Seeking Advice on Treating Proctitis in Ostomates

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Scott Chance
Hi all,

Brief history: I had a sudden attack/flare-up of severe ulcerative colitis last March (I didn't even know I suffered from the condition). Despite a month's worth of intravenous steroids, anti-inflammatories, immunosuppressants, etc., the problem couldn't be cured, and by May, my colon had been removed.

Since then, life on the whole has been pretty okay. I think I've pretty much come to terms with the ileostomy and wearing a bag. Last summer, I had a period of reflection off work to recover from the operation and get used to things, that paid off. A lot of people on this forum were kind to me, and reading their experiences made me realize I wasn't the only one going through this kind of thing. I've since returned to full-time work and generally seem to be living a "normal" life - sure, there are a few things I used to do before the illness which I wouldn't be completely comfortable doing now, but compared to the state I was in when the SUC flared up, I am in a much better position.

One problem though, and I must admit I do find it frustrating - proctitis (e.g., rectal discharge) - essentially leftover colitis in the rectum (but hey, it can't be called colitis if you don't have a colon, right?)

Has anyone successfully treated this?

My symptoms are that twice a day I get the sensation of needing to go to the toilet ala a colonista, sometimes the sensation can be quite urgent. I trot to the loo, and sure enough, a red-colored mucousy/watery substance is discharged. This only happens twice a day, usually once in the morning and once at night.

Both my GP and specialist have assured me that this isn't anything to worry about and is "normal" for someone in my condition (as have others when I queried it last year on this forum). But I do find it irritating, taken on its own it's only two visits to the loo a day, but then when you take into account the time already lost to emptying/changing bags, it's a further irritation I could do without and time I'd like to claw back!

So far, I have been prescribed mesalazine suppositories and predfoam enema.

The mesalazine is very messy to apply (literally a pain in the arse!), takes time as you need to lay down for the stuff to absorb, and leaves you with a Tipp-Ex style white mark in your underpants! Not good if you're on the go!

The predfoam is easier to apply but sometimes irritates me (e.g., makes me feel like I need to go to the loo, but I guess that's the consequence of spraying something up there!). Also, my GP advised me that prolonged use could result in the rectum being perforated?

Bottom line is (pardon the pun!), neither medicine has cured this. They reduce the symptoms, e.g., the discharge becomes more brown than red (presumably meaning I'm less inflamed down there), sometimes the need to go is less urgent, sometimes I'll go a day without needing to sit on the toilet, but the next day I'm back to twice a day again.

Do I simply need to persevere with these treatments over a long duration before they'll shift the problem for good? Is there another treatment I should be trying? Or is something I'm going to have to put up with?

I would be interested in reading other ostomates' experiences.
Pinky

Hi Scott - I will share my experience with proctitis - mine is from radiated tissue due to rectal cancer - for what it is worth.

First off - you are fortunate to have access to the Proctofoam - here in the US it is extremely expensive for that tiny container, so I have had to use cortisone suppositories which are cheap but not as effective, but I can live with that.

Speaking of "live with it" - that's what my surgeon recommended I try to do! He told me the alternative would be to inject the affected tissues with formalin (formaldehyde) which would mummify them and then they would stop producing mucus.

Forget that! So I do live with the flare-ups. There are some folks on this site that would encourage you to have the rectum removed entirely, but I have also heard of folks who still suffered proctitis afterward and then had no way of treating it with foam or suppositories.

I will say the proctitis has settled down some now in the second year of the colostomy.

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beyondpar

FYI. I don't believe you can have proctitis without the rectum as proctitis is defined as the inflammation of the lining of the rectum. No rectum, no inflammation of the lining.

And as far as "Live with It" commentary from the #$%^ * doctors, spoken from a person who is not living with it... They would not be saying that if it were them...

MY ADVICE
GET YOUR RECTUM REMOVED... YOU WILL BE GLAD YOU DID... I KNOW I AM THRILLED TO NOT HAVE MINE OR EVER BE REMINDED OF MY ISSUES DOWN THERE... EVER!!!!!!!!!!!

YIPEE!!!!!!!!!!!!!!!!!!!!!!!!!!!

I welcome anybody to add input here. Michael

cee
Hi Scott,

I also, like Pinky, have proctitis from radiated tissue. The urge to go to the bathroom and the mess and the odor was extremely unpleasant. I was also prescribed enemas and when I asked for something more portable to travel, I got the cortisone foam. I do not want any more surgery so I used the meds and toughed it out. However, I have noticed that it seems to have gone away. I am almost afraid to write this in fear of offending the potty gods. My colostomy was done in August of 2009 and I would say that this fall of 2010...15 months after the surgery, it seems to have remarkably improved. In fact, I haven't used anything in several months. Not sure what your outcome will be but thought I would contribute my experience.

Lynn
scotiaman

Scott... a bit on my own experience.... To some degree, I have been dealing with proctitis since I received an ileostomy in 2007. Over the first six months, it reduced to the point that I was only discharging once per 6-8 days. That lasted until this past spring and then became more frequent to the point that in the past four months, I have had to discharge once every 24 to 36 hours. I can't explain any reason for it. I do consume lots of dairy, which stimulates mucus production. I guess the ulcerative colitis, which took my lower bowel in the first place, just wants to hang on. The surgeon says that's normal. I take a SOLFALK suppository after each discharge, and that seems to keep things regulated. I have decided against a reversal after lifestyle considerations, so I am only a few weeks away from having the rectal surgery. There are two reasons for it: the first is to eliminate the chances of rectal cancer (which is a nasty form of cancer as it can spread without symptoms) and to eliminate the current problem. Again, a good surgeon is important in the success of this issue. There is a small ring of mucus cells just inside the anus (I may need to be corrected on this!) and if that is not thoroughly removed, some leakage-like complications can occur, as I understand it. But a good surgeon should be able to rectify the proctitis. Best of luck, Scotiaman.

 
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Scott Chance

Thanks everybody for their replies.

Pinky - if it's not too personal, how much do you have to pay for the Predfoam?

Pinky

Sorry Scott - haven't been on here a lot lately. I was paying $75 co-pay, but the actual price was more like $175 for a little container of Proctofoam. I found the Anusol hydrochloride (hydrocortisone) suppositories nearly as effective and they are dirt cheap - like $7 for a hundred!