Proctitis in Emergency Medicine Clinical Presentation
- Author: Lisandro Irizarry, MD, MPH, FAAEM; Chief Editor: Robert E O'Connor, MD, MPH more...
History
- General symptoms
- Feeling of rectal fullness
- Anal and rectal pain
- Diarrhea, usually frequent, small amounts
- Frequent or continuous urge to have a bowel movement
- Pain in the lower left abdomen
- Passing mucus through the rectum
- Rectal bleeding
- Idiopathic proctitis
- Passage of blood and mucus per rectum
- Tenesmus
- Occasionally, passage of loose stool, with or without lower abdominal pain or rectal cramping
- Infectious proctitis
- Pruritus
- Rectal and anal pain (may become severe)
- Avoidance of defecation due to pain
- Most common causes - Neisseria gonorrhoeae, Chlamydia trachomatis, herpes simplex virus (HSV) types 1 and 2
- Indolent and extensive HSV types 1 and 2 infections: Symptoms may include the following: tenesmus, rectal pain, discharge, and hematochezia. The disease may run its natural course of exacerbations and remissions but is usually more prolonged and severe in patients with immunodeficiency disorders. Presentations may resemble dermatitis or decubitus ulcers in debilitated, bedridden patients. A secondary bacterial infection may be present.
- Radiation-induced proctitis
- Early symptoms include tenesmus and diarrhea that resolve shortly after the radiation treatment period.
- Later symptoms of proctitis (occurring months to years after the completion of radiation therapy) include tenesmus, bleeding, low-volume diarrhea, and rectal pain.
- Symptoms of radiation-induced proctitis are associated with low-grade obstruction or fistulous tracts into adjacent organs.
Physical
Physical examination findings may include the following:
- Mucosal erythema
- Mucosal friability
- Groups of vesicles eroding into circular superficial ulcers enlarged
- Tender inguinal lymph nodes (HSV)
- Painless chancres
- Hemoccult positive stools
- Telangiectasias
- Elevated fecal calprotectin and fecal lactoferrin[2]
Causes
Causes of proctitis may include the following:
- N gonorrhoeae
- C trachomatis
- HSV 1 (10%) and HSV 2 (90%)
- Radiation therapy
- Immunodeficiency disorders
- Crohn disease
- Syphilis (usually secondary)
- Papillomavirus
- Amebiasis
- Lymphogranuloma venereum
- Ischemia
- Toxins (eg, hydrogen peroxide enemas)
- Vasculitis
- Cytomegalovirus (CMV)
- Clostridium difficile
- Campylobacter species
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