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What is Ulcerative Proctitis?
Ulcerative proctitis is a milder form of the inflammatory bowel disease, ulcerative colitis, which is inflammation of the colon that begins just above the anus and extends to varying continuous lengths along the colon. When the inflammation's upper limit into the colon extends only about 20cm or fewer, it is ulcerative proctitis. About 25-30% of people diagnosed with ulcerative colitis actually have this milder form of the disease.
In this condition, there is ulceration of the colon's inner surface and certain types of inflammatory white blood cells infiltrate the involved area. Inflammation only involves the inner mucosal lining and does not extend into the muscle wall. The age distribution of patients with ulcerative proctitis is the same as that of ulcerative colitis and thus the peak occurrence is in people from their teens through their 30s.
What causes Ulcerative Proctitis?
As in all other types of inflammatory bowel disease, the cause of ulcerative proctitis is unknown in spite of a fair degree of research. Since the condition is a variant of ulcerative colitis (UC), all the theories as to the cause of UC apply to ulcerative proctitis, however, why the inflammation is limited to the rectum is unclear. Researchers have not found an infectious cause, nor have they found any causal correlation to factors such as stress, allergies, and toxins. It is possible that this is an autoimmune disease triggered by some unknown initial bowel insult. Researchers looking at genetic influences show increased occurrence in certain family groups.
It is important to note that the disease almost never spreads or extends to other parts of the bowel and the area first affected is always subsequently involved while the rest of the bowel remains normal. Extension farther up the bowel to involve the sigmoid colon occurs in only about 15% of patients with proctitis.
What are the symptoms of Ulcerative Proctitis??
The presenting symptoms of ulcerative proctitis all relate to the rectum. Blood in the stool occurs in almost all patients. Diarrhea is a common symptom although constipation may develop, since inflammation of the rectum can impair its normal function in managing bowel movement.
Irritation (inflammation) of the rectum may cause senses of urgency to have a bowel movement, discomfort after having a bowel movement, and of incomplete emptying of the bowels. Systemic symptoms such as fever, tiredness, nausea, and weight loss do not usually occur.
How is Ulcerative Proctitis diagnosed?
Typically, the physician makes a diagnosis of ulcerative proctitis after taking the patient’s history, doing a general examination, and performing a standard sigmoidoscopy. A sigmoidoscope is a lighted instrument with a tiny camera inserted via the anus so the physician can view the bowel lining. Small biopsies taken during the sigmoidoscopy may help rule out other possible causes of rectal inflammation. Stool cultures may also aid in the diagnosis. X-rays are not generally required although at times they may be necessary to assess the small intestine or other parts of the colon.
Are there any complications?
There are very few complications of ulcerative proctitis. With increased irritation to the anal and rectal area, hemorrhoids may occur but abscesses or fistulae are uncommon. Extra-intestinal manifestations such as inflammation of the eyes, enlarged joints, and certain skin rashes may occur but the incidence of these is rare. Patients with ulcerative proctitis are not at any greater risk for developing colorectal cancer than those without this disease.
How is Ulcerative Proctitis treated?
Since the inflammation of ulcerative proctitis is limited to a small area and is relatively accessible, treatment is more successful when given rectally. Your physician may prescribe treatment for you in the typical manners described below, or use an approach designed specifically for your situation.
There are two categories of rectal medications: corticosteroids and 5-ASA (5-amino-salicylic acid) preparations. The corticosteroid is usually a form of hydrocortisone that comes in a liquid preparation, thick foam, or suppository.
The liquid corticosteroid preparations, Betnesol® 100mL and Cortenema® 60mL are often effective. However, if the patient has significant diarrhea, then the medication may expel. Cortifoam® is a foam preparation of a smaller volume so the patient may retain the treatment in the rectum longer.
5-ASA preparations come as a liquid or suppository. The Salofalk® (500mg or 250mg) suppository is a twice-a-day therapy and Pentasa® (1g) suppository is a once-a-day therapy. In a more difficult case of proctitis, you may receive 5-ASA enema therapy (Salofalk® 4g & 2g/60mL and Pentasa® 1g, 2g, or 4g/100mL) for a short course followed by suppositories as the inflammation improves.
Patients use rectal medications nightly at first and then, as the disease improves, treatments are less frequent. Sometimes your doctor will stop treatment and start it again if there is a flare up, and sometimes maintenance therapy two to three times a week may be required long-term. Typically, a patient starts on one type of preparation and if there is inadequate response, then switches to another type. On some occasions, it may be necessary (and some patients prefer) to use an oral form of 5-ASA to keep the disease in remission.
Dietary adjustments such as the addition of bulking agents to the diet may be helpful, as well as avoidance of irritating foods.
Although ulcerative proctitis can sometimes be very resistant to therapy, it is rare to have surgery to treat this disease.
Further research is essential to uncover the cause, potential treatments, and possible prevention strategies for many digestive diseases and disorders. Historically, gastrointestinal research in Canada has been severely under-funded. Ongoing public support will help further scientific advances.
Are you taking prescription medication for any of the following stomach problems/symptoms:
Stomach pain or discomfort
Heartburn
Sour taste in mouth/acid regurgitation
Excessive burping/belching
Increased abdominal bloating
Nausea
Early satiety
If you answer yes to any one of the symptoms listed above then take this test to see if your current medication is adequately controlling your stomach symptoms.
The PASS Test
PPI* Acid Symptom Suppression Test
*PPI is short for proton pump inhibitor, a class of medication used to suppress the acid in your stomach. These include Losec®, Nexium®, Pantoloc®, Pariet™, and Prevacid®.
