What is radiation proctitis?
Radiation proctitis is inflammation of the rectum that results from injury to the rectum during radiation to the pelvis (treatment for cancers such as prostate or cervical cancer). Radiation proctitis may be acute (presenting during or up to 6 months after completion of radiation therapy) or chronic (presenting more than 6 months after radiation treatment). Up to 20% of patients who receive pelvic radiation may develop chronic radiation proctitis.
What are symptoms of radiation proctitis?
Symptoms may include diarrhea, bleeding per rectum, abdominal or pelvic pain and cramping, mucous discharge, tenesmus (a sense of urgency to have a bowel movement, even when there is no stool in the rectum) or incontinence.
In patients who develop chronic radiation proctitis, injury to the rectum may result in a fistula (abnormal connection) between the rectum and vagina in women or rectum and urethra in men. Incontinence may result from intractable diarrhea. In addition, partial or complete blockage or obstruction of the rectum may occur presenting as either diarrhea or constipation.
How is radiation proctitis diagnosed?
Your colorectal surgeon can make the diagnosis after a thorough evaluation and physical exam, which will include an examination of your rectum with a proctoscope. A colonoscopy may also be necessary to evaluate the remainder of your colon for damage and to exclude another cause for your symptoms.
How is radiation proctitis treated?
Most patients can be treated with medical therapy with steroid or anti-inflammatory suppositories or enemas. Diarrhea can be controlled temporarily with anti-motility medications. Sometimes if one is in the middle of radiation treatment, the treatment may be stopped, even if temporarily, to allow the radiation effects to heal.
If medical treatments fail, Dr. Zaghiyan can offer other treatments including instillation of topical formalin into the rectum. This may be performed in the office or at the time of colonoscopy. Alternatively, an endoscopic treatment called argon plasma coagulation (APC) may be performed.
In individuals who have developed a fistula or bowel obstruction as a result of radiation proctitis, surgery is typically necessary. Surgery may involve an advancement flap to treat a fistula or removal of the diseased portion of your rectum. A colostomy may be necessary. Sometimes a colostomy alone without an extensive resection may be recommended to control the bleeding, pain or complications (obstruction or fistula) associated with radiation proctitis.
Pelvic radiation is associated with an increased chance of rectal cancer. Therefore, patients with prior pelvic radiation are managed as being at higher risk for cancer and followed closely with colonoscopy every 5 years.
Make an appointment for a consultation with Dr. Zaghiyan in her office in Los Angeles for an examination and treatment recommendations for your specific condition.