Chronic proctitis symptoms. Proctitis is an inflammation of the mucous membrane of the rectum. Mode and physical activity

It is worth noting that the presence of proctitis suggests that the patient had errors and violations in the diet, which led to the creation of conditions for the development of the disease. In this regard, a thorough review of nutrition is necessary.

First of all, you need to exclude from the diet the use of alcoholic beverages, which are very aggressive on the mucous membrane. It is worth noting that even a healthy mucosa is negatively affected by alcohol, leaving traces of an acute inflammatory process on it, and damages it at the point of contact.

Smoking is another factor that negatively affects the mucous membranes, including the rectum. Tobacco smoke has a carcinogenic effect and leads not only to the development of this disease, but also to cancerous tumors.

Prohibited and permitted products for proctitis

Quite often, with proctitis, the mucous membrane is damaged in the higher parts of the digestive tract. It's about the stomach. In this regard, it is necessary to make a diet as sparing as possible. And so, from the diet of the patient it is necessary to exclude or minimize the use of:

• fried and spicy foods;
• spices and hot sauces;
• fiber-rich foods (cereals, fruits and vegetables). Nutritionists recommend eating only apples from fruits, and eating vegetables in small quantities and in a pureed form;
• salty dishes, since it is salt that delays inflammatory processes;
• sweets and chocolate.

For the treatment of inflammation of the rectum, special attention should be paid to the use of fermented milk products that contribute to the normalization of the stool. In addition, this group of products contributes to the normalization of the intestinal microflora, improves motor function and at the same time does not irritate the mucous membrane. Due to the wide range of fermented milk products in retail chains, it is absolutely not difficult to fulfill this recommendation.

It is worth noting that it is equally important for proctitis and diet. It should be fractional, in other words, you need to eat in small portions five to six times a day. Thus, the load on the intestines will be reduced, which acts as a kind of sparing regimen.

In the case of accompanying proctitis with constipation, it is necessary to carefully select laxatives. The reason for this is their action, which is based on irritation of the rectal mucosa, which thereby enhances intestinal motility.

In this case, it is recommended to resort to traditional medicine and use a decoction of flax seeds or psyllium seeds. Such a laxative forms mucus, which promotes the movement of feces through the intestines.

Menu for proctitis

Lunch should consist of meat broth or vegetable soup (well mashed), boiled meat passed through a meat grinder. Steamed fish or meatballs. Cranberry jelly is allowed.

Dinner may contain rice porridge cooked in water with a small amount of butter added, a steam cutlet and cottage cheese.

The rectum is the lower end of the intestine, ending at the anus. Under the influence of various factors, its mucous membranes can become inflamed, in which case a disease called proctitis develops. Often it is of a combined nature and also affects the sigmoid colon or fatty tissue.

The reasons

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

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

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

Local damaging factors

Rectal administration (through the anus) of any irritant:

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

Most often, they are used by patients as an alternative treatment for proctitis, which only aggravates the symptoms.

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

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

Types and forms of the disease

Classification of proctitis depending on the course of the disease:

1. Acute proctitis
2. Chronic proctitis

Acute proctitis

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

The fundamental symptom of acute proctitis is pain in the rectal cavity. They have a very strong character and are aggravated by the act of defecation. Painful sensations can also appear in the perineum, between the anus and the genitals. In women, there is pain in the labia and vagina, and in men - in the scrotum and penis. Some patients experience pain in the lumbar region. Constantly accompanied by a painful urge to defecate.

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

• Erosive - on the tissues of the intestine there are superficial lesions - erosion.
• Ulcerative - the intestinal mucosa is covered with deeper lesions - ulcers.
• Ulcerative-necrotic - there are ulcers on the tissues of the intestine, in some areas there is necrosis of the mucosa and its rejection.
• Catarrhal-hemorrhagic - the mucous membrane is bright red, edematous, many small hemorrhages are visible on it.
• Catarrhal-mucous - tissues acquire a bright red color, swell, and begin to secrete a lot of mucus.
• Catarrhal-purulent - the tissues are edematous in appearance, pus is present on them.
• Purulent-fibrous - the intestinal tissue is covered with a thin film - purulent-fibrous plaque.
• Polyposis - outgrowths that look like polyps appear on the mucosa.

