Corizol or Mesalacin suppositories. With radiation proctitis, mud therapy will help: therapeutic mud is applied to rectal tampons and segmental zones.
With proctitis, local therapy should also be performed. These can be microclysters with collargol or chamomile solution. When the inflammatory process subsides, it is worth continuing the treatment with microclysters, but they should be oily. Also, the patient needs to take sitz baths. They must be done with a 0.01% solution of potassium permanganate. A warm shower on the crotch area will also not be superfluous. It will relieve pain in both acute and chronic proctitis.
Surgical intervention is necessary only in cases where scars form on the intestine and this causes its narrowing.
Treatment of proctitis at home
Treatment of proctitis can be carried out at home. With such an inflammatory process, microclysters, which are performed before bedtime, help. A solution for them can be made from 15 ml of calendula infusion and 15 ml of a 3% solution of boric acid. If the patient has erosive proctitis, treatment can be carried out with the help of infusion of calendula. To prepare it: Take this remedy inside 20 ml three times a day. You can do microclysters with it, but for this you need to dilute 10 ml of infusion in a quarter glass of water.
A good folk remedy for the treatment of proctitis is an infusion of horsetail. It is best to take sitz baths with it. For this:
- Half a glass of horsetail is poured into 1000 ml of boiling water.
- Infuse the mixture for 10 minutes.
- Then it is filtered and poured into the bath.
- The treatment procedure should last 30 minutes.
Treatment of proctitis
Treatment of proctitis is not particularly difficult. All activities are usually held at home. Previously, the patient passes laboratory tests to determine the causative agent of the inflammatory process, undergoes sigmoidoscopy to identify the type of disease. These diagnostic procedures ensure the correct development of treatment tactics.
Antibacterial therapy takes place only after bakposev on the flora. They are available as tablets, powder or rectal suppositories. The drugs have a calming, antipruritic, anti-inflammatory effect, some also stop the pain syndrome. The complex treatment of acute or chronic proctitis includes physiotherapy procedures:
- mud treatment,
- paraffin therapy,
- hydrotherapy,
- physiotherapy,
- massage.
Diet
During the period of acute inflammation, it is necessary to strictly limit the use of alcohol-containing drinks, spicy, salty, smoked, spicy dishes, coarse plant foods. Sweets, chocolate, juices are also not recommended. These foods are irritating to the intestines and can make things worse. The diet should include lean meat, fish, cereals, baked apples. It is advisable to drink more fluids, the therapeutic effect of the water of Borjomi, Essentuki, etc., enhances.
The general treatment is to strengthen the body's defenses, prevent the development of chronic proctitis and complications of this disease. The doctor prescribes drugs that improve the functioning of the gastrointestinal tract, vitamin complexes. In severe advanced cases, bed rest is required, sometimes hospitalization. A common complication of inflammation is the narrowing of the rectum. This pathology develops with improper treatment of proctitis or neglect of therapeutic methods.
Sources: roseola.ru, lifewithgemorroy.east-medicine.ru, health.mail.ru, womanadvice.ru, procto-log.ru
Proctitis is an inflammation of the mucous membrane of the rectum. Often associated with inflammation sigmoid colon(the section of the large intestine that passes into the rectum), and then the disease is called proctosigmoiditis. If the inflammation passes to the adipose tissue that surrounds the rectum, then this disease is called paraproctitis.
There is no exact data on how common proctitis is. The disease occurs in people of different ages, with approximately the same frequency in men and women.
Anatomy and physiology of the rectum
The rectum is the final section of the intestine. Its main function is to remove undigested food. The rectum is located in the pelvic cavity and is surrounded on all sides by adipose tissue. It starts from the sigmoid colon and ends with the anus. The wall of the organ consists of a mucous membrane, and muscles that push the stool.
The mucous membrane of the rectum produces a lot of mucus, which serves as a lubricant to facilitate the passage of feces. The gut has two sphincter- muscle rings. Shrinking, they hold feces, and during defecation(stools) relax.
The rectal mucus contains some digestive enzymes. But they act weaker than in the rest of the intestine. Here, the remnants of nutrients are digested, and everything that is not digested is compacted and brought out.
Around the rectum is the hemorrhoidal venous plexus. This is a network of a large number of veins that are located under the mucous membrane and serve to connect bottom hollow(collecting blood from the entire lower body) and portal vein(collecting blood from the intestines to the liver).
