Ulcerative and actinic proctitis

Proctitis is an inflammation of the anus (anus) and rectum (rectum).
The rectum is a muscular tube connected to the end part of the Grimm’s arm (colon).
The feces pass through the rectum to be excreted from the body.
Proctitis can:

  • be of short duration (acute),
  • occur over a long period of time (chronic).

Ulcerative proctitis
Ulcerative proctitis is similar to ulcerative colitis, a chronic inflammatory bowel disease.
It is characterized by fine ulcerations of the inner wall of the colon mucosa, which, however, do not penetrate the intestinal muscles.
With ulcerative proctitis, inflammation is localized in the rectum.


What are the causes of proctitis?

Infectious proctitis Sexually transmitted diseases passed on through anal intercourse are the most common causes of proctitis.

The most common sexually transmitted infections that can cause proctitis are:
• gonorrhea, • chlamydia, • syphilis,

• genital herpes.

Proctitis caused by herpes viruses can be especially serious in people who are also infected with HIV.

Non-sexually transmitted infections Other infections
may be caused by the bacteria Salmonella and Shigella.
Streptococcal proctitis sometimes occurs in children and has its origin in strep throat.

Traumatic proctitis
Proctitis can result from trauma in the anorectal zone — consisting of the rectum and anus — and due to:

  • rectal prolapse,
  • Anal sex
  • introduction of objects or harmful substances into the rectum,
  • Enemas.

Follicular proctitis
Follicular proctitis is caused by inflammatory bowel diseases (ulcerative colitis and Crohn’s disease).
Ulcerative colitis causes irritation and ulcers, so-called wounds, in the wall of the colon and rectum.
Crohn’s disease usually causes irritation in the lower small intestine (ileum) and colon, but can affect any section of the gastrointestinal tract.

Other causes:

Antibiotics The use of antibiotics
can cause proctitis in some people.
These drugs kill both the bacteria that cause the infections and the “good” commensal bacteria.
The loss of commensal bacteria makes the gut more susceptible to other infections in the colon and rectum that can be caused by harmful bacteria such as Clostridium difficile.

Diet and nutrition
According to the nutritional theory of the blood group diet, there are foods that can provoke ulcerative proctitis, especially dairy products.
Depending on their blood type, some people may develop the disease after eating certain foods.
According to the hygienism of Shelton, Lezaeta and Ehret, ulcerative proctitis and colitis are caused by drugs, processed or canned foods, and foods of animal origin that provoke intestinal rot.

Allergic proctitis in children
Allergic proctitis can occur in infants who are breastfed.
A form of proctitis caused by an accumulation of white blood cells (eosinophils) in the rectal wall affects only children under 2 years of age.

Actinic or radioproctitis

Actinic proctitis is one of the most common complications of radiation therapy of the pelvis.
Radiotherapy is used to treat tumors of the female organs such as the uterus and male prostate cancer.
The rectum is located near these organs, which is why there is a risk of damage from radiation.

Actinic proctitis is classified as acute or chronic:

Acute proctitis
Acute radiation proctitis is an inflammatory process that involves only the superficial mucosa and can occur shortly after the start of therapy or up to 3 months after it.

Chronic proctitis
Radiation proctitis is called chronic if symptoms persist for more than 3 months after cessation of therapy (on average 8-12 months after completion of therapy).

Symptoms of proctitis

  • Feeling of a filled rectum
  • and rectal pain and burning
  • Frequent diarrhea in small amounts
  • Frequent or permanent irritation to empty the intestine, even if the rectum is empty (tenesmus)
  • Left-sided flank pain
  • Mucus secretion via the rectum
  • Rectal bleeding
  • Rectal spasms
  • Itch
  • Suppression of bowel movements due to pain

The disease progresses in episodes and remissions and usually progresses longer and more seriously in patients who have immunodeficiency.
It can manifest as a rash or, in bedridden patients, as bedsores (bedsores).
Secondary bacterial or mycotic infections may occur.

Symptoms of radiation-induced proctitis
The symptoms are:

  • painful urge to stand (tenesmus),
  • Diarrhoea
  • Bleedings
  • rectal pain,
  • Incontinence.

Symptoms of radiation-induced proctitis are associated with fistulas in the adjacent organs.

Diagnosis of proctitis

Examinations and tests for proctitis
The doctor must evaluate the patient’s entire medical history to determine whether there are any highly risky behaviors.
Most patients with suspected proctitis need to undergo the following examinations:

  • Investigation of the perianal region.
  • Digital rectal examination.
  • Rectoscopy (rectosigmoidoscopy): examination of the anus, rectum and sigmoid colon. A tube with an illuminated camera is inserted through the anus and is used to view the intestinal surface of the rectum.
    The images are projected onto a screen and enlarged to detect any changes.
  • Perform biopsy of the rectum (removal of a small piece of tissue) to rule out or confirm certain conditions or infections.
  • Stool examination – to detect the bacterium Clostridium difficile.
  • swab – The mucus outlets from the anus are examined in the laboratory to determine the presence of sexually transmitted organisms.
  • Blood tests to evaluate the amount of antibodies, for example, against syphilis.

Differential diagnosis
The doctor must exclude the following diseases:

  • rhagades,
  • fistulas
  • Soft chancre (Ulcus molle)
  • Colitis/proctitis caused by Clostridium difficile
  • Diverticulitis or diverticulosis
  • Foreign bodies in the rectum
  • Gonorrhoea
  • Herpes simplex
  • Inflammatory bowel disease
  • Venereal granuloma (lymphogranuloma venereum)
  • Syphilis
  • Haemorrhoids

Therapy of proctitis and medications

Treatment of proctitis depends on the cause of inflammation.

