Erosive proctitis is one of the types of inflammatory lesions of the mucous membrane of the rectum, which on the background of inflammation formed multiple defects in the rectal mucosa. Such defects are superficial and heal without scarring.
The disease poses no threat to health, especially for the patient’s life. But if it is not time to identify and treat possible progression of erosions to less deep ulcers whose treatment more difficult and prolonged.
Erosive proctitis is a universal disease. It is equally often occurs in men and women, inhabitants of small villages and large cities, young and old. Children suffer several less – this is due to the better than in adults, the regenerative capabilities of rectal mucosa.
Statistics on the disease, and erosive proctitis – is inaccurate. This is due to the fact that patients often refuse to visit a doctor and treat yourself. When the disease erosive proctitis should be addressed to the proctologist, but in small clinics, where there is no division of doctors specialists – General surgeon.
Causes and development of disease
The occurrence of erosive proctitis can be caused by many factors. This pathology belongs to the category of polietiologichesky – multiplexing.
We must distinguish between the immediate causes of erosive proctitis and the factors that contribute to its formation and progression. Inflammatory lesion in the rectum arises primarily from its influence on the mucous membranes of pathogenic microorganisms.
In this disease in the rectum identifies:
- more often nonspecific agents, that is, those that are able to provoke the development of many types of inflammatory and inflammatory-purulent diseases;
- specific – those that could cause only one disease (albeit in different locations).
Non-specific infectious agents that are most often detected in the rectum, indicate the range of microflora, which causes the development of inflammation in the large intestine as a whole. This:
The causative agents of specific diseases that can be detected in the rectum with erosive proctitis, is:
- Treponema pallidum – causes syphilis. This is one of the most frequent causative agents of inflammatory processes in the rectum, as it penetrates there during anal sex is practiced by couples where the partner (or both) syphilis;
- Mycobacterium tuberculosis (tubercle Bacillus);
- gonorrhea – causative agents of gonorrhea (infection is possible during anal intercourse);
- the causative agents of tularemia;
- Trichomonas vaginalis – the causative agents of trichomoniasis;
- chlamydia cause chlamydia.
Also note that the development of erosive proctitis can contribute to helminth and protozoan intestinal infections. This:
- Shigella – dysentery;
- intestinal ʙalantidij – ciliate, provoking the development of balantidioza;
- pinworms – provoke the development of enterobiasis;
- whipworm – he develops trihozefalez;
- roundworm – cause ascariasis.
Agents are embedded in the mucosa through its erosive defects and contribute to persistent course of inflammatory reactions, releasing into the tissues the waste products, which disrupt the normal tissue processes. Also tissue disorders can cause already dead pathogens, tissue which decomposed and act as an organic toxin.
Factors that contribute to the development of erosive proctitis can be divided into the following groups:
Nutritional factors contributing to the development of erosive proctitis, are the alcohol and food:
Such factors influence an irritating way on the rectal wall, increasing its damage at the level of cells and tissues.
Stagnant factor is chronic constipation. Stagnant in the colon the stool pressure on the veins of the rectal wall, worsening the outflow of venous blood. This exacerbates the inflammation, causing tissue swelling (and because of this, more pressure on the blood vessels) and impairs the processes of regeneration (restoration of damaged tissues in the site of development of erosions).
Traumatic factors, the most extensive group. They cause injury of the mucous membrane of the rectum, contributing to the formation of new erosions and deepening old erosive defects. Such fakery can be divided into mechanical, chemical and thermal.
To mechanical factors, trauma, contributing to the development of erosive proctitis include:
- diagnostic manipulations. Any careless use of diagnostic equipment that is inserted through the rectum can aggravate erosive defects caused in the mucous membrane of the rectum;
- treatments – the formation of erosions occurs for the same reasons as when performing diagnostic procedures. Most often this staging of enemas using the tips (with the broken-off ends), as well as ignorance (or simple lack) of lubricant;
- self-help in the development of resistant constipation. In the case of stagnation of feces in the rectum, patients try to remove it with the help of improvised means (fingers, sticks, cuttings Cutlery), damaging the mucous membrane of the rectum;
- anal sex. Contributes to erosion, if the partners did not consider the size discrepancies of the genitals and the rectal lumen, or if not using the lubricant;
- anal Masturbation. Inflammatory and erosive processes in the mucous membrane of the rectum are aggravated by mechanical stimulation of objects that can cause injury to rectal mucosa;
- the passage of the rectum sharp objects that have been swallowed either accidentally or intentionally. Needles, pins, hooks, studs, paper clips, fragments of animal bones, fish bones, fruit pits and so on. About a reason to remember when the appearance of erosive proctitis mentally ill patients, socially disadvantaged individuals, inadequate people, person, suicidal or damage to its own tissues to find yourself in a medical institution and thus to avoid social or legal responsibility.