In men, the rectum is adjacent to the bladder and prostate, and in women, to the vagina and uterus.
Defecation is a complex reflex that involves many muscles and nerves. Therefore, in the mucous membrane of the rectum there are many nerve endings.
Causes of proctitis and paraproctitis
Infectious causes of proctitis:
Causes of damage to the rectum:
- surgical interventions for hemorrhoids, anal fissures and other diseases of the rectum;
- anal sex: proctitis is common among men who have homosexual sex;
- undigested sharp objects in feces, for example, pieces of bones, etc.;
- injuries resulting from accidents and intentional damage;
- birth trauma - rupture of the vagina, perineum, rectal wall;
- anal fissure - a defect in the mucous membrane and skin of the anus.
Irrational nutrition
Inflammation of the rectum, which develops with malnutrition, is called alimentary proctitis.
Food, with frequent use of which alimentary proctitis can develop:
- spicy dishes;
- seasonings and spices;
- systematic alcohol abuse.
These types of food irritate the mucous membrane of the rectum, leading to the formation of excess mucus.
Diseases of other organs of the digestive system
In case of impaired digestion, incompletely processed food residues enter the rectum. They irritate the mucous membrane, lead to the release of excessive amounts of mucus, inflammation. Many diseases of the digestive system lead to diarrhea and constipation, which are also factors in the development of proctitis.
Diseases of the digestive system leading to proctitis
- Hepatitis (inflammation of the liver): viral, toxic (in case of poisoning), alcoholic, medicinal (as a result of side effects of drugs). The liver produces bile acids, which emulsify fats in the intestines and facilitate their digestion. If this process is disturbed, then constipation, diarrhea, bloating are noted, feces irritate the rectum.
- Cirrhosis (liver disease, accompanied by the death of its cells).
- Cholecystitis is an inflammation of the gallbladder. The accumulation and secretion of bile and bile acids is impaired.
- Pancreatitis is an inflammation of the pancreas, which secretes the enzymes trypsin (breaks down proteins) and sucrase (breaks down carbohydrates). This disrupts the digestion of proteins and carbohydrates. Undigested proteins are putrefied in the colon. Digestive disorders, dysbacteriosis develop.
- Gastritis and peptic ulcer of the stomach. With these diseases, digestion in the stomach is disturbed. A large amount of gastric juice is secreted, which contains hydrochloric acid. Together with food, it enters the small, large, and then the rectum.
- Intestinal dysbacteriosis
Dysbacteriosis is a disease in which the composition of the intestinal microflora is disturbed. The reproduction of "beneficial" microorganisms is suppressed, and conditionally pathogenic (capable of causing inflammation under certain conditions) is activated.
Dysbacteriosis manifests itself in the form of constipation, diarrhea, frequent stools, the presence of undigested food residues in the stool, and bloating. All this leads to the development of proctitis.
Blood vessel disorders
- With stagnation in the hemorrhoidal veins, the outflow of blood from the rectum is disturbed. Its mucous membrane receives less oxygen, its regeneration, protection against infection and other damaging factors is weakened.
- Diseases accompanied by venous congestion and leading to proctitis:
- hemorrhoids: expansion of hemorrhoidal veins, as a result of which nodes form under the mucous membrane of the rectum;
- varicose veins: varicose veins, accompanied by stagnation of blood and impaired blood supply to various organs, including the rectum;
- thrombophlebitis: the formation of blood clots in the veins and inflammation of their walls;
- heart failure: due to dysfunction of the heart, blood stagnates in the vessels of the lower half of the body;
- venous insufficiency in people who spend a lot of time sitting.
Malignant tumors of the rectum
Rectal cancer always leads to the development of proctitis. This is due to the fact that cancer cells are foreign, in response to them, antibodies are secreted in the body. A malignant tumor produces toxins that affect the mucous membrane of the rectum.
Gradually, tumor metastases spread to the peritoneum and lead to the development of peritonitis - inflammation of the abdominal cavity.
radiation injury
Proctitis is one of the manifestations of radiation sickness. Large doses of radiation cause damage to the rectal mucosa and a chronic inflammatory process. Inflammation of the rectum is a characteristic complication of long-term radiation therapy for malignant tumors.
The action of toxic substances
Poisoning with lead and other heavy metals can lead to proctitis.
Autoimmune diseases
Autoimmune causes of proctitis:
1. Crohn's disease. This is a chronic inflammation of the intestines that can spread to the rectum.
2. Chronic ulcerative colitis is an autoimmune-inflammatory disease of the large intestine, accompanied by the formation of ulcers on the mucous membrane.
