What is the treatment for rectal burning?

Treatment for Rectal Burning

For rectal burning, topical lidocaine is the first-line treatment to provide temporary relief of pain, while addressing the underlying cause is essential for long-term resolution. 1

Initial Assessment and Management

• Determine the cause of rectal burning, which could be related to radiation-induced telangiectasia, hemorrhoids, anal fissures, proctitis, or chemical irritation 2
• Assess for signs of severe injury such as bleeding, ulceration, or infection that may require urgent intervention 2
• Optimize bowel function and stool consistency, which may reduce irritation and burning sensation 2

First-Line Treatments

Topical Pain Relief

• Apply topical lidocaine to the affected area for temporary relief of pain and burning sensation 1
• Use only as directed and avoid applying to large areas of irritated or swollen skin 1
• Discontinue if irritation develops or symptoms persist for more than 7 days 1

Supportive Measures

• Ensure privacy and comfort during defecation to reduce strain and irritation 2
• Use proper positioning (small footstool may help) to assist with bowel movements 2
• Increase fluid intake and mobility within patient limits to improve bowel function 2

Treatment for Specific Causes

Radiation-Induced Rectal Burning

If burning is due to radiation proctitis or telangiectasia:

• Sucralfate enemas can be effective for radiation-induced rectal burning and bleeding 2

  • Preparation: 2g sucralfate suspension mixed with 30-50ml tap water
  • Administration: Twice daily initially, then once daily for maintenance
  • Technique: Patient should roll through 360 degrees to coat entire rectal surface and lie prone to cover anterior wall telangiectasia 2

• For severe cases affecting quality of life, consider:

  • Hyperbaric oxygen therapy which has shown benefit in randomized trials 2
  • Avoid argon plasma coagulation in radiation-damaged tissue due to high risk of complications including deep ulceration, bleeding, and fistulation 2

Chemical Irritation

• If burning is due to chemical irritation from enemas or suppositories:
  • Discontinue the offending agent immediately 3, 4
  • Mild cases may heal spontaneously with supportive care 3
  • Severe chemical burns may require surgical intervention in rare cases 4

Inflammatory Conditions

• For burning associated with inflammatory conditions like proctitis:
  • Rectal budesonide foam may be considered for mild-to-moderate inflammation 5
  • Mesalamine enemas can be effective with remission rates of approximately 75% after 6 weeks of treatment 5

Precautions and Contraindications

• Enemas are contraindicated in patients with:

  • Neutropenia or thrombocytopenia
  • Paralytic ileus or intestinal obstruction
  • Recent colorectal or gynecological surgery
  • Recent anal or rectal trauma
  • Severe colitis, inflammation or infection of the abdomen
  • Toxic megacolon
  • Undiagnosed abdominal pain
  • Recent radiotherapy to the pelvic area 2

• For topical lidocaine:

  • Do not bandage or apply local heat to the area
  • Avoid contact with eyes and mucous membranes
  • A transient burning sensation may occur upon application 1

Follow-up Recommendations

• If symptoms persist despite treatment, further investigation with flexible sigmoidoscopy or colonoscopy may be necessary 2
• For recurrent or persistent symptoms, consider referral to a specialist for evaluation of underlying conditions 2
• Monitor for complications such as stricture formation, which may develop after healing of rectal burns 3