Radiation proctitis history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rekha, M.D., Mahshid Mir, M.D. [2]

Overview

The most common symptoms of radiation proctitis include mild diarrhea, tenesmus, fecal urgency and mucus discharge. Less common symptoms of radiation proctitis include abdominal pain, constipation, severe diarrhea and rectal bleeding.

History and Symptoms

History

History plays a pivotal role in diagnosing the radiaition proctitis and to exclude other differentials therefore history should include:

• Exposure to the radiation
• Recent history of travel
• Recent parasitic infection
• History or risk factors for STD
• Recent use of antibiotics or NSAIDS
• History of atherosclerosis
• Immunosuppression

Common Symptoms

Common symptoms of Radiation proctitis include:

• Changes in bowel habits,usually mild diarrhea
• Tenesmus
• Fecal urgency
• Mucus discharge

Less Common Symptoms

Less common symptoms of radiation proctitis include

• Abdominal pain
• Constipation
• Severe diarrhea
• Rectal bleeding

Acute radiation proctitis

Symptoms occur in the first few weeks after therapy. These symptoms include diarrhea and the urgent need to defecate, often with inability to do so (tenesmus). Acute radiation proctitis usually resolves without treatment after several months, but symptoms may improve with butyrate enemas. This acute phase is due to direct damage of the lining (epithelium) of the colon.

Chronic radiation proctitis

Symptoms may begin as early as several months after therapy but occasionally not until several years later. These symptoms include diarrhea, rectal bleeding, painful defecation, and intestinal blockage. Intestinal blockage is a result of narrowing of the rectum which blocks the flow of feces due to stricture and results in symptoms in the form of constipation, rectal pain, urgency, and rarely fecal incontinence due to overflow. Connections fistulae may also develop between the colon and other parts of the body such as the skin or urinary system. Inury to the nearby organs can lead to cystitis, urethral stenosis, small bowel obstruction and small bowel bacterial overgrowth.

Endoscopic image of radiation proctitis before and after therapy with argon plasma coagulation.