Factors that are not a direct cause of proctitis, but contribute to its development:
- hypothermia;
- frequent infections;
- decreased immunity;
- inflammatory diseases of neighboring organs: the bladder (cystitis), internal female genital organs (vaginitis - inflammation of the vagina, vulvovaginitis - inflammation of the vagina and external genitalia, oophoritis - inflammation of the ovary);
- any stool disorders.
Types of proctitis
Classification of proctitis depending on the course of the disease:
Acute proctitis. Symptoms are permanent, but disturb the patient for a short time. The disease is often accompanied by fever, general weakness and malaise. Acute proctitis can be caused by acute infectious diseases, rectal injuries,
Chronic proctitis. Symptoms of the disease are less pronounced, but they bother for a long time. The course is usually undulating: periodic exacerbations are replaced by remissions (improvements). Chronic proctitis is often caused by chronic infections, autoimmune diseases, malignant tumors of the rectum, vascular pathologies.
Classification of acute proctitis depending on the nature of pathological changes in the rectum:
- catarrhal-hemorrhagic - the mucous membrane of the rectum is edematous, has a bright red color, it has a large number of small hemorrhages;
- catarrhal-purulent - the mucous membrane of the rectum is edematous, there is pus on it;
- catarrhal-mucous - the rectal mucosa has a bright red color, it is edematous, it secretes a large amount of mucus;
- polyposis - outgrowths resembling polyps are formed on the mucous membrane of the rectum;
- erosive - erosions are formed on the mucous membrane of the rectum - surface defects;
- ulcerative - on the mucous membrane of the rectum, deeper defects are formed - ulcers;
- ulcerative-necrotic - there are ulcers on the mucous membrane of the rectum, it necrosis and rejection occurs in certain areas;
- purulent-fibrinous - the mucous membrane of the rectum is covered with purulent-fibrinous plaque - a thin film.
The most severe forms of acute proctitis are: catarrhal-purulent, erosive, ulcerative, polyposis.
Classification of chronic proctitis depending on the changes that occur in the rectum:
- hypertrophic: the mucous membrane of the rectum is thickened, all its folds are very well expressed;
- normotrophic: the mucous membrane has a normal appearance;
- atrophic: the mucous membrane is thinned, all the folds on its surface are smoothed out.
Symptoms of proctitis
Symptoms of acute proctitis
- Pain in the rectum. It is acute and worsens with defecation.
- Other unpleasant sensations in the rectum: burning, feeling of heaviness.
- Pain in the perineum - the area located between the anus and the genitals. In women, it can be given to the labia and vagina, in men - to the scrotum and penis.
- Lower back pain - occurs with proctitis in some patients.
- Discharge from the rectum. Most often they are purulent and bloody.
- Increase in body temperature. Usually up to 37 - 38 * C.
- General malaise, chills, fatigue.
- Stool disorders: constipation or diarrhea.
- Frequent painful urge to defecate.
- Impurities of fresh blood or its clots in the stool. This symptom is characteristic of ulcerative and ulcerative-necrotic proctitis.
- Bloody discharge, burning and heaviness of the rectum are signs characteristic of radiation damage to the rectum.
Symptoms of acute proctitis occur within hours or days. With proper treatment, they pass quickly. When they occur, you need to contact a proctologist as soon as possible.
Symptoms of chronic proctitis
- Pain in the rectum is present, but they are very mild, practically do not cause concern to the patient.
- Itching and burning. They are also relatively weak.
- An increase in body temperature is not always observed. Most often, its performance does not exceed 37 * C.
- Constant discharge from the rectum. They look like mucus or pus.
- Impurities in the feces of blood in certain forms of proctitis, for example, caused by nonspecific ulcerative colitis, chronic anal fissures.
- Paleness, anemia. Develop with chronic bleeding in the rectum.
- Exhaustion. It occurs if proctitis is caused by cancerous tumors of the rectum and other serious diseases.
Chronic proctitis can be initially an independent disease or the result of undertreated acute proctitis.
