Emergency Department Care
After life-threatening conditions have been excluded or controlled, aim for providing patient comfort during the examination.
Treatment depends upon the etiology, including the following:
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Sitz baths, antispasmodic medications, stool softeners, low residue diet (may provide relief)
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Steroid enemas or suppositories for ulcerative proctitis canasa 1 g enema or suppository daily for a month
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Ceftriaxone and doxycycline for gonorrheal proctitis
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Acyclovir for herpetic proctitis
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Tetracycline or doxycycline for chlamydial proctitis
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Shigella proctitis is usually self-limiting but may require, under certain circumstances, prolonged (2-4 wk) antibiotic treatment with ampicillin, tetracycline, ciprofloxacin, or trimethoprim and sulfamethoxazole (TMP-SMZ).
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Yersinia proctitis is usually self-limiting, but, if systemic bacteremia occurs, treat with intravenous antibiotics such as tetracycline or ceftriaxone.
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Campylobacter proctitis is a self-limiting disease; treatment is aimed at symptomatic relief.
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Metronidazole (Flagyl) or iodoquinol for amebiasis proctitis
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Metronidazole (Flagyl) or oral vancomycin for C difficile proctitis
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Radiation proctitis treatment may include the following: sucralfate alone or with rectal prednisolone enemas, short-chain fatty acid enemas, or pentosan polysulfate. In addition, hyperbaric oxygen theoretically inhibits bacterial growth, preserves marginally perfused tissue, and inhibits toxin production. Formaldehyde, argon plasma coagulation via endoscopy and bipolar electrocoagulation (BiCap) may be used to control refractory bleeding in hemorrhagic proctitis. [5, 6, 7]
In an observational study, investigators analyzed data from 26 patients with acute proctitis symptoms. Lymphogranuloma venereum (LGV) serovar L2 was confirmed in all patients, all of whom were men who have had sex with men (MSM) and 24 of whom were HIV-positive. After standard treatments with doxycycline 100 mg twice per day for 3 weeks, the cure rate was 100%. [8]
Discharge
Discharge if no life-threatening condition exists and the patient is able to comply with the therapeutic regimen.
Discharge should include follow-up with a colorectal surgeon or gastroenterologist who will monitor the patient's progress clinically and endoscopically, in addition to following results of cultures, labs, and biopsies.
For patient education resources, see the Digestive Disorders Center, as well as Rectal Pain and Rectal Bleeding.
Maintenance medical therapy is not used routinely in idiopathic proctitis unless the patient's condition is slow to respond, difficult to control, or has frequent flare-ups.
In radiation proctitis, there is no evidence that indicates that corticosteroids and/or various aminosalicylic acid derivations given as an enema or orally are beneficial in preventing the progression of the disease.In hemorrhagic proctitis, topical formaldehyde is effective in controlling bleeding with no serious complication, but further studies are needed. [6]
Consultations
Consult a colorectal surgeon or a gastroenterologist for further evaluation of the lower gastrointestinal (GI) tract by sigmoidoscopy, if indicated (to rule out more proximal disease), after anoscopy.
A colorectal surgical consultation may also be considered for management/evaluation of deep tissue infection.
