Ulcerative Proctitis
Ulcerative Proctitis, like other diseases, can cause a number of problems. Don't be discouraged. Giant strides have been made in helping people like yourself cope with their disease and live normal, active lives.
Your Ulcerative Proctitis is the least severe form of Inflammatory Bowel Disease, but its symptoms can be quite troublesome.
Even though the cause of Ulcerative Proctitis is unknown, one encouraging fact is certain: You can live a normal, active life even with your disease. provided you follow some reasonable guidelines. This booklet provides those guidelines, and gives useful information about Ulcerative Proctitis that is designed to answer any additional questions or concerns you may have.
Your colon is about five feet long. Ulcerative Proctitis affects, at most, 6-8 inches of it.
Ulcerative Proctitis is a mild-to-moderate form of a more severe disease called Ulcerative Colitis. Although Ulcerative Colitis can be found anywhere in the world, it tends to be concentrated in the more developed countries like the United States. In fact, about 10,000 new cases are diagnosed here each year. Ulcerative Colitis affects people of all ages, but is seen most often in individuals between 20 and 40 years of age.
Nearly 300,000-500,000 Americans suffer from Ulcerative Colitis, of these, about 35% (105,000-175,000) are Ulcerative Proctitis patients like yourself. Unlike Ulcerative Colitis, which is more extensive, Ulcerative Proctitis is confined to the small area of the colon known as the rectum.
The word "Ulcerative" is used to describe your Proctitis because the disease actually causes ulceration (the formation of sores) on the inner lining of your rectum. The length of colon involved is not as extensive as that seen with Ulcerative Colitis. But the inflammation that results, though generally more superficial than that caused by Ulcerative Colitis, can be serious. This inflammation leads to a variety of symptoms-some quite severe-which can include diarrhea, rectal pain and/or bleeding and a persistent urge to empty the bowel known as "tenesmus." This urge to empty the bowel may result in diarrhea, fecal matter coated with blood, or formed stools accompanied by large amounts of mucus.
Symptoms may also include the passing of blood or mucus without any fecal matter several times during the day or night. Though bleeding caused by Proctitis can be frequent, it is usually not enough to require blood transfusions.
Though many patients recover completely from their first attack, most Ulcerative Proctitis patients experience symptoms for the rest of their lives. The disease may affect you constantly. Or, you may not experience any problems for months, even years-then, suddenly, the symptoms can flare up again.
So much for the bad news. The good news is that Ulcerative Proctitis actually affects. at most, only 10 to 15% of your colon-about 6-8 inches.
Because Ulcerative Proctitis involves such a small portion of your colon, you probably won't experience some of the effects associated with more serious Inflammatory Bowel Disease - extreme pain, fever, weight loss, malnutrition, anemia or other complications. In fact, the chances that Proctitis will spread higher up into your colon are slim - 10 to 20%.
It's not your fault
No one really knows what causes Ulcerative Proctitis. Research does tell us that food and emotional stress are not responsible and that Ulcerative Proctitis is not transmitted from one person to another. Research has also revealed that when any form of Inflammatory Bowel Disease is present, the body's defenses begin operating against what they recognize as foreign substances called antigens. The inflammation you are experiencing may be directly caused by these antigens or by their stimulation of your body's "defense systems."
Scientific investigators are also probing the fields of immunology (the study of the body's immune defense system) and microbiology (the study of microscopic organisms with the power to cause disease) for causes of Ulcerative Colitis. Many scientists now believe that some outside agent (such as a virus or bacterium) may interact with the body's immune system to trigger the disease. Another possibility being investigated is that the same type of outside agent may cause damage to the intestinal wall, thus starting or accelerating the process that leads to diseases like Ulcerative Proctitis.
Regardless of how your Ulcerative Proctitis began, it is important for you to remember that the cause of your disease is not emotional. You didn't create it. There is nothing you could have done to prevent it.
This is probably as bad as it gets
The vast majority of Ulcerative Proctitis patients do not develop more widespread disease, nor are they at any increased risk for developing cancer. As mentioned earlier, however, Ulcerative Proctitis is a chronic disease. It requires regular follow-up examinations by your doctor: long-term use of medication may also be necessary. Fortunately, all this usually can be accomplished without hospitalization.
One reason the outlook for Proctitis patients has brightened in recent years is the development of "topical" medications. These topical medications can be applied directly to the inflamed area of your colon for maximum benefit. Topical agents are among the drugs available to your doctor for your treatment program and include:
- Mesalamine (also known as "5-ASA') enemas
- Mesalamine suppositories, the newest treatment option requires only twice-a-day administration for a period of 3 to 6 weeks.