Complications of proctitis
acute paraproctitis - inflammation of the fatty tissue that surrounds the rectum;
- chronic paraproctitis and rectal fistulas - holes that form due to purulent fusion of tissues and connect the rectum to the surface of the skin, neighboring organs (for example, rectovesical fistulas);
- pelvioperitonitis - inflammation of the pelvic peritoneum - a thin film that lines the inside of the abdominal cavity;
- sigmoiditis and colitis - an inflammatory process in the overlying sections of the large intestine: the sigmoid and colon;
- polyps and malignant tumors of the rectum - complications of a chronic polyp;
- narrowing of the rectum due to scarring caused by a severe inflammatory process;
- decreased immunity caused by chronic infection and inflammation.
Diagnosis of proctitis
| Type of diagnostics | How is it carried out | What helps to identify | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Digital rectal examination of the rectum | The study can be performed without special preliminary preparation. The patient takes the knee-elbow position: The doctor washes his hands and puts on sterile gloves. Lubricating the right index finger with petroleum jelly, he introduces it into the rectum and conducts a study. Digital rectal examination gives many patients discomfort, so the doctor must perform it carefully and quickly. |
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| Rectoscopy | Proctoscope is a metal tube with a diameter of 1.5 - 2 cm and a length of 25 - 30 cm with an eyepiece for inspection and a light bulb. There are also flexible fibrocolonoscopes- endoscopic equipment similar to that used in gastroscopy. The patient takes the knee-elbow position. The doctor gently inserts a proctoscope, lubricated with Vaseline, into his rectum. In order to better examine the lumen of the rectum, it is slightly inflated with air.
DietWith proctitis, you need to exclude from the diet all food that irritates the rectum: spicy, salty, sour, fatty, spices. During acute proctitis and chronic exacerbation, vegetables, fruits, berries, and any sweets should be temporarily abandoned. Approximate diet for proctitis: Mode and physical activityWith proctitis, a long stay in a sitting position is contraindicated, as this leads to a weakening of the pelvic floor muscles, congestion in the veins of the pelvis and lower extremities. Even with a serious condition of the patient and bed rest, a minimal set of physical exercises is often prescribed. With ulcerative, ulcerative-necrotic, polypous acute proctitis, the patient is usually hospitalized in a hospital. In other forms, treatment is carried out on an outpatient basis in a polyclinic. Chronic proctitis is also treated on an outpatient basis. Hospitalization is indicated in some cases with exacerbation. Bad habits During the treatment of proctitis, you need to stop drinking alcohol. Treatment of proctitis with the use of drugs, enemas
Indications for surgical treatment of proctitisComplication in the form of paraproctitis. It is necessary to excise the focus of purulent inflammation in the adipose tissue that surrounds the rectum. Complication in the form of narrowing of the rectum - the operation is aimed at restoring the normal width of its lumen. Long-standing sluggish inflammation that cannot be cured with medicines. Non-specific ulcerative colitis - surgery is performed according to indications. Proctitis caused by tumors of the rectum. Prevention of proctitis
Can a child develop proctitis, for what reasons? How to identify the symptoms, what are the principles of treatment of this disease in children? Children also have proctitis, and children under the age of 1 year are more likely to suffer from this disease, which is associated with milk intolerance. Causes of proctitis in children: 1. The primary cause of proctitis is trauma to the rectal mucosa:
 Symptoms of proctitis in infants:
Features of the course of proctitis in older children:
1. For infants, the only method treatment is the transfer of the baby to artificial nutrition with mixtures of split protein. Breastfeeding can be maintained if the mother completely refuses dairy products (including fermented milk), eggs (especially protein), soy, and other legumes, seafood and other obvious allergens. 2. For older children:
How often do children have complications of proctitis? Complications of proctitis in children occur less frequently than in adults. The most common narrowing of the rectum and paraproctitis. Negative consequences after proctitis occur only with incorrect or untimely treatment, and especially with self-medication. Prevention of proctitis in children:
Rectal fistula and paraproctitis with proctitis, how to identify what is dangerous?With prolonged inflammation of the rectum, purulent ulcers form in its wall. Pus is always looking for a way out. A more favorable outcome is if a breakthrough of pus occurs in the intestinal lumen. But the intestinal wall melted by pus becomes thinner over time, so a breakthrough of purulent contents can occur in nearby tissues, namely, in the fatty layer surrounding the rectum. Such a state is called paraproctitis (« para-" from Latin "about"). Paraproctitis often develops against the background of chronic proctitis, but it also happens with an acute process.This complication of proctitis requires surgical intervention in the form of removal of an abscess (abscess). If this was not done at the time, then pus from fatty tissue looks for a way out and forms rectal fistulas(abnormal passages formed by tissue destruction, connecting the rectum with surrounding organs or skin). Rectal fistulas are a manifestation of chronic paraproctitis.
