periodic bright red blood with mesalamine suppositories

I am a 38 year old female who was told two weeks ago based on biopsy results that I have mild ulcerative proctitis. Before my diagnosis, I was experiencing bowel urgency, loose stools and one bout of substantial pus with no excrement. I have had a bout of bright red blood even though I'm taking mesalamine suppositories. I've also been diagnosed with hemmoroids (hemorrhoids) right near my anus, internal and external.  My gastro doesn't think I need a colonscopy since the sigmoid with biopsies only showed mild proctitis.  Why woould I have the bout of pus (prior to suppositories) and  a bout of bloody loose stool (on suppositories) if I only have colitis of the rectum?  Do I need a colonoscopy? Can mild proctitis be unresponsive to these suppositories or could I have upper large intestine involvement?  My stools, although improved, remain somewhat loose. Generally, I feel pretty good.  What percentage of people progress to colitis after the initial diagnosis of proctitis? Thank you.

[Kevin Pho, MD]

Hello - thanks for asking your question.

Ulcerative proctitis can be normally classified into 3 spectrums - mild, moderate and severe.  Loose stools with blood is normally classified as moderate disease.  Thus, it is certainly possible to have bloody loose stool with moderate ulcerative proctitis.  

Mesalamine suppositories is normally pretty good for this disease but it is possible that the proctitis would not be responsive to this.  If it fails, other options includes oral salicylates, oral corticosteroids or immunotherapy (i.e. 6-mercaptopurine (6-MP) or azathioprine (AZA)).  

It is possible that the proctitis may extend to the whole colon (pan-colitis).  I would suggest a colonoscopy if you continue to have symptoms despite optimal medical therapy.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.