Treatment of proctitis
caused by infection The doctor may prescribe medications to eliminate the cause of infection. Options include:
1. Antibiotics. With proctitis caused by bacterial infection, the doctor may recommend antibiotics.
2. Antivirals. In the case of proctitis caused by viral infection such as genital herpes, the doctor may prescribe an antiviral (acyclovir).

Treatment of actinic proctitis (caused by radiotherapy)
The doctor may recommend several treatments:

Anti-inflammatory drugs, such as 5-aminosalicylic acid (5-ASA) and corticosteroids, may be given in the form of tablets, suppositories, and enemas.
These medications can help keep inflammation under control and reduce bleeding.

This drug is prescribed mainly for the treatment of duodenal and peptic ulcer, but can also be used for actinic proctitis, because it has the ability to:

  • repair mucosal tissue,
  • to form a protective barrier.

Emollients for the stool can help relieve blockages in the intestines.

Treatment for cauterization of damaged tissue
Some therapies for proctitis ease symptoms by cauterizing the blood vessels of the abnormal, bleeding tissue.
The main methods of cauterization in proctitis are:

  • Use of a formalin solution,
  • coagulating heat treatments.

Less frequently used:

  • Laser therapy,
  • Argon-plasma coagulation.

Laser therapy uses a focused beam of light (laser) that selectively burns the abnormal tissue in the rectum.
Argon-plasma coagulation occurs by sending an argon gas jet together with electric current.

Proctitis caused by inflammatory bowel disease The treatment of forms of proctitis linked to conditions such as Crohn’s disease
or ulcerative colitis serves to reduce inflammation in the rectum.
Treatment includes:

  • Drugs for the treatment of rectal inflammation. The doctor may prescribe anti-inflammatory medications such as mesalazine (Asacol) or corticosteroids.
    These drugs come in the form of tablets, suppositories and enemas.
    Cortisone suppositories or enemas can relieve inflammation in the rectum.
    The inflammation in individuals with Crohn’s disease often needs to be treated with a medication that suppresses the immune system, such as infliximab (Remicade).
  • Surgery. If pharmacological treatment does not relieve the signs and symptoms, the doctor may advise surgery to remove the damaged portion of the digestive tract.

Eosinophilic proctitis
The removal of various foods from the diet, and subsequently their gradual reintroduction, is an effective treatment strategy for this disease.

Nutrition for ulcerative or actinic proctitis

Nutrition is one of the main treatment measures, it shows excellent results and does not have the contraindications of the drugs.

A person can be healthy by:

  • vegan diet,
  • Diet based on animal proteins.

Some vegans develop symptoms and illnesses because they eat a lot of (especially gluten-containing) grains.

  1. The theory of hygienists recommends eating plenty of raw food because it contains vitamins and other nutrients, while the cooking process results in the degeneration of vitamins, minerals, etc.
    Since the human body is similar to that of frucivores (animals that feed on fresh fruits, nuts, vegetables and seeds), our diet should be similar to that of these animals.
    According to the hygienists, one should only eat between 12 and 20 o’clock, so that the body has enough time from 20 to 12 o’clock the following day to absorb the nutrients and eliminate the waste products.
    The digestion of the previously consumed meal must be completed before eating food again, in this way incorrect food combinations are avoided, which can lead to fermentation in the intestine.
    One can eat potatoes and legumes in limited quantities, which should be preceded by a plate of vegetables.
    A fasting cure is often recommended because it allows the body to concentrate its energies on healing and excreting toxins.
  2. The theory of the blood type diet arose after it was discovered that some foods cause diseases and symptoms in people of a certain blood type, but not in the others.
    For example, pistachios can cause severe symptoms in blood type A people, while peanut butter can cause health problems in people in blood type B.
    In case of proctitis, it is generally recommended to abandon milk and dairy products, first of all.

Natural remedies for proctitis

These natural remedies can maintain good overall health:

  • Consume antioxidant foods, including fruits (such as blueberries and cherries) and vegetables (such as pumpkin, tomatoes, and peppers).
  • Eat foods with a high content of vitamins of group B, calcium and magnesium, for example:
    • Almonds
    • Beans
    • dark leafy vegetables (spinach and cabbage).
  • Avoid refined foods such as white bread, pasta and especially sugar.
  • Eat less red meat and more lean meat, cold-water fish, tofu, soy and beans to get enough protein.
  • Use healthy oils such as olive oil or vegetable oil.
  • Reduce or eliminate trans fats in commercial baked goods, such as cookies, crackers, cakes, french fries, onion rings, donuts, processed foods and margarine.
  • Avoid milk and dairy products.
  • Avoid caffeine, alcohol and tobacco.
  • Drink 6-8 glasses of filtered water daily.
  • Exercise for at least 30 minutes a day, 5 days a week.

Helpful supplements to relieve symptoms of proctitis

The doctor may recommend:

  1. Incorporating more soluble fiber into the diet helps fight constipation.
  2. Probiotics containing Lactobacillus acidophilus.
    Taking antibiotics can kill “good” and “bad” bacteria and upset the balance the body needs for healthy digestion.
    Probiotics, or “good” bacteria, can help restore the balance of bacteria in the gut.
  3. Vitamin C (500 mg) and vitamin E (400 mg) three times a day.
  4. Omega-3 fatty acids, such as those contained in fish oil.

How long does the disease last? Will you be healed?

Chronic proctitis does not heal completely, but there are periods of remission and others when the exacerbation of symptoms occurs.

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