Since many patients postpone going to the proctologist for an indefinite time (until it gets hot at all, because unpleasant manipulations are waiting there), especially patient patients adapt to the state of paraproctitis. There is a chronic course, the intensity of symptoms decreases, over time, symptoms of the formation of rectal or pararectal fistulas. Symptoms of rectal fistulas, depending on the type.
Common symptoms of rectal fistulas:
 Rice. No. 1. Schematic representation of the types of anorectal fistulas.
What to do, how to treat? 1. Only surgical treatment is effective - opening abscesses, removing fistulas, sanitizing affected structures, and so on. Radiation proctitis, what are the causes, symptoms, diagnosis and treatment? Radiation proctitis is a chronic proctitis caused by long-acting ionizing radiation. Most often, such a process is the result of radiation therapy to the abdomen and pelvis, used to treat cancer patients (cancer of the intestines, genital organs in men and women, and so on). Among these patients, radiation proctitis develops in every tenth case. Symptoms of such a complication do not develop during radiation therapy, but after a few months. Symptoms of radiation proctitis:
For diagnostics this type of proctitis use the same research methods as in other types, and biopsy of the rectal mucosa necessarily included in the research algorithm for the differential diagnosis of radiation proctitis and cancerous tumors. For a biopsy, the material is taken in several places, they necessarily capture not only the mucous, but also the submucosal layer of the intestine. The histological picture of radiation proctitis differs from other types of inflammation of the rectum, although, as with other processes, nonspecific inflammation is observed. In addition to biopsy, they also carry out mandatory stool culture, since radiation proctitis in most cases is accompanied by intestinal dysbiosis. Often there is a combined lesion of the rectum:
1.
Mostly radiation proctitis after full examination does not require hospitalization
, patients with comorbidity and severe and/or complicated course of the disease need inpatient treatment. After the symptoms subside:
1.
the presence of complications of proctitis, How to treat proctitis at home? Is the alternative treatment of proctitis effective? Can proctitis be completely cured?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 is a deterioration and loss of precious time.
1.
Diet
with the exception of spicy, salty, fatty, fried foods, as well as raw foods of plant origin. The most effective methods of traditional medicine for the treatment of proctitis.
Can proctitis be completely cured? Acute proctitis with adequate and timely treatment is completely curable. But if the disease has acquired a chronic course, then no methods of treatment lead to a complete recovery. But with the right therapy and diet, you can achieve a long-term remission of the disease and prevent the development of complications. Photo, what might the signs, symptoms of proctitis and its complications look like? This is what it looks like rectal mucosa in ulcerative proctitis . There are multiple ulcers on the intestinal mucosa (with purulent contents), against the background of vascular injection (vascular reaction to inflammation, hyperemia).
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General recommendations for proctitis
What symptoms indicate the development of paraproctitis?
For diagnostics such fistulas, in addition to inspection, use instrumental research methods:
Principles of treatment of proctitis at home:
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Somehow it just so happened that one of the most unpleasant and painful diseases of the gastrointestinal tract are diseases of the rectum.
Of course, it’s bad if a person has a very sore throat, he can hardly speak and swallows food with pain. But the condition is much worse when a person experiences excruciating pain, bleeding from the anus, or it is simply impossible for him to go to the toilet to empty his intestines freely ..
Today we will talk about proctitis, or rather, about a whole group of diseases, which is united in this collective name. Every person, especially those who are in "sedentary" work, should know the causes and manifestations of this disease, and how to treat proctitis.
Proctitis - what is it?
Proctitis is a whole group of diseases in which the wall of the rectum becomes inflamed. As you know, the rectum is the last section of the intestine in general, and the last section of the large intestine in particular. And it is precisely the pathology of the large intestine in other departments that most often causes the appearance of inflammatory changes in the rectum.
Let us immediately clarify that the rectum, like all other organs in anatomy, has a double name. The Latin language is "rectum", hence rectal examination, rectal suppositories, sigmoidoscopy, and other terms that "manipulate" the rectum. And the Greek name is “proctos”, which refers mainly to diseases: proctitis, paraproctitis, and so on.
About the causes of proctitis
Since the rectum is part of the digestive tract, then "storms" reach it, which happen much higher. There are the following common causes of the development of the disease:
- lowering down the infection from the higher located sections of the intestine;
- various autoimmune processes and allergies;
- long-term use of laxatives without interruption;
- the use of strong alcoholic beverages and irritating (spicy) dishes and sauces.
