What is the focus of the clinical history for suspected proctitis and anusitis?

Updated: Mar 27, 2020
  • Author: David E Stein, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

In taking the patient's history, pertinent questions should include a personal history of inflammatory bowel disease (IBD), pelvic irradiation, travel history, and sexual history (including questions regarding anal intercourse). [3] The patient's HIV status is important to note as well. Obtaining a list of medications used (eg, nonsteroidal anti-inflammatory drugs [NSAIDs] or antibiotics) is clearly important. A family history of IBD or other gastrointestinal (GI) diseases is extremely important.

A review of systems is needed to review any systemic symptoms that can be related to the proctitis, such as IBD and collagen vascular disorders. In addition, identifying patients who are immunocompromised is important, because some infections that may cause proctitis (eg, cytomegalovirus, cryptosporidiosis) affect only this subset of patients.

The physical examination findings may be unremarkable. Abdominal tenderness may be seen in IBD, infectious colitides, and ischemic proctitis. As a consequence of tenderness, it may not be possible to perform a digital rectal examination. If this is the case, an evaluation under anesthesia is required.


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