Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android

Inflammatory Proctitis

  • • A mild form of ulcerative colitis that is limited to the rectum

    • The disease course is often self-limited

Radiation Proctitis

  • • Occurs in a patient with a history of radiation to the rectum

    • Disease may develop months to years after the injury


Inflammatory Proctitis

  • • Colonic manifestations of ulcerative colitis develop in 10% of patients

Radiation Proctitis

  • • Follows radiation injury

Symptoms and Signs

Inflammatory Proctitis

  • • Rectal bleeding, discharge, diarrhea, and tenesmus

Radiation Proctitis

  • • 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:

    • -Recurrent urinary tract infections

      -Vaginal discharge

      -Fecal incontinence

      -Rectal bleeding

      -Changes in stool caliber


Imaging Findings

Inflammatory Proctitis

  • Sigmoidoscopy: Rectal mucosa is inflamed and friable, but the remainder of the colon appears normal on exam

Radiation Proctitis

  • • Endoscopy may reveal friable edematous mucosa, telangiectasias, or strictures and may show internal openings of fistulas

  • • Infectious proctitis

    • Crohn disease

    • Malignancy

Rule Out

  • • An infectious process must be ruled out before initiating corticosteroid therapy

    • Malignancy

  • • History and physical exam

    • Sigmoidoscopy/colonoscopy

    • Biopsies are taken at endoscopy to rule out infectious processes and Crohn disease

When to Admit

  • • Severe bleeding

    • Bowel obstruction

    • Bowel perforation

Inflammatory Proctitis

  • • 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

Radiation Proctitis

  • • 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


  • • Corticosteroid enema

    • Oral steroids

    • Mesalamine, oral or rectal

Treatment Monitoring

  • • Lack of response to appropriate therapy calls for reassessment of the patient


Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.