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Radiation Proctitis

Radiation Proctitis is one of the common side effects of radiotherapy, especially after treatment for cancers in the pelvic region, such as prostate cancer, cervical cancer, anal cancer, rectal cancer, and bladder cancer. It is primarily caused by inflammation resulting from damage to rectal tissue due to radiation exposure. This condition often leads to long-term discomfort and significantly impacts the daily life of affected patients.

Symptoms

Early Symptoms	Diarrhea, loose stools, edema, or mild intestinal damage typically appear within two weeks after treatment.
Chronic Symptoms (lasting more than three months)	Rectal bleeding: Ranging from mild blood streaks to significant bleeding. Rectal fibrosis: Hardening or narrowing of the intestinal wall. Increased urgency and discharge: Due to reduced rectal elasticity. Severe cases May lead to ulcers, intestinal perforation, or peritonitis.

Complications

Complications Related to Bleeding	Anemia: Chronic or significant rectal bleeding can cause iron-deficiency anemia, leading to fatigue, dizziness, or shortness of breath. Acute hemorrhage: Severe cases may require blood transfusion or urgent endoscopic hemostasis.
Structural Changes in the Intestine	Loss of elasticity may result in rectal narrowing or impaired bowel function. Intestinal stricture: Fibrosis narrows the rectal lumen, affecting bowel movements and possibly requiring surgical intervention. Intestinal perforation: Severe inflammation and ulcers may cause bowel rupture, leading to peritonitis.
Infections	Intestinal infection: Damaged rectal tissue makes it susceptible to bacterial invasion, causing persistent inflammation or abscesses. Peritonitis: Following bowel perforation, the infection can spread to the abdominal cavity, a medical emergency.
Functional Issues	Fecal incontinence: Reduced bowel elasticity or damage to rectal muscles may impair bowel control. Urgency: Loss of normal rectal storage function may cause frequent and urgent bowel movements. Excessive discharge: Damaged rectal mucosa may increase mucus secretion.
Psychological Health Issues	Anxiety and depression: Chronic symptoms can affect quality of life, leading to mental distress. Social challenges: Symptoms like frequent bowel movements, incontinence, or bleeding can hinder social activities.

Causes:

Vasculitis and microvascular damage caused by radiation therapy, leading to fragile proliferating blood vessels prone to bleeding.
Damage to intestinal stem cells, with bacterial infections triggering persistent inflammation, resulting in fibrosis or hardening of the intestinal wall.

Risk Factors:

Use older radiation therapy techniques (higher incidence rate, up to 50%).
Radiation dosage and treatment area.
Higher risk in older individuals.

Diagnosis

Clinical Examinations: Assess the patient’s symptoms and treatment history.
Endoscopic Examination: Observe intestinal damage, detect vascular proliferation, and identify fibrosis.
Tissue Biopsy: Conducted to rule out other pathological conditions.
Stool Tests: Detect bacterial infections or inflammatory markers.

Treatments

Medication	Enema Therapy: Sucralfate enema: Forms a protective layer on the intestinal mucosa to promote healing. Non-steroidal anti-inflammatory drugs (e.g., mesalamine): To reduce inflammation. Adjunctive Therapy: Hyperbaric oxygen therapy: Promotes tissue healing (available in select hospitals).
Endoscopic Treatment	Argon plasma coagulation (APC): Uses thermal coagulation to stop bleeding. Radiofrequency ablation (RFA): Applies pressure and heat to achieve hemostasis quickly.
Surgical Treatment	For severe fibrosis or intestinal strictures, stoma placement may be performed to relieve symptoms.
Diet and Lifestyle Management	Avoid high-fiber, high-fat, and irritating foods. Increase protein intake to promote wound healing. Attend regular follow-ups to monitor hemoglobin levels and intestinal health.