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

Chronic form

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

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

The chronic form is divided into:

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

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

There are the following forms of the disease:

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

What does proctitis look like: a photo of the disease

In the photo below, you can see the normal rectal mucosa, and next to it is proctitis.

In the photo on the left is proctitis, on the right is the norm

Symptoms of proctitis

If proctitis is detected during the examination of the patient, the symptoms can be very diverse. They largely depend on the form of the course of the disease.

Acute proctitis is characterized by the following symptoms:

• pain syndrome in the lower abdomen;
• feeling of discomfort;
• feeling of heaviness;
• pain during bowel movements;
• itching;
• tenesmus;
• the appearance of blood in the stool.

The chronic form is accompanied by the following symptoms:

• 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, . Develop with chronic bleeding in the rectum.
• Exhaustion. It occurs if proctitis is caused by cancerous tumors of the rectum and other serious diseases.

Diagnostics

The diagnosis is confirmed by the doctor based on medical history and visual examination. For clarification, it is necessary to conduct additional examinations of the patient:

1. Palpation of the walls of the rectum.
2. Sigmoidoscopy. This procedure is one of the simplest and fastest methods of examining the intestines. During the manipulation, it is possible to examine the entire thick section and partially affect the sigmoid. One of the undoubted advantages of this procedure is that if any formation is detected, the doctor can take a piece of it for a biopsy.
3. Cytological examination of the contents of the intestine, biopsy of the intestinal walls. This gives a complete descriptive description of the inflammatory process, which makes it possible to distinguish the post-radiation, chronic, superficial type of the disease from a tumor in the rectum. In order to determine the state of the intestinal flora, stool culture is performed.

Treatment of proctitis

How to treat intestinal proctitis? The proctologist prescribes treatment depending on the causes that caused the inflammation of the mucosa, and the form of the disease. The therapy is based on adhering to a certain diet and a set of hygiene measures, and also includes taking medications.

Effective treatment of proctitis consists of following a diet compiled by a doctor, excluding spicy, raw, sweet, fatty and fried foods from the diet, refraining from drinking alcohol and smoking, flour and confectionery products, maintaining an active and mobile lifestyle, constant physical exertion on the body, regular cleansing of the rectum with anti-inflammatory and healing enemas from chamomile, calendula, sea buckthorn oil, etc.

With 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 proctitis, the patient may be prescribed the following drugs:

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

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

Surgical intervention is rarely used and consists in resection of various parts of the rectum or in its complete removal, depending on the situation. Sometimes suturing is done. With narrowing, the width of the lumen is restored. In oncology, the tumor is removed.

Candles

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

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

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

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

Dieting

Diet is very important in the treatment of this disease. It is necessary to reconsider your diet, follow all the requirements of the diet:

1. alcoholic beverages are completely excluded, as they irritate the mucous membrane, leaving damage and signs of an acute inflammatory process at the site of contact,
2. You should stop smoking, because tobacco smoke irritates the mucous membrane in the gastrointestinal tract.
3. From the patient's diet, it is necessary to exclude or minimize the use of:
   • fried and spicy foods;
   • spices and hot sauces;
   • fiber-rich foods (cereals, fruits and vegetables). Nutritionists recommend eating only apples from fruits, and eating vegetables in small quantities and in a pureed form;
   • salty dishes, since it is salt that delays inflammatory processes;
   • sweets and chocolate.

It is worth noting that it is equally important for proctitis and diet. It should be fractional, in other words, you need to eat in small portions five to six times a day. Thus, the load on the intestines will be reduced, which acts as a kind of sparing regimen.

It is most useful for proctitis to eat more fermented milk products. An obligatory dish should be cottage cheese, kefir, fermented baked milk, homemade yoghurts, low-fat sour cream. These products effectively soften the stool, facilitate bowel movements, and do not irritate the intestinal mucosa.

It is also useful to include in the diet steamed, boiled lean meat: veal, beef, poultry, rabbit meat. Useful light vegetable soups. Vegetables, fruits - only in stewed, steamed form. It is good to eat baked apples.

