Proctitis

[jerry465]

About 2 months ago I was diagnosed with proctitis after the performance of a sigmoidoscopy by a gastroenterologist. I was prescribed Anusol-HC suppositories which seemed to clear the problem up after about a week and a half. About a week after that, however, the problem began again. I had the prescription refilled and once again, things seemed perfectly fine after about two weeks of the suppositories. Now, though, once again, the proctitis seems to have come back. I’m going to make another appointment with the doctor but had two questions in the meantime.



First, I’m not real clear as to what causes proctitis. Everything I’ve read points to things that just don’t apply to me. My doctor had likened it to something like eczema and said that sometimes there really just isn’t any definitive cause. True?



Second, are there long-term effects that I need to be concerned about? Is this something that can worsen or somehow spread? Is is possible for proctitis to “travel” and cause problems farther up the rectum and on into the  bowel?



Also, does proctitis ever just go away of its own accord, or do I really need to seek aggressive treatment?



Your help is very much appreciated.

[Kevin Pho, MD]

Hello - thanks for asking your question.  



Proctitis is an inflammation of the lining of the rectum.  Proctitis can be short term (acute) or long term (chronic). Proctitis has many causes. It may be a side effect of medical treatments like radiation therapy or antibiotics. Diseases like ulcerative colitis, Crohn's disease, and sexually transmitted diseases may also cause proctitis. Other causes include rectal injury, bacterial infection, allergies, and malfunction of the nerves in the rectum.



The course of the disease and treatment depends on the cause.  This can be performed via a biopsy that should have been done during the sigmoidoscopy.  



Questions on cause, treatment, prognosis, time course and spread of the proctitis all depends on the cause.  Ask about whether a biopsy was performed.  If the case is ulcerative proctitis, then the treatment would include salicylate suppositories, steroids, or immunomodulating medications.  



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.

[jerry465]

Kinda just mailing it in, aren't you Kevin? I've already read everything you said on the site.



Thanks anyway.

[kevinmd]

Hello,

Sorry you're disappointed.  Without knowing what kind of proctitis (ulcerative proctitis? radiation proctitis? proctitis via STDs?) you have, it is impossible to be more specific.  The treatment and prognosis differs for every type.



If you can provide more information on what kind of proctitis you have, I will be happy to give more information.



Thanks,

Kevin, M.D.

[jerry465]

Thanks, Kevin. I understand the difficulties you must face in having to provide answers with the just the relatively small amount of information you receive in a forum such as this.



The problem I'm having is that my proctitis doesn't have what I would consider a common or typical source, at least in so far as what I have read. It's not radiation proctitis, proctitis via STD's, etc.  Ulcerative proctitis? I don't know. My gastroenterologist tells me that often times proctitis can come about without any real obvious cause. I have no reason to doubt him but it would be nice to know if there's something (dietary, for example) that I should avoid or change.



I guess my larger question is this: if he's right - and there's no discoverable cause - then how does one know what treatment to proceed with or what the long-term prognosis would be? Are we just going to be shooting in the dark? If he's wrong - and there is, indeed, a definitive cause - do I barricade myself in his office until he promises to find out exactly what it is?



Again, Kevin, thank you. I appreciate your patience.

[kevinmd]

In general, proctitis can be divided into several large categories.  1) STDs (gonorrhea, chlamydia etc.), 2) other infectious (Campylobacter, Salmonella, Shigella), 3) radiation, 4) misc (including ulcerative proctitis).  A sigmoidoscopy or biopsy should be able to determine whether it is infectious or not.  Infectious proctitis needs to be treated with appropriate antibiotics.  



If it isn't, then treatment for ulcerative proctitis should be considered.  You have used Anusol-HC suppositories.  Other treatments includes the following: sulfasalazine, mesalamine, mesalamine suppositories, oral corticosteroids, or immunomodulator therapy (6-mercaptopurine or azathiaprine).



The course of ulcerative proctitis involves periods of flare-ups and complete remissions.  There are a small percentage of patients that are unable to achieve remission.  Surgery may then be considered.



Thanks,

Kevin, M.D.

[jerry465]

Thanks, Kevin. I appreciate the info. -J

[odg]

I'm having a very similar situation to yours.  I was diagnosed with mild ulcerative proctitis two weeks ago based on a sigmoidoscopy with biopsies.  My symptoms have also improved and then relapsed while being on a continuous course of mesalamine suppositories. My suspicion is that I have upper colon involvement that couldn't be visualized by the sigmoidoscopy.  My doctor said he'll try oral meds soon and then do a colonoscopy if they fail. He told me there is no known cause of ulcerative proctitis.  Theories peg it as an autoimmune disease that involves  genetic and environmental triggers (virus or bacteria).  Good luck- this can be trying.

[jerry465]

Thanks. Yeah, it can be trying. Then again, I suppose if this is the worst thing that happens to us we can consider ourselves pretty lucky, eh?

[Jennifer Juice]

Hi,
I was diagnosed with Ulcerative Proctitis about 2 1/2 years ago. I had a sigmoidoscopy and a colonoscopy which diagnosed my symptoms. I was put on Canasa suppositories for about 5 months. When I moved I found another doctor in the area and he said 5 months was way too long. He took me of the suppositories and put me on 50 mg of Mercaptopurine (6MP) after a sigmoidoscopy was done. The test showed that my symptoms had stayed in the rectum and had not traveled to my colon. The 6MP stopped my symptoms for months and then in January 07 I had a flare up that would not go away on its own, my Dr upped my Rx to 1 1/2 tablets a day. (75mg a day)My symptoms went away again and now 6 months later I am having another flare up. I have monthly blood tests done and they have all come back ok. I haven't told my doctor yet because I want to see if my body can fight it on its own. It was a week with mucus and cramping and now It's the second week and I have blood in my stools and mucus, gas and bloating.My questions are:
1. how safe is it to up my medication again if my doctor decids to do that.
2. Is there any new treatment for ulcerative proctitis caused my an immune disorder?
3. It seems like when I exercise or have alot of sex (sometimes doggie style) or extreme stress my condition gets worse, can that be?
4. I have tried to change my diet, A bowl of cereal/oatmeal with fruit in the morning, a 100 calorie snack, a sandwhich(tuna, or turkey on wheat) a protein shake and for dinner usually a piece of fish, or chicken,potatoes and a salad. I have stopped drinking milk, soy instead and I have limited my intake of red meat. I am 162lbs 5'6" and I am also trying to lose weight. Is there anything I can add or delete from my diet to help with my ulcerative proctitis?

Thank you so much for listening to me, for your time and your effort...

Jennifer

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