- Hydrocortisone enemas. foams or suppositories These newer medications have another distinct advantage: They can be applied by patients themselves. Though enemas and foams are inserted into the rectum, they are convenient and easy to use: enemas require once-a-day administration. and foams arc usually applied twice a day.
Regardless of which treatment your doctor prescribes, remember that any drug, no matter how effective, can't do the job alone. You must make a sincere effort to improve your condition.
You'll need periodic check-ups-even if you feel fine
As the inflammation caused by Ulcerative Proctitis is reduced, you will feel less rectal discomfort and urgency to defecate. Your rectal bleeding will also diminish.
To verify your improvement, your doctor will need to visually examine the small area of bowel lining affected by your disease. This is usually done with an instrument called a "Sigmoidoscope," which your doctor may have used to first diagnose your disease.
Though it may seem intrusive or embarrassing, keep in mind that visual examination of the rectum is necessary to verify that your disease is indeed getting better. Furthermore, because Ulcerative Proctitis is generally a persistent disease, your doctor will probably want to examine you periodically with a Sigmoidoscope, even when you have no apparent symptoms. (Another reason is that symptoms often improve before medication has completely healed the tissue.) But don't be alarmed-the examination is usually painless and well tolerated.
In the event your Ulcerative Proctitis returns following a remission, your doctor will re-evaluate you to determine the extent of disease and to find out if your condition is being complicated by infection, drug reaction or some other factor. When drug treatment is resumed, your doctor probably will prescribe the same agent you were treated with previously If the drug you are using doesn't seem to be working, your doctor will discuss alternate drug treatment with you.
You can work and play as usual
Though it can be troublesome, Ulcerative Proctitis shouldn't debilitate or disable you. In fact, you should be able to conduct your recreational and career activities with little difficulty-in short, be as active as you feel like being.
Remember, though, that living with Ulcerative Proctitis requires vigilance. You'll probably be on some form of medication for long periods of time, and regular medical checkups may also be required. To control the disease effectively it is important that you adhere to the medication schedule that your doctor gives you. Also, it is equally important that you inform your doctor immediately if any other symptoms should appear-symptoms such as rectal bleeding, discomfort or frequent urges to defecate.
You don't have to change the way you eat
There is no evidence that specific diets will make your Proctitis better-or worse. But there are certain things you can do that will make your disease easier to live with. For instance, foods that are high in fiber may prove useful if you are frequently experiencing painful bowel movements or urgency to defecate. If your symptoms should include constant diarrhea, a low-fiber diet that includes soft, bland foods can help, but only temporarily In addition, some Proctitis patients are unable to properly digest lactose, a sugar found in milk and many milk products. This condition may cause cramps, pain, gas, diarrhea and a bloated feeling in the stomach. If you fall into this category, a lactose-free diet may be beneficial. Your physician can advise you on this.
The right attitude is essential
As mentioned earlier, it is not your fault that you have this disease. You can live with it quite effectively if you remember these important points:
- Keep a positive mental attitude. Although emotional factors do not cause Proctitis, stress and tension can sometimes worsen the symptoms. If you feel this is happening to you, behavior modification, usually with relaxation techniques, can help. It is also normal to feel depressed at times about your disease or because no one seems to understand how you feel. You should discuss such thoughts with your doctor or family members.
- It may also be helpful to talk to someone else who has Ulcerative Proctitis; the National Foundation for Ileitis and Colitis (NFIC) may be able to refer you to other Proctitis patients in your vicinity Check your telephone directory for the NFIC chapter in your area, or ask your doctor.
- You should also remember that meaningful advances are being made in treating all forms of inflammatory bowel disease; over the past decade, we have added to our understanding of what Ulcerative Proctitis is and how it works. Ongoing research insures that new discoveries about the causes and course of this disease will be made, and that newer treatments will be developed. But for now, keep in mind that Ulcerative Proctitis is relatively easy to cope with-provided you maintain the will and determination to keep it under control.
- And remember, too, that taking your medication as directed is also a vital part of controlling Ulcerative Proctitis; follow your doctor's instructions carefully.
- Learn as much as you can about Ulcerative Proctitis. Here are some sources of expert information.
- Reid-Rowell, makers of Rowasa® (mesalamine) suspension enemas and suppositories, has prepared another booklet on a related topic; "What you should know about Ulcerative Colitis: A booklet for patients and their families." Because Ulcerative Proctitis is a milder form of Ulcerative Colitis, you may find this book helpful. It is available from your doctor, or you can write to Reid-Rowell at the address on the back of this booklet to obtain a free copy.
- The National Foundation for Ileitis and Colitis is an excellent source for more information. The NFIC has chapters in many areas of the country; check your local telephone directory or ask your doctor.
Your doctor can also answer any questions you have about your medication or condition.