Menu for proctitis for the day:

1. Breakfast: egg white omelette, a serving of semolina porridge cooked in water with 1 tsp. butter. Or a cup of yogurt with a serving of cottage cheese.
2. Lunch: light meat broth or vegetable puree soup. Steam cutlets or a piece of boiled (stewed fish). You can drink berry jelly.
3. Dinner: thin, well-boiled rice porridge in water with 1 tsp. butter, a piece of boiled chicken, a small plate of cottage cheese, yogurt or a glass of fermented baked milk.

Prevention

To prevent the inflammatory process, you should eat right, avoid risk foods and excessive alcohol consumption. Recommendations:

• Timely treatment of pathologies that contribute to its appearance;
• Timely treatment of constipation;
• Refusal to wear synthetic underwear;
• Minimizing the consumption of alcoholic beverages;
• Compliance with the diet after surgical interventions on the rectum;
• Compliance with all rules of intimate hygiene.

This is all about intestinal proctitis in adults: what kind of disease is it, what are its main symptoms and signs, and treatment features. Be healthy!

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, stagnation of feces, 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.

The reasons

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.

Proctitis is characterized by the presence of an inflammatory-dystrophic process of the rectal mucosa. Often becomes a concomitant disease. Rarely seen as a standalone unit. It is possible to diagnose the disease on the basis of examination and complaints of the patient.

The reasons

There are acute and chronic stages of the disease. Acute proceeds within two to three days. Symptoms appear almost immediately. The surface of the mucous membrane is affected. Chronic proctitis is expressed in:

• catarrhal-hemorrhagic form;
• erosive form;
• catarrhal-purulent form;
• polyposis.

The reasons are differentiated as follows:

Inflammation of the rectal mucosa develops rapidly. The symptom is the presence of bloody discharge from the intestine. Purulent inclusions or streaks are possible. The person describes a sharp pain during a bowel movement.

Possible exacerbation of hemorrhoids. The appearance of mucus in the feces. Aching pain from the lumbar region may radiate to the perineum. The course of an acute form of proctitis can affect a person's daily activities.

Therapy

At home, herbal decoctions are used to treat proctitis. The patient takes baths while sitting in the prepared composition. Folk remedies have proven to be an effective method of dealing with the manifestations of the disease. It is forbidden to independently prescribe any means from traditional medicine to relax the intestines. You can do more harm than good. The right choice of collection or combination of herbs should be recommended by the attending physician. You should not change the dosage on your own.

The main condition for the treatment of proctitis is the correction of nutrition. Diet for proctitis is the main and indispensable stage of therapy. To achieve the maximum effect in the treatment, it is necessary to comprehensively influence the disease. Properly assigned nutrition becomes fundamental. The diet for proctitis becomes sparing, the products are served in a pureed form. There should be no additional irritating factors acting on the mucosa. Drug therapy focuses on the form of proctitis. It is on her that the appointment of laxative or fastening medications depends.

Ulcerative proctitis needs daily medical supervision. The patient is hospitalized for the duration of therapy. The complex of therapy consists of taking medications and dietary nutrition. The serving temperature of prepared meals must be acceptable to the patient. Properly selected nutrition for proctitis helps to restore the function of the excretory system.

This has a positive effect on the patient's condition as a whole. The duration of the diet is at least five weeks. With chronic ulcerative proctitis, food restriction can last much longer. Small portions will help restore the digestive system. Doctors do not recommend eating after 21:00. can be treated on an outpatient basis.

Post-radiation proctitis is subject to a complex of influences and consists of medicines, dietary nutrition and prescribed procedures. Nutrition corrects the resulting discomfort.

For the treatment of any type of proctitis, there are a number of general recommendations that the patient must follow:

1. Rejection of bad habits. Alcohol and smoking adversely affect the functioning of the digestive system of the body.
2. The fragmentation of nutrition becomes the cornerstone. Portions of food become smaller, and the absorption of food - more often. Products do not accumulate in the stomach. There is no decay process.
3. Medications aimed at correcting the situation with going to the toilet should be selected strictly individually. The danger of laxatives is that they irritate the intestinal mucosa. At the same time, inflammation progresses. In such cases, folk methods come to the rescue. An effective remedy is a decoction of psyllium seeds. Due to the formation of a composition close in consistency to mucus, a lump of food moves more easily through the intestines.

