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$Unique_ID{BRK04138}
$Pretitle{}
$Title{Proctitis}
$Subject{Proctitis Ischemic Proctitis Antibiotic-Induced Proctitis Radiation
Proctitis Gonorrheal Proctitis Syphilitic Proctitis Herpetic Proctitis
Ulcerative Colitis Crohn's Disease}
$Volume{}
$Log{}
Copyright (C) 1990 National Organization for Rare Disorders, Inc.
810:
Proctitis
** IMPORTANT **
It is possible that the main title of the article (Proctitis) is not the name
you expected. Please check the SYNONYM listing to find the alternate names
and disorder subdivisions covered by this article.
Synonyms
Ischemic Proctitis
Antibiotic-Induced Proctitis
Radiation Proctitis
Gonorrheal Proctitis
Syphilitic Proctitis
Herpetic Proctitis
Information on the following diseases can be found in the Related
Disorders section of this report:
Ulcerative Colitis
Crohn's Disease
General Discussion
** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only. It should not be used for diagnostic or treatment
purposes. If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.
Proctitis is a chronic inflammatory disease arising in the rectum and
characterized by bloody diarrhea. There are two types of Proctitis,
Ulcerative and Gonnorheal, which are differentiated by the means in which they
are contracted. Gonnorheal Proctitis is transmitted through sexual contact.
Symptoms
Symptoms of Proctitis are most frequently pain in the rectal area and a
frequent desire to pass feces. Bloody diarrhea, painful defecation and
bleeding in the rectal area are also common. Diarrhea may be followed by
constipation with spasm and severe straining of the rectal muscles
(tenesmus). In some cases, stools may be well formed but surrounded by blood
and mucus.
Proctitis usually runs a mild, intermittent course over many years.
Occasionally there is neurological involvement with urinary bladder
dysfunction, weakness and burning of the lower limbs (paresthesias) and pain
in the thighs. Men may have difficulty maintaining penile erections. When a
diagnosis of Gonnorheal Proctitis is confirmed, individuals also should be
tested for other sexually transmitted organisms such as syphilis, amebiasis,
chalmydia, campylobacter, shigella, and herpes simplex virus infections.
Upon examination, individuals with Ulcerative Proctitis show ulcers in
the rectum. Ulcerations are usually accompanied by rectal bleeding,
straining of rectal muscles (tenesmus) and an anal discharge of bloody mucus.
However, anal bleeding is seldom severe. Individuals with diarrhea often
describe no increase in stool volume but rather frequent passage of small
amounts of mucous or blood. Fever and weight loss are rare. Symptoms of
Ulcerative Proctitis are very similar to Ulcerative Colitis. However,
Ulcerative Proctitis is not as serious as Colitis and is limited to the
rectum. (See related disorder section for more information on Ulcerative
Colitis.)
Causes
Proctitis can be caused by the pus-producing bacteria gonococci and by the
herpes simplex virus, primary and secondary syphilis, chlamydia trachomatis
and the human papilloma viruses. Gonococcal Proctitis usually results from
passive anal intercourse with men who have infection in the canal that
empties urine from the bladder (urethra).
Ulcerative Proctitis may be caused by radiation injury, trauma from a
foreign body, constriction or obstruction of a blood vessel (ischemia),
infection or the cause may be unknown (idiopathic).
The effects of irritating enemas or laxatives may be confused with
Ulcerative Proctitis. This disorder may also mimic the symptoms of long-term
trauma.
Affected Population
Proctitis is increasing in incidence. Gonococcal Proctitis is most
frequently found in women and homosexual men who practice anal-receptive
intercourse.
Related Disorders
Symptoms of the following disorders can be similar to those of Proctitis.
Comparisons may be useful for a differential diagnosis:
Ulcerative Colitis is an acute inflammation of the large intestine
(colon) characterized by multiple, irregular, superficial ulcerations. The
inflammation results in thickening of the wall of the colon with scar tissue
and polyp-like growths. The primary symptom of Ulcerative Colitis is bloody
diarrhea. The disease may involve only one side of the colon or it may
eventually spread throughout the entire large intestine. (For more
information on this disorder, choose "Ulcerative Colitis" as your search term
in the Rare Disease Database.)
Crohn's Disease is a form of inflammatory bowel disease and is
characterized by chronic diarrhea, abdominal pain, fever, weight loss and a
solid mass in the abdomen. The intestine gradually becomes thickened and
leathery. Complications may appear in the joints, skin and eyes. (For more
information on this disorder, choose "Crohn's Disease" as your search term in
the Rare Disease Database.)
