Management of Proctocolitis in Older People

What Is Proctocolitis?

Proctocolitis is defined as the combination of proctitis and colitis. Proctitis is the inflammation of the rectum, and colitis is the inflammation of the colon. Proctocolitis is a painful condition and presents with symptoms like abdominal pain, diarrhea, and swelling of the rectum. It can be considered a part of inflammatory bowel disease (IBD). In this condition, the inflammation of the colon can extend as far as 12 to 15 centimeters above the anus. Proctocolitis in infants occurs as a response to an allergic reaction to the formula or breast milk, and they present with symptoms such as rectal bleeding or blood in the stool. In adults, it commonly occurs due to irradiation, sexual transmission, vasculitis, ischemic colitis, and medications.

What Are the Causes of Proctocolitis in Older People?

• Infections: Organisms that can cause proctocolitis are Neisseria gonorrhoeae, chlamydia trachomatis, shigella dysenteriae, herpes simplex virus, and campylobacter species.

• Sexual Intercourse: Proctocolitis is common in people having anal sex with people infected with sexually transmitted diseases (STD).

• Inflammatory Bowel Disease (IBD): IBD is an autoimmune disorder that causes inflammation of any part of the gastrointestinal tract from mouth to anus. It includes Crohn’s disease and ulcerative colitis. Bloody diarrhea, abdominal pain, weight loss, fever, anemia, etc. are the symptoms of IBD.

• Ischemic Colitis: It occurs when blood flow to the colon is significantly reduced for a short time. The symptoms of ischemic colitis are, blood in feces, abdominal cramps, diarrhea, nausea, and much more.

• Microscopic Colitis: It is the chronic inflammation of the colon that occurs due to abnormal reactions in the immune system. A patient with microscopic colitis presents with abdominal distension, pain, bloating, fatigue, an urgency to empty the bladder, etc.

• Drug-Induced Colitis: Drugs, especially non-steroidal anti-inflammatory drugs (NSAIDs) can induce colitis, which resembles inflammatory bowel disease. NSAIDs may cause inflammation and bleeding in the small intestine.

• Iatrogenic: In some cases, proctocolitis occurs due to radiation therapy or chemotherapy. Drug-induced colitis also comes under iatrogenic colitis.

• Idiopathic: When proctocolitis arises from an unknown cause, it is known as idiopathic. Two types of idiopathic colitis are lymphocytic and collagenous colitis.

What Are the Symptoms of Proctocolitis?

Following are the signs and symptoms a person with proctocolitis presents with:

• Frequent diarrhea.

• Stools may contain blood, mucus, or pus.

• Extreme tiredness.

• Weight loss.

• Frequent urge to empty bowel.

• Perianal ulcers.

• Mouth ulcers.

• Arthritis or inflamed joints.

• Irritation in eyes.

• Rapid heartbeat.

• Shortness of breath.

• Pale skin.

• Brittle nails.

• Involuntary spasms.

How Is Proctocolitis Diagnosed?

The initial examination of proctocolitis is done with a medical device called a proctoscope. It is a thin tube-like device with a lens and light which is used to view the anus and rectum, and also to remove small tissue from these areas for biopsy. In a biopsy, the physician will scrape small tissue from the rectum to examine it under the microscope. Stool examination is also advised to detect the presence of any disease-causing microbes.

Anoscopy is another method where a small hollow device slightly wider than the finger is used to view the lining of the anus and rectum. It is commonly used to diagnose hemorrhoids, fissures, and rectal cancers. Biopsies and exudates can also be taken with the help of an anoscope.

Microscopic examination of the exudate is evaluated to detect polymorphonuclear leukocytes. The presence of herpes simplex virus, chlamydia trachomatis, Neisseria gonorrhoeae, and treponema pallidum has to be evaluated in all cases of proctocolitis.

What Is the Treatment for Proctocolitis in Older People?

If any bacteria or viruses are detected after the microscopic examination of the exudate or smear, treatment depends on the causative microbes. The most commonly recommended antibiotics are ceftriaxone and doxycycline. Other prescribed antibiotics are azithromycin and fluoroquinolones. If the patient is diagnosed with genital herpes, then the recommended antiviral drugs are acyclovir, valacyclovir, and famciclovir.

In severe cases of herpes infection, an intravenous (IV) injection of acyclovir is administered. In acyclovir-resistant genital herpes, foscarnet is administered intravenously. Patients who acquire the disease through sexual contact are advised to abstain from any kind of sexual intercourse until they and their partners are completely treated. Topical corticosteroids are prescribed for pain and swelling.

Immunosuppressants, such as corticosteroids, which include prednisolone or budesonide are given to patients with inflammatory bowel disease, which are considered an autoimmune condition. Suppositories or enemas are given to treat anal and rectal ulcers. Medicated mouthwashes and local anesthetic topical gels can be used to treat mouth ulcers that occur as a result of proctocolitis. Endoscopic procedures are performed to stop bleeding. When the medications fail to treat the condition, then surgery is indicated.

If left untreated, proctocolitis may result in formation of abscess, ulcers, fistula, anemia, etc.

What Is Corrosive Proctocolitis?

It is a type of proctocolitis that occurs due to the accidental contamination of endoscopes, especially with cleansing agents used in cleaning endoscopes, such as hydrochloric acid and ethoxylated alcohol. In some cases, people themselves administer hydrogen peroxide, herbal medicines, alcohol, and detergents rectally to treat constipation. But these chemicals may result in adverse reactions in the anal region like bleeding, severe pain, and burning sensation. Corrosive proctocolitis is treated with intravenous antibiotics and fluid replacement therapy.

How to Prevent Proctocolitis in Older People?

• Diet plays a major role in any diseases associated with the gastrointestinal tract. People who eat food rich in saturated fat and refined carbohydrates are at higher risk for proctocolitis.

• Drink plenty of water. Avoid caffeine, alcohol, and carbonated drinks.

• Eat smaller meals throughout the day.

• Sexual transmission is another main cause of proctocolitis. Screening the partner's health and using condoms before sexual contact can prevent sexually transmitted proctocolitis to a certain extent.

• Lactose intolerance patients can avoid milk and other dairy products.

Conclusion

Proctocolitis is a painful condition, if left untreated, can lead to several complications in older adults. Blood in feces, weight loss, ulcers in the anus and mouth, arthritis are some of the symptoms of proctocolitis. These symptoms can cause extreme discomfort and may affect a person’s daily activities. The treatment of proctocolitis depends on the cause. If it is due to bacterial or viral infections, then patients will be put under antibiotic or antiviral therapy. Suppositories or enemas will be given to reduce inflammation. Corticosteroids are also administered in cases of autoimmune conditions that cause proctocolitis. Surgery is the only option when medications do not work. However, proctocolitis can be prevented by taking extreme precautions before sexual intercourse as it is one of the main causes. Avoiding unhealthy foods, drinks, and lifestyles can also prevent proctocolitis to a certain extent.