If diarrhea and constipation occur alternately, be alert to proctitis!

Author: Fan Xueshun, Chief Physician of China-Japan Friendship Hospital

Reviewer: Lin Guole, Chief Physician, Peking Union Medical College Hospital

Have you or your family ever experienced alternating diarrhea and constipation? If so, you must think that it may be proctitis!

1. Why does proctitis cause alternating diarrhea and constipation?

The rectum is at the end of the digestive tract and is the closest section of the intestine to the anus. It starts from the plane of the second sacral vertebra, connects with the sigmoid colon, passes through the pelvic floor, and connects with the anal canal. The total length is 12-15cm.

Figure 1 Original copyright image, no permission to reprint

When proctitis occurs, the main symptoms include mild dull pain in the left lower abdomen; blood and pus in the stool, sometimes mixed with blood and pus; the stool is sometimes dry and sometimes watery, and some patients may experience a feeling of anal prolapse.

Some patients may wonder why proctitis causes dry or loose stools, sometimes diarrhea, and sometimes constipation?

Because if the inflammatory exudation is more obvious, a lot of fluid will be secreted, and the fluid and blood will be mixed together. At this time, due to intestinal irritation, it will manifest as frequent and unformed stools.

However, some patients cannot defecate due to rectal spasm, and the intestines excessively absorb water in the stool, resulting in constipation.

So proctitis will cause two changes: diarrhea, constipation, or alternating diarrhea and constipation.

2. If you suspect you have proctitis, what tests do you need to do?

Generally speaking, the doctor will first make a preliminary judgment based on the patient's self-report of pain in the left lower abdomen, alternating constipation and diarrhea, increased frequency of bowel movements, a feeling of anal prolapse, mucus in the stool, or sometimes mucus and blood in the stool.

Secondly, digital examination should be used to check whether there is stenosis at the end of the rectum, whether there is a polyp-like protrusion, and whether there is a tumor. More importantly, it is necessary to observe whether there is mucus-like blood in the stool on the finger glove. Sometimes, the mucus should be cultured to observe whether there is bacterial infection, whether there is gonococcal or tuberculosis infection. These are necessary and very meaningful to help confirm the diagnosis.

At the same time, you should check the tightness of the anus. Because proctitis recurs and the rectum keeps contracting, the anus will be in a spasm state.

In addition, some mucosa can be taken for a live pathological examination, which is also frequently used in clinical practice.

Anoscopy and sigmoidoscopy are also necessary to observe whether there is congestion, edema or erosion at the end of the rectum. More importantly, a comprehensive full digestive tract fiber colonoscopy is required to determine whether there are inflammation or ulcers in other parts of the digestive tract besides the rectum. These examination methods are very common in clinical practice.

3. How to treat proctitis?

Different methods are used according to different patients. Generally, oral medication or intravenous infusion can be used, or enema can be used.

Oral medications can be treated through traditional Chinese medicine differentiation of symptoms, or probiotics that regulate the flora can be used with Western medicine, etc. When necessary, antibiotics can be infused intravenously, including immunosuppressants, and sometimes some glucocorticoids are given to control symptoms.

Topical medications are mainly enema, which includes Chinese medicine enema and Western medicine enema. However, sometimes glucocorticoids are also needed, mainly to control the symptoms and directly absorb them through the intestines to achieve a therapeutic effect.

In addition, when anal swelling and anal pain occur, a potassium permanganate sitz bath with anti-inflammatory effects can relieve anal muscle spasms and relieve the inflammatory irritation of perianal exudation, so it is meaningful for relieving discomfort symptoms, but it is actually of little significance for rectal inflammation.

Figure 2 Original copyright image, no permission to reprint

4. What should patients with proctitis pay attention to in their daily lives?

First, in terms of diet, raw, cold, greasy, spicy food, including seafood, drinking, and smoking should be reduced as much as possible or eliminated.

Second, pay attention to physical exercise, don’t overwork yourself, and maintain a regular life.

Third, pay attention to emotional stability and a happy mood, and try not to be angry or anxious, because these will affect the body's immunity.

Fourth, it is very important to avoid staying up late, because it is extremely harmful to the human body and will have a negative impact on the immune system.

Fifth, patients with proctitis should also pay attention to avoid anal sex. This suggestion comes from frequent observations in clinical practice. In the past, many patients did not pay attention to this problem, which eventually led to gonorrheal proctitis, herpetic proctitis, or syphilitic proctitis.

The symptoms of gonorrheal proctitis are not much different from those of ordinary proctitis, but this problem can be discovered when doing bacterial culture of secretions. Some men may also develop balanitis, so avoiding anal sex has a positive significance in reducing the occurrence of proctitis.