Proper nutrition

Recommended for the use of dishes that can easily be absorbed by the body. The high content of vitamins and minerals in foods has a positive effect on organ function. Products at the time of cooking are strongly boiled, have a bland taste, and the amount of fat is minimized. Allowed to eat baked apples, products that have lactic acid bacteria in the composition, containing a large amount of protein, cereals that have a water base.

From flour products, it is allowed to use wholemeal bread products, figs. Fruits allowed for consumption: figs, bananas, tangerines. Juices need to be diluted. Meat is recommended to boil or steam. It is allowed to eat vegetables that have been stewed.

Dietary food creates conditions for the movement of a lump of food along the tract, bringing minimal irritation.

To restore the functions of the digestive organ, it is recommended:

1. Minimize your intake of foods high in fiber.
2. Exclude from the diet those foods that enhance the functionality of the secretion glands. Food should not accumulate. Otherwise, rotting and fermentation occurs.
3. Reduce your intake of salt and pickles. The substance prevents getting rid of the inflammatory process.

Proctitis is a disease that limits the use of flour, legumes, fried and fatty foods. Under the ban are smoked products, all kinds of sauces, sweets and some cereals. It is forbidden to use products of plant origin that contain essential oils.

The component irritates the mucous membrane, exacerbating the disease. Do not eat fresh vegetables and fruits. They contain substances that cause irritation of the inflamed mucosa, as well as fiber.

When compiling an approximate menu, it is necessary to remember about the fragmentation of nutrition. It is appropriate to include cottage cheese, boiled chicken, vegetable broth in the diet. Soups can be made from low-fat broth. Butter is recommended to be eaten in minimal doses, flavoring it with porridge from some types of cereals. Fluid intake should be increased to prevent constipation.

Dietary nutrition in the treatment of proctitis involves taking medications. These may be antibiotics. Prevents the spread of infection to nearby organs and the entire body. The first signs of pain in the intestines suggest the need to consult a doctor.

Proctitis is an unpleasant disease. Relief of its manifestations is quite real and without acute medical intervention. The main thing is to notice the manifestations in a timely manner and contact a tedious specialist without hesitation. Self-elimination of only symptoms contributes to the flow of the disease into a chronic form.

The information on our website is provided by qualified doctors and is for informational purposes only. Do not self-medicate! Be sure to contact a specialist!

Gastroenterologist, professor, doctor of medical sciences. Prescribes diagnostics and conducts treatment. Expert of the group on the study of inflammatory diseases. Author of more than 300 scientific papers.

There are diseases, or rather a whole group of diseases, which, although they are not life-threatening, can significantly reduce its quality. One of these pathologies is proctitis. Obsessive discomfort in the rectum and other symptoms inherent in the intestinal disorder, which occur against the background of inflammation, do not allow the patient to follow his usual daily routine.

In order to save yourself from such an outcome, you need to identify the pathology in a timely manner and begin its treatment immediately. Classify acute and chronic forms of rectal proctitis, each of them has its own causes of development. The presence of such a disease in a patient's history can greatly facilitate diagnosis in the future.

Cause classification

It is customary to distinguish the causes that can lead to an inflammatory process in the rectum into two groups. The first group consists of local damaging factors that directly affect the mucous membrane of the organ. The second group consists of factors of a general nature that affect not only the final sections of the intestine, but also the whole organism in particular.

It is worth noting that common causes in most cases lead to the development of a chronic form of proctitis. The acute form, in 83% of cases, develops against the background of exposure to a damaging factor of local action (an exception is gastrointestinal infections).

