Proctitis

The disease is an inflammation of the mucous membrane of the rectum. The typical symptoms of proctitis is the feeling stinging in the rectum, the emergence of itching and soak in the anus, the mucus discharge during stool (sometimes under false desires).
The most frequent cause of disease is violation in nutrition (excessive consumption of spicy foods and alcoholic beverages, food poisoning, viral, influenza, angina). Proctitis often arises in underwent dysentery, and also in patients with dysbacteriosis of the intestine caused by antibiotics and other drugs. In other words, the reason for the development of proctitis may be changes in the composition of the normal intestinal microflora due to the appearance in the intestine conditionally pathogenic microorganisms (hemolytic Staphylococcus and Streptococcus, pathogenic strains of Escherichia coli, and so on).
Proctitis often develops in patients with violations of the gastric secretion (decrease or complete absence of acidity, as well as her. a sharp increase)observed ulcers of the duodenum and hyperacid gastritis.
In addition, proctitis found in patients suffering from diseases of liver, gallbladder and pancreas. Proctitis may develop after operations on the rectum, such as hemorrhoids, fissures, paraproctitis, etc.
Because the symptoms of proctitis often associated with changes in the perianal skin, such patients sometimes wrongly treated by a dermatologist.
Often a pain in the anus (the result of irritating discharge) is regarded by the doctors as the fissures and in accordance with this treatment is unsuccessful.
The clinical course proctitis is divided into acute, subacute and chronic.
On postmortem changes and character detachable distinguish proctitis catarrhal, purulent, fibrous, and hemorrhagic peptic ulcer. The germs that cause inflammation, can be transferred in the course of the gastrointestinal tract (dysentery bacilli, typhoid fever, tuberculosis and others) or penetrate through the anus (for example, gonorrhea in women with pus fall of the vagina when gonorrheal defeat him). Acute proctitis may cause concentrated chemicals mistakenly used for treatment or medical enema (solution of sublimate, carbolic acid, calcium chloride, iodine), as well as foreign body rectum. Reactive inflammation in the walls of the rectum can cause inflammatory processes in the surrounding organs and tissues - the paraproctitis (see), cystitis (see), prostatitis (see), metritis (see Metroendometrit) and parametritis (see), vulvovaginitis, abscess red space and other
Subacute proctitis flows with less severe pains. The urge to have a bowel movement less frequent. If a long time has separated from the bowel lumen, it irritates the surrounding skin, causing the maceration, eczema, itching.
Chronic proctitis usually runs simultaneously with chronic colitis can cause constipation.
Treatment of acute and sub-acute proctitis depends on the nature of the infection. Assign appropriate antimicrobials. Locally applied warm enema 2 - 3 times a day with colibacterin, with a solution of potassium permanganate 1 : 3000-500 ml, etakrydina (rivanol) 1 : 500-500 ml, extract of camomile 10 : 200, 2% solution of colloid or of protargol to 10 ml, and other Candles (betiol, anusol) with pain relievers. Useful warm sitting baths or perineal shower with disinfecting preparations (tannin). If there rectal ulcers can be applied (through rectoromanoscopy or through the rectal mirror) powder antibiotics, sulfa drugs. Recommended bed rest, limiting foods that contain plenty of fiber; excluded fried, spicy dishes (pickles, smoked, pickled vegetables), alcoholic beverages.
For the treatment of chronic proctitis (colitis) apply for constipation medication and diet AIDS. Enema at night: 50-100 ml of fish oil, 10 ml of 2% solution of colloid or protargol. Recommended sanatorium-resort treatment - Essentuki, Borjomi, Truskavets, Izhevsk Mineral Water, Druskininkai, Arzni and others (see the Resorts).