In addition to the general ones, there are also local or local reasons. This is frequent constipation or diarrhea for various reasons and without them, frequent use of drugs in rectal form (capsules, suppositories), frequent anal sex and its “surrogates”.
Also, specific infections (syphilis and tuberculosis), various helminthic invasions, and gonorrhea can lead to proctitis. Special types of diseases are allergic and radiation proctitis, as a form of manifestation of radiation sickness caused by ionizing radiation.
Given that the disease has so many causes, it can be assumed that there are many forms of the disease too.
Types of proctitis in humans
It really is. First of all, there is an acute lesion, and there is a chronically current disease, with periods of exacerbations and remissions. In chronic proctitis, it is important how pronounced the changes in the intestinal mucosa are. Therefore, hypertrophic, normotrophic and atrophic variants can be distinguished. Acute proctitis, in turn, happens:
- Catarrhal (simple);
- Purulent;
- Ulcerative. The precursor of this form is erosive proctitis.
- Ulcerative - necrotic (severe form);
- hemorrhagic;
- fibrinous.
But the rectum is not at all an easy formation. It has several departments, and, depending on the location of the site of inflammation, proctologists distinguish five variants of the course, namely: diverticulitis, cryptitis, perineal proctitis, pectenosis and papillitis. We will not analyze these options in detail, the main thing is to know how proctitis proceeds in general terms, and what you need to pay attention to.
Symptoms of proctitis - pain and discharge
There are many permanent and temporary "symptoms of intestinal proctitis", as people ignorant of medicine say, as well as the "luminaries" of traditional medicine. The most common and characteristic are:
- Pain in the rectum. They are constant in the case of acute proctitis and variable in chronic inflammation;
- Allocations. Most often they occur in acute illness. Depending on the form, they are mucous, purulent, serous and hemorrhagic;
- In an acute process, body temperature rises, malaise occurs;
- There is a violation of the evacuation function of the organ, the sphincter of the intestine is sharply weakened, gaping of the anus occurs, and functional fecal incontinence may develop.
As for the symptoms of chronic proctitis, it often happens that there are practically no complaints. An admixture of mucus can be found in the feces, and the diagnosis can often only be made during sigmoidoscopy.
In some cases, the course of the disease may be different. So, the process can proceed according to the type of paraproctitis, with the involvement of peri-intestinal fiber. There may be pain in the depth of the pelvis, an increase in blood leukocytosis, a violation of the general condition of the patient. This is how diverticulitis proceeds, in which a painful infiltrate is formed, which can be felt in the thickness of the wall of the rectum during its digital examination.
Also, sometimes the disease occurs with a periodic sensation of a foreign body in the anus and the occurrence of pain.
About diagnostics
Proctitis refers to those diseases that are easily diagnosed by questioning and examination, including rectal.
However, as in the case of chronic venous insufficiency of the lower extremities, only the use of additional research methods, such as sigmoidoscopy, stool analysis for microflora, bacteriological examination, fecal analysis for worm eggs can help determine the cause of proctitis.
The final conclusion about the nature of the disease, in the case of chronic proctitis, allows you to make a biopsy of the rectal mucosa.
Treatment of proctitis - drugs and diet
And in acute and especially in chronic forms of proctitis, the main thing is conservative treatment. Emergency situations where the patient's life is at stake are rare. The main conservative measures include the following:
- diet,
- local treatment,
- physiotherapy,
- antibiotic therapy.
Let's consider these stages in more detail.
Diet
The diet for proctitis may not differ from that for acute intestinal infection - with enteritis, or enterocolitis. The basis should be the maximum physical and chemical sparing of the rectum.
Since “it’s far from the rectum”, thermally one can afford a variety: hot and cold dishes are not forbidden. Coarse fiber and vegetables are excluded, which may not be digested and cause pain.
It is necessary to completely abandon alcohol, fatty, spicy foods, sauces and snacks. Fatty foods can speed up the passage of food, and this will cause intense muscle contraction of the walls of the rectum.
The basis of nutrition should be moderately acidic and low-fat sour-milk foods, steam dishes, vegetable soups, oatmeal, baked apples, cottage cheese, jelly, kissels and mousses.
Local treatment
Local treatment of proctitis refers to various baths and enemas with herbal preparations and weak antiseptics, a perineal shower, and toileting of the anus.