Symptoms of acute rectal proctitis

In most cases, signs of acute proctitis appear either immediately or within a few hours from the moment of exposure to the damaging factor. An exception in this case are tumors. The patient suffers from two main symptoms:

pain - low and medium intensity, which has a pulling character, which can intensify at the time of defecation. Quite often, the patient cannot indicate the exact localization of the pain syndrome, since the pain can radiate to the lower back or lower abdomen. But with an active survey, it turns out that the exact localization of pain is the region of the anus or sacrum. Unpleasant sensations do not go away throughout the day and begin to disturb the patient, lead him into a state of increased irritability. Slightly relieve the pain syndrome by taking combined (Spazmalgon, Baralgin), or anti-inflammatory (Nimesulide, Ibuprofen, Ketorolac) drugs;

violation of the process of defecation - the patient is disturbed by tenesmus. The stool becomes thick with mucus as bowel movements become more frequent. Only mucus with small impurities of blood can stand out. Constipation may also occur due to a psychological block (the patient is afraid of going to the toilet, because defecation provokes more severe pain).

The symptomatic picture of severe proctitis can be supplemented by discomfort in the stomach (dysmotility), an increase in body temperature to subfebrile levels, and a decrease in appetite.

Symptoms of chronic proctitis

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

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

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

Symptoms of radiation proctitis

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

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

suppression of immunity, which increases the risk of developing respiratory and intestinal diseases;

lack or significant decrease in appetite;

weight loss.

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

Diagnostics

In order to correctly diagnose proctitis, you need to undergo a comprehensive examination. You need to start the procedure with a routine examination of the perinatal and anal area.

What can be determined by inspection

In the presence of acute proctitis or at the time of exacerbation of the chronic form of the pathology, there are such changes:

the wall of the anal canal is painted in a rich red color. In some cases, cracks are determined visually, with the naked eye;

fistula openings may be present. They are small protrusions of the skin that are painful to palpation and secrete blood or pus;

redness of the skin in the perinatal area (around the anus).

Bleeding damage to the anus makes it possible to suspect the presence of acute proctitis. With a long course of proctitis in adult patients, the appearance of hemorrhoidal nodules, which are dark in color, is quite often observed. On examination, they can be within the rectum or protrude from the organ cavity.

Inspection technique

The patient assumes a knee-elbow position for optimal visual access. To perform an examination of the final sections of the intestine and the anal ring itself, the patient should relax as much as possible. In order to perform a more thorough visualization, the doctor may use an anoscope (a special device for proctological examination).

Carrying out a finger examination

It is one of the most ancient diagnostic methods that does not require special tools. Using this method, the doctor can not only suspect the presence of rectal proctitis, but also detect the probable cause that caused the disease (mechanical injury, foreign object, tumor).

No preparation is required on the part of the patient. The optimal position is the knee-elbow position. If for some reason the patient is unable to accept this position, he is advised to lie on his left side and bring his legs to his stomach.

During the examination, the doctor evaluates:

the nature of the discharge (according to the residues on the glove);

the presence of formations within the wall of the rectum (abscesses, fistulous passages, tumors);

the condition of the walls of the rectum and its integrity.

Before performing the procedure, the doctor lubricates the glove with vaseline oil, so such a study is painless for the patient.

Instrumental Methods

The best option for diagnosing rectal proctitis is an instrumental examination. The diagnosis of proctitis cannot be made without an examination by a proctologist. To date, the following methods are used:

anoscopy - carried out using a rectal (proctological) mirror lubricated with vaseline oil. It is inserted into the anus and somewhat expand it. This allows you to get a better view compared to other types of inspection. This technique also does not require special preparatory procedures from the patient. It is carried out in the same position as the previous manipulations;

sigmoidoscopy is an endoscopic method during which a detailed examination (up to 30 cm) of the walls of the rectum is performed. This operation is carried out using a sigmoidoscope - an elastic tube equipped with a camera and a light source, which is inserted through the anus and allows you to analyze the mucous membrane and determine the form of the pathology:

• catarrhal proctitis - occurs most often due to the action of irritating substances on the rectal mucosa. A characteristic feature is an increase in the vascular pattern and pronounced edema;

  purulent proctitis - the presence of pus in the cavity of the rectum and infiltration of the wall with leukocytes indicates the presence of this form of pathology. Develops against the background of exposure to microorganisms;

  erosive proctitis - this form is characterized by thinning of the surface layer of the rectum and most often develops with a long course of the process;

  ulcerative proctitis - characterized by the formation of deep erosions affecting the muscle layer of the organ. One of the signs of the presence of nonspecific ulcerative colitis;

  mixed forms - arise due to the combination of several pathogenic factors.