Proctitis (proctitis study; from the Greek. proktos - anus - is an inflammation of the rectum. There are acute proctitis (proctitis study acuta) and chronic (proctitis study chronica). P. as a stand-alone process is rare. Often it is accompanied by inflammation of the colon - colitis (see). But can be and local lesions of individual sections of the rectum: cryptic (cryptitis) is an inflammation of one or more anal sinuses (crypts), sphincteric (proctitis study sphincterica) - inflammation of the skin and mucosal areas of the anal canal, papilla - inflammation of anal papillae (papillae anales).
The cause of acute proctitis, often becomes chronic, is the introduction in the intestine wall of one of the types of intestinal infections (dysentery, intestinal, bruchkomitsky coli, Enterococcus, Trichomonas, balantidia and others) flora or some specific diseases (tuberculosis, syphilis, gonorrhea, chancroid, the fourth venereal disease, actinomycosis, Coccidioides, candidiasis). Proctitis may be a reaction to exposure to chemicals (mercuric chloride, arsenic, lead, calcium chloride), mechanical (passive gays) and temperature (burn) stimuli. Contribute to the disease avitaminosis, alcohol, spicy dishes, stagnation of feces, abuse of laxatives, frequent use of enemas. Chronic proctitis is a consequence of the acute colitis or acute proctitis, rarely can be a primary disease. Secondary proctitis is observed in acute paraproctitis, hemorrhoids, prolapsed rectum, incomplete internal fistula with purulent discharge, with full fistulas, fissures, polyps rectal cancer, diseases of the genital organs, foreign bodies intestine. Expressed radiation proctitis possible in women who have undergone radiation treatment for cancer of the uterus. Light jet proctitis observed in almost all patients that have received massive doses of local radiotherapy.

proctitis
Fig. 1 - 6. Proctitis: Fig. 1 - catarrhal; Fig. 2 - slimy; Fig. 3 - purulent; Fig. 4 - ulcer; Fig. 5 - ulcer-hemorrhagic; Fig. 6 - necrotic.


Pathological picture of acute proctitis (printing. Fig. 1-6) is reduced to catarrhal, hemorrhagic, sores, ulcers or necrotic changes in the mucous coat that looks swollen dramatically damaged, can have extensive erosion, ulcers, covered with pus mixed with blood, mucus, fibrin. In subacute proctitis all these phenomena are less pronounced. Chronic proctitis is characterized by prevalence of atrophic or hypertrophic changes. In the first case there is a proliferation of connective tissue elements mucosal and submucosal layer. The mucous membrane thickens, folds her appear swollen, there warty exaltation by type papillomatosic formations - false polyps or she has the appearance of shagreen leather. In atrophic proctitis folds of mucous membrane smoothed, it is very thin, pale, visible vessels submucosal layer, there are podsypaya filmy overlay. If those and other changes in the mucous membrane is easily damaged and can receive the ulcer surface, covered with bleeding granulations. Possible perforation, deformation and cicatricial stenoses of the intestines. Chronic ulcers in radiation proctitis are widely infiltrated the base, dense, createrootpane raised edge, remind wounded malignant tumor and in the literature sometimes a wrong term pseudoryx.
In acute proctitis be sharp and in subacute more dull pain in the rectal area that is transmitted in the sacrum, the bladder. In both cases, there are burning, frequent, liquid, mucous stool with tenesmus, sometimes mixed with blood and pus. Can be dysuric disorders. The body temperature is raised. It is necessary to exclude diseases that cause secondary proctitis.
Manifestations of chronic proctitis can be hardly visible. The disease is often associated with symptoms of colitis, proctosigmoiditis. When the primary chronic proctitis patients concerned about a feeling of fullness, the pressure in the rectum, unstable chair, mucus secretion, vague pain in the pelvic region and along the colon. When expressed events colitis observed spastic constipation.
Treatment of acute and sub-acute proctitis begun to address the causes of the disease. Recommended bed rest. Limit dishes containing fibre. Exclude fried, spicy food, pickles, smoked, salted foods. Prohibit alcoholic drinks. Prescribe regular bowel discharge medication soothing, disinfectant character - kolimitsin 25 000-50 000 UNITS per 1 kg of patient's weight per day (daily dose given in 4 receptions with an interval of 6 hours), neomycin sulphate in tablets or solution 100 000-200 000 IU 2 times a day; one of the sulfa drugs (sulfadimezin, ftalazol, dialpan and others) and 1 g in consistently decreasing doses- 5, 4, 3, 2, 2, 2 g / day; an extract krasavki (belladonna) or opium 0.015 g with 0.3 g glucose 2 times a day. Prescribed warm enema 2-3 times a day with colibacterin, potassium permanganate solution -1:3000 - 200-500 ml, wild camomile tincture 10 grams per 200 ml of water, fish oil 50-100 ml, 2% colloid or protargol - 10 ml Treatment of chronic proctitis - elimination of causal factors, high-fiber diet. For constipation - regulation chair with diet, periodically - purgative means, enemas, sub-Aqua irrigations. Can be recommended Spa treatment - Truskavets, Essentuki, Borjomi, Izhevsk mineral water.