• Diarrhea, rectal bleeding, discharge, tenesmus, pain, and incontinence
• Symptoms of late disease are secondary to strictures, fistulas, and telangiectasias
• Patients with late disease present with the following:
• Infectious proctitis
• Crohn disease
• History and physical exam
• Biopsies are taken at endoscopy to rule out infectious processes and Crohn disease
• Severe bleeding
• Bowel obstruction
• Bowel perforation
• Corticosteroid retention enemas are given for 2 weeks
• If there is no response, a short course of oral corticosteroids may be given
• Mesalamine (5-aminosalicylic acid) may be given orally or rectally in an enema or suppository
• Initial therapy includes bulk-forming agents, antidiarrheals, and antispasmodics
• Topical corticosteroids, mesalamine preparations, misoprostol suppositories, and short-chain fatty acids have all been used
• Radiation proctitis
-Treat late complications of radiation injury: Dilatation of strictures and laser coagulation of telangiectasias
-Surgical success in treating fistulas to the bladder or vagina is interposition or transposition of healthy nonirradiated tissue into the field
-Infrequently is the rectum so badly damaged that it must be removed
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