Chemical factors trauma is any aggressive substances which, in contact with the mucosa of the rectum can disrupt it processes at the tissue and cellular level.
Chemical trauma of the mucous membrane of the rectum is observed at introduction in a rectum of corrosive substances:
- by mistake – for example, if during medical manipulations mixed containers with liquids;
- purposefully, with hope for the therapeutic effect of the injected material;
- in situations with a criminal shade during the interrogations with the purpose of punishment, and so on.
Thermal factors contributing to the development of erosive proctitis, is:
- introduction into the rectum by mistake or deliberately is too cold or too hot solutions, as well as medical instruments, are often too hot;
- the location of the crotch on hot surfaces.
Radiation factors – effects on the mucous membrane of the rectum to radiation. It is observed in the following cases:
- in radiation therapy during the treatment of oncological diseases of the female genital organs, prostate, urinary tract, intestines, soft tissues of the perineum;
- because of the specificity of work, where the inevitable contact with radioactive substances and/or radiation sources. Most often radiation happens because of the violation of labor protection rules on the part of employers and/or employees;
- if unauthorized access to radiation sources or radioactive substances.
Also irradiation of the rectal wall may occur during hostilities.
The first place in prevalence among radiation erosive practical belongs to inflammatory lesions, which have arisen on the background of the contact gamma therapy, at least – because of the remote gamma-therapy and carrying out methods of therapy.
Immune are factors that vaguely contribute to the formation of erosive proctitis, but they have a place in its development. This can be attributed to impaired immunity General and local. Virtually any immunodeficiency States can foster the growth of an infectious agent that provokes pathological changes in the mucous membrane of the rectum.
Among the somatic factors contributing to the development of erosive proctitis, discusses a number of diseases (mainly inflammatory) – including the rectum. This:
- hemorrhoids – expansion of the venous plexus of the lower rectum;
- fissure of the anus – linear damage of the mucosa;
- abscess – an inflammatory or inflammatory lesion coloramerican tissues;
- vulvovaginitis – inflammation of the mucous membrane of the vagina and vulva in women;
- cystitis – inflammation of the mucous membrane of the bladder;
- prostatitis – inflammation of prostate tissue in men
Symptoms of erosive proctitis
Hallmark of erosive practical is sudden onset with the acute development of local (tenesmus, or false urge to defecate) and common (chills, fever) signs.
Clinical signs characteristic of erosive proctitis, is:
- a feeling of heaviness;
- violation of defecation;
- the pathological admixtures in feces;
- violation of the General condition.
Characteristics of pain:
- localization in the rectal area;
- distribution – sometimes radiating to the lower back, rump, perineum, bladder, inner thighs;
- character – first nouse-pressing, then burning;
- the intensity is expressed by, annoying, sometimes unbearable;
- at the emergence – practically from the onset of pain are permanent.
Itching, burning and a feeling of heaviness is observed in the area of the anus. They are caused by the irritation of inflamed mucous membranes and erosions stool.
Violation of defecation manifested by such signs:
- chair becomes liquid;
- the acts of defecation become more frequent.
In the stool, on underwear or hygiene products can be detected:
In some cases, blood and mucus (often bloody mucus) are allocated from the outside of the anus the act of defecation, when tenezma.
Violation of the General condition manifested by such signs as:
- the increase in body temperature to 37.5 to 37 degrees Celsius;
- may experience chills.
The clinical picture can vary depending on what factors provoked the development of inflammatory and erosive process in the rectum, and how extensive it is. So, in gonorrheal proctitis the symptoms are less pronounced – there are mild itching and burning in the anus, pain medium-intensive, and periodic false urge to defecation. Radiation erosive proctitis in some patients, is in the form of severe lesions of the rectum with a characteristic pronounced pain, often tenesmus and significant increase in body temperature. But in other patients who are treated with radiation methods, the symptoms faded or may even be absent altogether.
It should be noted that patients with erosive proctitis often become irritable due to pronounced pain syndrome, which developed suddenly, against the background of complete well-being.
Diagnosis of erosive proctitis
As clinical signs of erosive proctitis are not specific for an accurate diagnosis should involve additional testing – physical, instrumental, laboratory.
Data physical examination the following:
- when inspecting the perineum – at the initial stages of development of the disease, there was spastic contraction of the sphincter, with the progression of the relaxation. Perhaps the gaping anal hole, from which emanate mucus, blood, and liquefied feces. Because of the secretions may experience maceration (skin corrosion) of the skin of the perianal area. Inspection of the patient should be carried out on the gynecological chair;
- when digital examination of the rectum revealed a rectal wall swelling, soreness, glove explores the traces of blood, mucus and pus.
