From the Guidelines
Stercoral proctitis should be treated with a focus on relieving constipation and preventing further complications, rather than solely addressing the inflammation, as the primary goal is to prevent morbidity, mortality, and improve quality of life. The treatment of stercoral proctitis involves relieving constipation through the use of stool softeners, osmotic laxatives, and stimulant laxatives, as well as manual disimpaction in severe cases [no direct evidence provided]. However, for proctitis in general, a mesalamine 1-g suppository once daily is the preferred initial treatment for mild or moderately active proctitis 1. Key aspects of treatment include:
- Relieving constipation to reduce pressure on the rectal mucosa
- Preventing further complications such as stercoral ulceration and perforation of the rectum or colon
- Establishing a consistent bowel routine
- Avoiding medications that cause constipation when possible
- Increasing fluid intake and dietary fiber to prevent constipation In cases of refractory proctitis, treatment with systemic steroids, immunosuppressants, and/or biologics may be required 1. It is essential to prioritize the prevention of complications and the improvement of quality of life in the treatment of stercoral proctitis.
From the Research
Definition and Causes of Proctitis
- Proctitis is an inflammation involving the anus and the distal part of the rectum, frequently diagnosed in the context of inflammatory bowel diseases (IBD) 2.
- It can also be caused by infectious agents, such as Neisseria gonorrhoeae, Chlamydia trachomatis, Herpes Simplex virus, and Treponema pallidum, especially in individuals participating in anal intercourse 2, 3.
- Other causes of proctitis include radiation, ischemia, diversion, and traumatisms 2.
Types of Proctitis
- Ulcerative proctitis is a type of ulcerative colitis that is considered one of the initial manifestations of the disease 4.
- Stercoral proctitis is not explicitly mentioned in the provided studies, but it can be inferred that it is a type of proctitis caused by fecal impaction or other non-infectious agents.
Diagnosis and Treatment of Proctitis
- Diagnosis of proctitis is supported by the combination of clinical history, physical examination, and endoscopic, serologic, and microbiologic findings 2, 3.
- Treatment of proctitis depends on the underlying cause, but topical 5-aminosalicylates (5-ASA) and corticosteroids are effective in the treatment of ulcerative proctitis 4, 5.
- Mesalazine suppository is a common treatment for ulcerative proctitis, and it has been shown to be more effective than oral 5-ASA in some cases 4, 6.