Radiation Proctitis

Proctitis is a type of inflammation in the lining of the rectum. The rectum is in the lower part of the large intestine (colon) just above the anus. Proctitis can be caused by many things. Radiation proctitis occurs from having radiation treatment for cancer in the pelvic area. It can cause rectal pain, bleeding, and problems with pooping (bowel movements).

This condition is caused by radiation therapy to treat cancer in the rectum or the areas around it. This includes these nearby areas:

• Anus
• Bladder
• Prostate
• Testes
• Colon
• Ovaries
• Cervix
• Uterus

You’re at risk for this condition if you’ve had radiation therapy on your rectum or on areas around it. This includes radiation treatment for rectal, anal, bladder, cervical, ovarian, uterine, prostate, or testicular cancer. People who receive a higher dose or certain types of radiation are at greater risk for radiation proctitis.

Symptoms may start during or within 6 weeks of radiation treatment (acute). Or they may appear months or years after treatment has ended (chronic).

Symptoms can include:

• Rectal, belly (abdominal), or anal pain or cramping
• Rectal bleeding
• Bloody poop
• Pain when pooping
• An urgent or constant feeling that you need to poop
• Your rectum feels full
• Mucus discharge in poop
• Diarrhea
• Constipation

If not treated, complications can occur such as:

• Pus-filled infections (abscesses)
• Narrowing of the rectum (rectal stricture)
• Open sores in the rectum and colon (ulcers)
• An abnormal passage that forms due to sores or an abscess (fistula)
• Anemia due to blood loss

Some of these symptoms can also be caused by other health problems. Always see your healthcare provider for a diagnosis.

Your healthcare provider will ask about your symptoms and take your health history. If you’ve had radiation therapy, your provider may suspect that you have radiation proctitis. A physical exam will also be done. This may include a physical exam of the rectum (called a digital rectal exam). For this, the provider will put a gloved finger into your rectum and feel for any problems.

You may also have some tests done to rule out other conditions. These tests may include:

• Blood tests. These may be done to check for an infection.
• Stool test. This may be done to check your poop for an infection.
• Endoscopy. This test uses a thin, lighted tube with a camera (endoscope) to view the lower part of the colon and the rectum.
• Imaging tests. A CT scan may be done to rule out other conditions such as inflammatory bowel disease.
• Colonoscopy. This is an endoscopic exam of your colon. During this exam, the provider may also take a tissue sample (biopsy) and have it checked under a microscope.

If symptoms occur during radiation therapy, your healthcare provider may advise stopping radiation treatment for a short time until symptoms improve.

Treatment is based on your symptoms:

• Mild symptoms. For some cases with mild symptoms, no treatment may be needed. The condition may go away on its own. But if mild symptoms don’t go away, your healthcare provider may advise medicines. Depending on your symptoms, these may help to reduce bleeding, diarrhea, and inflammation, and to soften your poop (stool softener). These may be given in pill form, or as suppositories or enemas.
• Lasting or moderate rectal bleeding . Your provider may advise other treatments to reduce bleeding such as:
  • Formalin. A chemical called formalin is applied to seal the damaged areas of the rectal lining.
  • Argon plasma coagulation (APC). A long, thin, flexible tube with a probe is inserted into the lower intestinal tract. It sends electrically charged argon gas to the damaged tissue.
  • Radiofrequency ablation (RFA). During RFA, heat is sent directly to the damaged areas through a long, thin, flexible tube. This destroys the damaged tissue.
• Severe complications. Surgery may be advised when other treatments don’t work. Or when there are severe complications such as fistulas, abscesses, or strictures that may create bowel blockages. Surgery may be done to remove the damaged part of the rectum. In some cases, all of the rectum may be removed.

In addition to the above treatments, your provider may talk to you about lifestyle changes that may help ease symptoms. These will depend on what symptoms you have. They may include changing your diet and staying away from caffeine, alcohol, and tobacco.