Proctitis

Typically, patients report tenesmus (a strong feeling of need to defecate when stool is not present), rectal bleeding, or passage of mucus.

Proctitis resulting from gonorrhea, herpes simplex, cytomegalovirus, or monkeypox may cause intense anorectal pain.

Diagnosis of proctitis requires proctoscopy or sigmoidoscopy, which may reveal an inflamed rectal mucosa. Small discrete ulcers and vesicles suggest herpes infection. Rectal swabs should be tested for Neisseria gonorrhoeae and Chlamydia species (by culture or nucleic acid amplification test, such as PCR), enteric pathogens (by culture), and viral pathogens (by culture or immunoassay).

Serologic tests for syphilis Diagnosis Syphilis is caused by the spirochete Treponema pallidum and is characterized by 3 sequential symptomatic stages separated by periods of asymptomatic latent infection. Common manifestations... read more and stool tests for C. difficile toxin are done. Sometimes mucosal biopsy is needed.

Colonoscopy may be valuable in some patients to rule out inflammatory bowel disease.

Infective proctitis can be treated with antibiotics. Patients who engage in anal-receptive intercourse who have nonspecific proctitis may be treated empirically with ceftriaxone 250 mg IM once, plus doxycycline 100 mg orally 2 times a day for 7 days. Antibiotic-associated proctitis due to C. difficile is treated with vancomycin 125 mg orally 4 times a day or fidaxomicin 200 mg orally 2 times a day for 10 days.

Radiation proctitis that is bleeding is usually treated initially with a topical drug; however, evidence of efficacy from well-done studies is lacking. Topical treatments include corticosteroids as foam (hydrocortisone 90 mg) or enemas (hydrocortisone 100 mg or methylprednisolone 40 mg) 2 times a day for 3 weeks, or sucralfate retention enemas (2 g in 20 mL water 2 times a day) may also be effective. Patients unresponsive to these forms of therapy may benefit from topical application of formalin, or from hyperbaric oxygen therapy Recompression Therapy Recompression therapy is administration of 100% oxygen for several hours in a sealed chamber pressurized to > 1 atmosphere, gradually lowered to atmospheric pressure. In divers, this therapy... read more .

Endoscopic therapies may be used. Argon plasma coagulation seems effective in reducing symptoms at least in the short term (≤ 6 weeks). Other methods of coagulation include lasers, electrocoagulation, and heater probes. (See also the American Society of Colon and Rectal Surgeons' 2018 clinical practice guidelines for the treatment of chronic radiation proctitis.)

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.