The form allows you to more accurately determine the cause of proctitis, but does not significantly affect the selection of treatment methods.

How to prepare for sigmoidoscopy

It is necessary to carry out a complete cleaning of the rectum from feces, so that there are no obstacles during the examination. Preparation consists of the following steps:

in the evening before sigmoidoscopy, the patient can eat a light dinner;

after 50 minutes, the patient is subjected to enemas with a frequency of once an hour, until a clean flush appears;

sigmoidoscopy is performed on an empty stomach, so the patient should refuse breakfast;

in the morning they put repeated enemas until a clear result appears;

just before the study, a digital examination is performed so that the anus is prepared before the introduction of the endoscope.

Biopsy

This term describes the process of removing tissue from the rectal wall for further examination under a microscope. A biopsy is a component of sigmoidoscopy and is performed using endoscopic forceps. Local anesthesia is not indicated for this procedure, so the patient may experience some discomfort. However, a biopsy is an extremely important procedure that allows you to exclude the presence of a malignant process in the organ.

As additional methods, laboratory diagnostic tests (general analysis of feces, urine, blood) can be used. But such methods can be informative only in the case of chronic proctitis, as a definition of the underlying disease.

Treatment

The tactics of treating pathology differ significantly depending on the type of proctitis, therefore, high-quality diagnostics is the first step towards getting rid of the pathology. Only a qualified doctor (proctologist) can carry out such a diagnosis and prescribe the correct treatment.

Treatment of acute proctitis

In the treatment of this pathology, it is important to combine non-drug treatment with the use of pharmaceuticals. Non-drug treatment consists in limiting physical activity and bed rest. It is desirable for the patient to sit on a sparing diet and follow it until the complete disappearance of all manifestations of proctitis. The diet is based on the exclusion of:

products that can cause dysmotility and constipation (pasta, flour dishes, pomegranate);

chemically irritating foods (fried, bitter, salty, sour);

mechanically irritating drinks and dishes (too cold or hot food, the optimum temperature of the dishes should be 15-20 degrees).

An important factor is the observance of regular and fractional meals. It is not necessary to take long breaks between meals, as this can cause a violation of the passage of the food bolus through the intestines. A long break is more than 6 hours.

In addition to diet, non-drug treatment includes the implementation of local anti-inflammatory procedures, for example:

baths with potassium permanganate - taken in a sitting position no more than four times a day;

finger application or enemas of olive and sea buckthorn oil, to lubricate the intestinal wall;

as an improvement in the general condition of the body, light sedatives can be used - an infusion of motherwort, valerian. Reception of such infusions can be performed up to 4 times a day, dissolving 30-40 drops of the drug in half a glass of water.

Drug treatment of the disease depends on the cause of acute proctitis. The most common treatment regimens include:

When irritating substances are introduced into the intestine or after receiving a mechanical injury (small)

With infectious inflammation of the rectal mucosa

First of all, the provoking factor should be eliminated - to destroy the harmful bacteria located in the rectal cavity. It is worth noting that if proctitis occurs against the background of an intestinal infection (dysentery, escherichiosis), drugs should be used to perform sanitation of the entire intestine.

Glucocorticosteroids (hormones) for topical use are not recommended in the presence of infectious inflammation, as they can cause the spread of bacteria and interfere with intestinal sanitation.

The treatment regimen for infectious proctitis is as follows:

Antiseptic ointments and topical creams that ensure the destruction of bacteria. For example: "Simetrid", "Proctosan".

How to use these tools. The drug must be administered twice a day. If the product is purchased in the form of an ointment, then it must be applied using the applicator (included in the kit). After the introduction of a suppository or ointment, the drug must be kept in the intestinal cavity for half an hour. You don't need to intentionally delete it. After the symptoms of the pathology have disappeared, it is advisable to continue the course for another 7-9 days.