Instrumental methods of investigation used in the diagnosis of erosive proctitis, the following:
- rectoscopy – examination of rectum is carried out by means of rectal mirror, which is introduced into its lumen. If the examination reveals swelling and redness of the mucous membrane of the rectal wall, the presence of multiple erosions and fibrinous-purulent bloom. Additionally, it can be identified of anal fissure and hemorrhoids;
- sigmoidoscopy in the rectum introduce a sigmoidoscopy (a type of endoscopic equipment, which improves visibility through the optical system and illumination). Visually identify those changes that can be detected by rectoscopy – but with sigmoidoscopy to examine the mucosa of the entire colon, up to its transition into the sigmoid colon;
- biopsy – do the fence of tissues in different areas of rectal mucosa, and then carried out their histological and cytological study. A biopsy can be done during the inspection of the rectum with a rectal mirror and sigmoidoscopy. Removed portions of tissue, which was in doubt.
The size and number of defects mucosa with erosive proctitis quite vary – it can be individual minor erosion, and numerous injuries across the rectal mucosa. If inflammatory ulcerative process extends from the rectal mucosa on the mucosa of the sigmoid colon, diagnosed proctosigmoiditis.
In the diagnosis of erosive proctitis used such methods of laboratory studies, such as:
- General analysis of blood – in the blood by increasing the number of leukocytes and ESR;
- coprogram – feces were examined for the presence of blood, mucus and pus;
- fecal occult blood test – helps detect blood in the stool, if it has not been identified visually, when viewed from the feces;
- the analysis of a feces on eggs a worm – helps to determine worm infestation, which can worsen erosive proctitis;
- direct microscopic examination of feces – the feces examined under a microscope, it is determined bacteria, helminths or protozoa, which have contributed to the development of erosive proctitis;
- bacteriological examination of feces are stool cultures on nutrient media, then grown colonies make a conclusion about the type of pathogens that are found in the rectum and contribute to the development of inflammatory and erosive process in its mucosa.
Differential diagnosis of
Differential diagnosis of erosive proctitis should be carried out with such diseases and pathological conditions, such as:
Complications of erosive proctitis
The most frequent complications of erosive proctitis is:
- ulcerative proctitis – occurs deeper than erosions, ulcerations of the rectal mucosa on the background of its inflammatory lesions;
- abscess – an inflammatory or inflammatory lesion coloramerican tissues;
- rectal fistula – abnormal passages that connect the rectum with the skin of the perineum or ending blindly in coloramerican tissues. Formed as a result of the abscess, which, in turn, occurs as a complication of erosive proctitis;
- stenosis of the rectum – its narrowing on the background of frequent exacerbations and remissions (this form of the disease is observed at chronic).
Treatment of erosive proctitis
The basis of treatment of erosive proctitis lies with conservative therapy. Treatment goals:
- elimination of the etiological (causal) factors;
- mild inflammation;
- the promotion of regeneration (tissue repair) of mucosal origin of the erosions.
The appointment of the following:
- bed rest;
- infectious agent;
- local treatment.
The goal with diet is to reduce the irritation of erosions stool. The basis of this supply – following recommendations:
- exclusion from the diet of fatty, fried, smoked, salty, spicy and pickled foods;
- eating is fractional (5-6 times a day), small portions;
- limiting the amount of fiber;
- exception of alcoholic beverages (even alcoholic).
Prescribe antibiotic, Antiprotozoal or anthelmintic drugs (depending on pathogen).
As a local therapy administered:
- warm enema with protargol, collargol, infusion of chamomile and other herbs that have antiseptic effect;
- rectal suppositories (candles) with methyluracil;
- sitz baths with chamomile extract.
If erosive proctitis came on the background radiation therapy, cancel it or reduce the dose.
To prevent the development of erosive proctitis should:
- to prevent the development of pathogenic infection in the rectum, and if it arose – promptly identify and liquidate;
- to avoid trauma to the rectal mucosa;
- to promptly detect and treat diseases, against which may develop erosive proctitis;
- to regulate the bowel movements (in particular, for this purpose to adjust the power);
- to pass periodic maintenance inspection at the proctologist, even in the absence of any symptoms from the rectum.
Describe the outcome of the disease depends on the cause of its development, severity and spread of the inflammatory process, the state of General and local immunity, early detection of erosive proctitis and timely treatment, the presence of complications. In General, the prognosis is favorable, but in some cases, will require time to tissue rectal mucous membrane at the place of occurrence of erosions regenerated.
Outcome of erosive proctitis may be as follows:
- full recovery;
- the progression of the erosive process and its transformation (transition) in the ulcerative process;
- the chronic process – acute effects disappear, then the disease take the form of alternating exacerbations with periods of remission (absence of clinical picture).