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Radiation Proctitis

Radiation Proctitis

What is Radiation Proctitis?

Radiation proctitis is a condition characterised by inflammation and damage to the rectum as a result of radiation therapy, typically administered for treating cancers in the pelvic area, such as prostate, cervical, and rectal cancers.

Radiation proctitis can be classified into acute and chronic forms, with acute occurring during or shortly after radiation therapy, and chronic developing months to years later. The condition arises because radiation therapy, while targeting cancer cells, can also harm healthy rectal tissue, leading to the observed symptoms.
Radiation proctitis singapore
Radiation proctitis is inflammation of the rectum caused by radiation therapy for pelvic cancers.

What causes Radiation Proctitis?

Radiation proctitis is caused by the damage inflicted on the rectal tissues during radiation therapy, which is commonly used to treat cancers in the pelvic region. Radiation induces inflammation and cellular damage in the rectal mucosa by generating reactive oxygen species (ROS) and free radicals. These reactive molecules cause direct DNA damage, disrupt cellular structures, and lead to cell death. The inflammation triggers a cascade of immune responses, which results in increased vascular permeability and infiltration of inflammatory cells into the rectal tissue. 

Over time, chronic exposure to radiation leads to fibrosis and reduced blood flow, which further impairs tissue repair and results in the long-term symptoms observed in chronic radiation proctitis. This ongoing damage and impaired healing process result in the characteristic symptoms of pain, bleeding, and diarrhoea associated with radiation proctitis.

What are the symptoms of Radiation Proctitis?

The symptoms of radiation proctitis can vary depending on whether it is acute or chronic.

  • Acute radiation proctitis symptoms
      • Diarrhoea: frequent, loose stools.
      • Rectal Pain: discomfort or pain in the rectal area.
      • Rectal Bleeding: the presence of blood in the stool.
      • Urgency to Defecate: a strong, sudden need to have a bowel movement.
      • Tenesmus: a feeling of incomplete evacuation after a bowel movement.
  • Chronic radiation proctitis symptoms
      • Persistent rectal bleeding: ongoing or recurrent bleeding from the rectum.
      • Chronic diarrhoea: long-term, frequent, and loose bowel movements.
      • Mucus discharge: passage of mucus from the rectum.
      • Rectal pain: chronic or intermittent pain in the rectal area.
      • Strictures: narrowing of the rectum, which can cause difficulty in passing stools.
      • Fistulas: abnormal connections between the rectum and other organs or the skin.
      • Ulcers: open sores in the rectal lining.

Both types of radiation proctitis can significantly impact the quality of life and may require medical management to alleviate symptoms.

rectal pain radiation proctitis singapore
Rectal pain is a common symptom of radiation proctitis, caused due to inflammation and damage to the rectal tissue.

Is Radiation Proctitis painful?

Yes, radiation proctitis can be painful. The condition involves inflammation and damage to the rectal tissue, which can cause significant discomfort and pain.

Acute radiation proctitis often presents with rectal pain as a primary symptom whereas chronic radiation proctitis can lead to persistent pain due to ongoing inflammation, ulceration, and the formation of strictures in the rectum.

This pain can be intermittent or constant and may worsen during bowel movements.

The discomfort associated with radiation proctitis can significantly affect a patient’s quality of life, which makes it essential to manage the symptoms effectively through medical treatments and lifestyle adjustments.

Who is at risk of Radiation Proctitis in Singapore?

In Singapore, individuals at risk of developing radiation proctitis are primarily those undergoing radiation therapy for cancers located in the pelvic region. This includes patients receiving treatment for prostate cancer, cervical cancer, rectal cancer, and other gynaecological cancers. The risk is heightened for patients who:
  • Receive high doses of radiation: higher radiation doses increase the likelihood of damaging healthy rectal tissues.
  • Undergo concurrent chemotherapy: chemotherapy can sensitise tissues to radiation, which increases the risk of proctitis.
  • Have pre-existing conditions: conditions like inflammatory bowel disease (IBD) can make the rectal tissue more susceptible to damage from radiation.
  • Have a history of pelvic surgeries: previous surgeries in the pelvic area can affect the sensitivity and healing capacity of rectal tissues.
  • Are older adults: older patients may have a higher risk due to decreased tissue resilience and healing capacity.
These risk factors increase the pressure and strain on the anus, which can cause tears in the lining, resulting in an anal fissure.

How is Radiation Proctitis diagnosed?

Radiation proctitis is diagnosed through a combination of medical history, symptom assessment, and diagnostic tests. The diagnostic process typically includes the following steps:

  • Medical history and symptom assessment: the healthcare provider will begin by taking a detailed medical history, including information about the patient's cancer treatment, especially the type and duration of radiation therapy. They will also ask about the symptoms the patient is experiencing, such as rectal pain, bleeding, diarrhea, and urgency to defecate.
  • Physical examination: a physical examination, including a digital rectal exam, may be performed to check for signs of inflammation, tenderness, and other abnormalities in the rectal area.
  • Endoscopic procedures:
      • Sigmoidoscopy or Colonoscopy: these procedures involve inserting a flexible tube with a camera into the rectum to visualize the lining of the rectum and lower colon. This allows the doctor to directly observe any inflammation, ulcers, bleeding, or strictures indicative of radiation proctitis.
      • Biopsy: during the endoscopic examination, the doctor may take small tissue samples (biopsies) from the rectal lining to examine under a microscope. This helps to confirm the diagnosis and rule out other conditions, such as infections or recurrent cancer.
  • Imaging studies: in some cases, imaging studies such as a CT scan or MRI may be used to assess the extent of inflammation and to rule out other potential causes of the symptoms.
  • Laboratory tests: blood tests and stool tests may be conducted to check for signs of infection, inflammation, and anaemia due to rectal bleeding.

By combining these diagnostic methods, healthcare providers can accurately diagnose radiation proctitis and differentiate it from other conditions with similar symptoms, which helps ensure appropriate treatment and management.

Colonoscopy singapore
Colonoscopy helps diagnose radiation proctitis by direct visualisation of rectal inflammation and damage.

Frequently Asked Questions

While it’s not always possible to prevent radiation proctitis, strategies like using advanced radiation techniques to minimise exposure to healthy tissues and closely monitoring radiation doses can help reduce the risk.

Symptoms of acute radiation proctitis can appear during or shortly after radiation therapy, while chronic radiation proctitis symptoms may develop months to years after treatment.

Acute radiation proctitis often resolves within weeks after treatment, but chronic radiation proctitis can be a long-term condition requiring ongoing management.

Yes, dietary changes such as following a low-residue diet and avoiding irritants like spicy foods, caffeine, and alcohol can help manage symptoms and reduce discomfort.

Radiation proctitis specifically results from radiation therapy for cancer, while other forms of proctitis may be caused by infections, inflammatory bowel disease, or other conditions.

Yes, even after initial improvement, symptoms of radiation proctitis can recur, especially if there is ongoing damage or inflammation in the rectal tissues.

Location

Colorectal Care Specialists (CRCS)

3 Mount Elizabeth, #14-15, Mount Elizabeth Medical Centre, Singapore 228510

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