How are proctitis and anusitis treated?

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

The indications for therapy vary according to the etiology of the proctitis. For example, in patients with inflammatory bowel disease (IBD), a colonoscopy should be performed to find out the extent of the inflammation. Many patients with IBD who present with proctitis may progress to left-side colitis and possibly pancolitis. The first-line management of these patients is medical therapy (see below). Surgical treatment is indicated for failed medical therapy, any dysplasia seen on biopsy specimens, and cancer.

Surgery is rarely indicated for proctitis secondary to an infectious etiology. The goal of therapy is to treat the infection causing the inflammation. Rarely, profound sepsis may necessitate surgical resection as a life-saving maneuver.

Finally, the indication for treatment of chronic radiation proctitis is also based on the symptomatology and grade of proctitis. Persistent rectal bleeding and diarrhea initiate a workup, including a rigid proctoscopy and/or colonoscopy. The presence of intractable bleeding despite multiple medical/endoscopic modalities, perforation, strictures, or fistulas is an indication for surgical intervention.

In the course of any proctitis, antispasmodic agents may prove helpful in alleviating the abdominal complaints. In addition, the use of a low-residue diet and stool softeners is beneficial because of the friability of the rectal mucosa and its vulnerability to damage from the fecal contents.


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