Of the drugs that are used, one can name calendula and a decoction of chamomile, sea buckthorn oil, colloidal solutions of silver and other components.
Antibacterial therapy
With an exacerbation of chronic proctitis, the appointment of antibiotics is indicated only when the inflammatory process in the intestinal wall has penetrated deeper than the submucosal layer, and signs of intoxication and a rise in temperature have appeared.
Such a strict approach to prescribing antibiotics is not accidental: after all, taking them leads to the development of dysbacteriosis, and it can manifest itself as diarrhea, which worsens the course of the underlying disease and requires immediate correction.
In the same case, if the patient has purulent, ulcerative necrotic, and other forms of severe proctitis, then it is necessary to prescribe antibiotics not only inside, but also intravenously - such forms of the disease require hospitalization in a surgical hospital, and in some cases surgery is indicated.
Of the antibiotics, broad-spectrum drugs are shown, such as Amoxiclav - amoxicillin in combination with clavulanic acid, third and fourth generation cephalosporins, Augmentin, and other drugs. It is desirable that before use there is a justification for the appointment of this particular drug - you need to get the result of a bacteriological study of the discharge from the rectum.
Deworming
Other types of helminths are rarely to blame for the development of inflammation of the rectum, but dysenteric amoebae can lead to severe ulcerative, and even perforative process. True, they are not limited to the area of intestinal priming alone, but cause severe inflammation in the upper sections of the large intestine.
The use of suppositories for proctitis
Since the rectum is located “on the border”, and there is access to it, a very important component of therapy is the use of therapeutic suppositories (rectal suppositories), which are used for various purposes. Candles for proctitis can be combined into several groups:
- There are wound healing suppositories that have a reparative effect. These are suppositories with methyluracil and sea buckthorn oil;
- Pain-relieving suppositories with a reparative effect: "Relief Advance". They contain benzocaine, which helps relieve pain, both in acute and chronic processes;
- Disinfectants and antiseptics, with anti-inflammatory effect - candles "Anuzol";
- Candles containing a strong anti-inflammatory component - corticosteroid hormones with painkillers - "Doloprokt" and "Ultraprokt".
Treatment of proctitis with suppositories should last at least a week.
In addition to these therapeutic measures, it is also possible to conduct antiviral (antiretroviral) therapy in patients with HIV infection, treatment of herpes infection in the form. In other words, the underlying disease needs to be treated as far as possible. The use of antispasmodics is also indicated.
Indications for surgical treatment
Surgical intervention for proctitis is rare. For this, there must be strong evidence:
- Paracancrotic, or neoplastic proctitis, caused by tumors of the rectum. In the later stages of rectal cancer, sometimes ulcerations and bleeding are mistaken for proctitis, and begin to be treated with "folk remedies";
- In the presence of non-specific ulcerative colitis, NUC, which is atypically low;
- With the development of paraproctitis and the appearance of an encysted purulent focus in the thickness of the pelvic and perirectal tissue.
Finally, there may be a number of reconstructive plastic surgeries. For example, when recovering from ulcerative proctitis, a scar formed on the mucous membrane of the rectum, which caused stenosis (narrowing of the lumen) of the intestine, and difficulty in defecation. In this case, an operation is performed to restore intestinal patency.
Treatment of chronic proctitis in remission
In the event that the symptoms of proctitis do not bother, then the patient can be sent to the physiotherapy department, or to a sanatorium - resort treatment. Pelotherapy is indicated, including the use of tampons with therapeutic mud, intestinal irrigation.
Highly effective bowel lavage using mineral waters with an alkaline reaction. They normalize the intestinal microflora, and are also sources of beneficial ions and trace elements that have a healing and regenerating effect.
It is also important that these irrigations remove mucus, which is usually prone to infection and congestion.
Forecast
We briefly reviewed the symptoms and principles of treating proctitis in adults - in the same case, if a person does not pay attention to increasing complaints, or, which often happens, is embarrassed to go to a proctologist for the first time in his life (especially the male population, for a known reason), then they can serious complications occur.
This is the penetration and accession of infection up to peritonitis, intestinal necrosis, paroproctitis, the formation of external and internal fecal fistulas, which in some cases can even lead to the death of the patient.
In the event that the patient is diagnosed in a timely manner and conservative treatment is started, then the disease can be cured and transformation into chronic proctitis does not occur, then everything ends with a complete recovery.
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