Therapies: Standard
Diagnosis of Proctitis is made when sigmoidoscopy reveals inflammation of the
mucus lining of the rectum with a clearly demarcated upper border above which
the lining is normal. The remainder of the colon and small intestine is
found to be normal by barium x-rays, while colonoscopy and rectal biopsy may
show changes which are indistinguishable from those of Chronic Ulcerative
Colitis. (For more information on Chronic Ulcerative Colitis, see the
related disorder section of this report.)
Treatment of Proctitis is determined by cause. Gonococcal Proctitis
responds to standard intramuscular injection with procaine penicillin or
spectinomycin, but less consistently to oral treatment with penicillin or
tetracycline. Primary Herpetic Proctitis responds well to acyclovir.
Chlamydial Proctitis responds to tetracycline. Treatment of idiopathic
(unknown cause) Ulcerative Proctitis is very similar to that of Ulcerative
Colitis and Crohn's Disease, and includes a nonlaxative diet, the
administration of antidiarrheal drugs such as diphenoxylate hydrochloride
with atropine sulfate (Lomotil) or loperamide. Topical corticosteroids may
be applied in the form of suppositories, steroid enemas or steroid foam.
Enemas or suppositories should be administered at bedtime to maximize their
retention. The drug sulfasalazine taken orally for three weeks or more may
also be prescribed. Other symptoms may be treated by pain-killing and
antispasmodic drugs. Hospitalization may be necessary for a thorough
physical examination.
Although Proctitis may persist for many years, it is not associated with
an increased incidence of cancer of the rectum or colon. With treatment,
Proctitis usually runs a course with periodic mild to severe episodes of
symptoms. The inflammation spreads beyond the rectum in only 10 to 30% of
individuals affected with Proctitis. Less than 15% of individuals with
Ulcerative Proctitis will develop Chronic Ulcerative Colitis.
Approximately 40% of homosexual males with Proctitis also have anorectal
gonorrhea. It is not unusual to discover multiple disease producing
organisms in patients with Proctitis. Men who have had passive rectal
intercourse with sex partners who have gonococcal infection of the ureter
should have cultures performed for gonorrhea, regardless of an apparent lack
of symptoms.
Therapies: Investigational
This disease entry is based upon medical information available through
September 1990. Since NORD's resources are limited, it is not possible to
keep every entry in the Rare Disease Database completely current and
accurate. Please check with the agencies listed in the Resources section for
the most current information about this disorder.
Resources
For more information on Proctitis, please contact:
National Organization for Rare Disorders
P.O. Box 8923
New Fairfield, CT 06812-1783
(203) 746-6518
National Digestive Diseases Information Clearinghouse
P.O. Box NDDIC
Bethesda, MD 20892
(301) 468-6344
American Social Health Association
100 Capitola Dr., Suite 200
Research Triangle Park, NC 27713
(919) 361-8400
National Sexually Transmitted Diseases Hotline
(800) 227-8922
Council for Sex Information and Education
444 Lincoln Blvd., Suite 107
Venice, CA 90291
References
CECIL TEXTBOOK OF MEDICINE, 18th ed.: James B. Wyngaarden, M.D., et al., eds;
W.B. Saunders Company, 1988. Pp. 787.
INTERNAL MEDICINE, 2nd Ed.: Jay H. Stein, M.D., ed.-in-chief; Little,
Brown and Co., 1987. Pp. 138, 150, 1671.
THE MERCK MANUAL, Volume 1, 14th Ed.: Robert Berkow, M.D., ed.-in-chief;
Merck Sharp & Dohme Laboratories, 1982. Pp. 251, 801-806, 985.
LYMPHOID FOLLICULAR PROCTITIS. A CONDITION DIFFERENT FROM ULCERATIVE
PROCTITIS? J. F. Flejou et al.; DIG DIS SCI (March, 1988: issue 33 (3)).
Pp. 314-320.
THE LIGHT AND ELECTRON MICROSCOPIC FEATURES OF EARLY AND LATE PHASE
RADIATION-INDUCED PROCTITIS. N. Y. Haboubi, et al.; AM J GASTROENTEROL
(October, 1988: issue 83 (10)). Pp. 1140-1144.
COMPARISON OF BECLOMETHASONE DIPROPIONATE AND PREDNISOLONE 21-PHOSPHATE
ENEMAS IN THE TREATMENT OF ULCERATIVE PROCTITIS. H. van der Heide, et al.; J
CLIN GASTROENTEROL (April, 1988: issue 10 (2)). Pp. 169-172.
PREVALENCE OF SEXUALLY TRANSMITTED DISEASE AMONG MALE PATIENTS PRESENTING
WITH PROCTITIS. H. Andrews, et al.; GUT (March, 1988: issue 29 (3)). Pp.
332-335.
ARGON LASER TREATMENT OF RADIATION PROCTITIS. J.J. O'Connor, et al.;
ARCH SURG (June, 1989: issue 124 (6)). Pp. 749.