Antibacterial drugs for the sanitation of the intestinal cavity from possible bacteria (only in the case of intestinal infections). The best among them is the drug "Furazolidone", which has a wide spectrum of action, is absorbed into the blood by only 30%, while reaching a maximum concentration in the intestine. Unfortunately, patients quite often develop an allergic reaction to this remedy. In such cases, antibiotics from the tetracycline group (Doxycycline, Unidox) are used as an alternative. They are contraindicated in children under 8 years of age and pregnant women. For this category of patients, the drug "Josamycin" is the safest, but the choice of the optimal antibiotic should be carried out exclusively by a doctor.

Restoration of normal bowel function. Since all the drugs described above purposefully destroy not only the pathogenic microflora in the intestine, but also normal bacteria, at the end of the course of treatment with these drugs, problems with the digestion of food (especially vegetable and dairy products) may develop. In order to "help" the body in such a situation, auxiliary complexes should be used: "Linex", "Bifidumbacterin", "Bifidum".

Combined drugs and NSAIDs.

Laxatives (presented above).

In most cases, the symptoms of infectious inflammation of the intestinal mucosa disappear within a few days, provided that the treatment was prescribed by a specialist reasonably.

When a foreign body is introduced into the intestine or inflammation of the perirectal tissue

In such cases, surgical intervention is required, which is aimed at eliminating the purulent focus in the tissues or removing foreign bodies from the intestinal cavity. After the operation, the surgeon determines the tactics of further therapy based on the presence of complications, the patient's condition and the degree of damage to the intestine. Most often it consists of:

laxative;

antibiotic.

clinical fact. The human intestine is able not only to provide intestinal peristalsis in the direction of the rectum, but also to move objects in the opposite direction (in case of obstruction of the exit). Therefore, any foreign object introduced into the rectum most often turns out to be within the sigmoid or colon, which is 30-50 cm higher relative to the rectum. In such cases, the surgeon cannot remove the foreign body without incisions, so the operation causes additional trauma.

For tumors in the rectum

In such cases, consultation with an oncologist is required. A repeat biopsy is performed, and if possible, CT. These techniques allow you to determine the degree of spread of the tumor, the presence of damage to the lymph nodes, metastases. When the tumor is confirmed to be benign, it is removed. If the tumor is malignant and has managed to grow into the surrounding organs or metastasize, then it is necessary to perform a resection of the entire rectum, followed by the imposition of a sigmostoma (a technique for removing the end opening of the intestine to the anterior abdominal wall). If the malignancy has spread beyond the end of the intestine, the patient undergoes radiation therapy or chemotherapy.

The described scheme is only exemplary and is presented for informational purposes only. In fact, only an oncologist can choose the tactics of treatment, since this is a complex process in which the patient's life is at stake.

Treatment of chronic rectal proctitis

In the presence of this form of the disease, all efforts are directed to the differentiation and elimination of the manifestations of the underlying pathology, which caused the development of this process. Successful treatment of the underlying disease is the only way to cure chronic proctitis. Treatment regimens for probable causes are very difficult to understand, so the table shows a simplified version (containing only fundamental points).

Treatment of radiation proctitis

With radiation proctitis, pain syndrome comes to the fore. It is so pronounced that the patient literally does not find a place for himself. Therefore, you can relieve pain with the help of any pharmacological drug that can cope with this pain. It is possible to take antispasmodics, NSAIDs, narcotic analgesics.

In addition, mandatory therapy is carried out, which is aimed at reducing the effects of radiation. For these purposes, antioxidants (tocopherol, ascorbic acid) are used. To reduce the inflammatory process, local hormonal agents are used ("Doloprokt", "Ultraprokt").

This scheme is exemplary for radiation proctitis of the rectum, and adequate therapy in each case is prescribed purely individually, during a consultation with a radiologist.

To date, rectal proctitis is not a dangerous disease. Clinicians have developed effective treatment regimens for any form of the disease, so that the patient can achieve a complete recovery or a state of stable remission. The main condition for ensuring a positive effect of treatment is timely seeking help from a specialist, since prolonged self-treatment can cause complications and aggravate the course of the disease.