Chronic Radiation Proctitis: Treatment & Care

Risk Factors

Risk factors for chronic radiation proctitis include:

• High total radiation dose and large radiation field size to the pelvis
• Concurrent chemotherapy administered during the radiotherapy course
• Prior pelvic surgery causing bowel adhesions near the rectum
• Diabetes mellitus and vascular disease affecting tissue healing capacity
• Low body weight and poor nutritional status at the time of treatment

Who is at Risk?

Patients who have received pelvic radiotherapy for prostate, cervical, uterine, bladder, or rectal cancer are at risk. Those receiving doses above 60 Gy to the rectum have the highest risk of developing chronic proctitis. Patients with vascular disease, diabetes, or prior pelvic surgery are more susceptible to developing chronic radiation proctitis.

Diagnosis

Diagnosis of chronic radiation proctitis involves:

• Flexible Sigmoidoscopy: Visualises rectal mucosal telangiectasia, pallor, and friability characteristic of radiation damage.
• Colonoscopy with Biopsy: Rules out recurrent cancer and confirms radiation-induced mucosal changes histologically.
• MRI Pelvis: Evaluates fistula formation, rectal stricturing, and involvement of adjacent pelvic structures.
• CT Abdomen and Pelvis: Assesses complications including perforation or fistula formation urgently.

Treatment Options

Treatment of chronic radiation proctitis is stepped. Mild cases are managed with topical sucralfate, mesalazine enemas, and stool softeners. Moderate disease is treated with endoscopic argon plasma coagulation (APC) to cauterise bleeding telangiectasia. Hyperbaric oxygen therapy promotes healing in refractory cases. Severe complications such as fistulas or strictures require surgical intervention by an experienced colorectal surgeon at Pristyn Care.

Treatments for Radiation Proctitis

Advanced treatment options for chronic radiation proctitis at Pristyn Care include:

• Argon Plasma Coagulation (APC): Endoscopic treatment to coagulate rectal telangiectasia and stop rectal bleeding effectively. Most effective for Grade 2 to 3 bleeding.
• Hyperbaric Oxygen Therapy (HBOT): High-pressure oxygen sessions promote angiogenesis and mucosal healing in refractory cases not responding to APC.
• Topical Formalin Application: Used endoscopically for severe refractory rectal bleeding unresponsive to other treatments.
• Rectal Surgery: For radiation-induced fistulas, strictures, or perforation — options include fistula repair, strictureplasty, or bowel resection with stoma creation.

Treatment is individualised based on symptom severity and patient fitness.

After Treatment

Post-treatment care for chronic radiation proctitis includes:

• High-fibre diet and adequate fluid intake to maintain soft stools
• Avoiding NSAIDs and aspirin which worsen mucosal bleeding
• Sitz baths for perianal comfort after endoscopic procedures
• Regular follow-up endoscopy to assess treatment response and recurrence
• Iron supplementation for anaemia from chronic rectal blood loss

Complications | Risks If Left Untreated

Chronic radiation proctitis left untreated can cause serious complications:

• Severe rectal haemorrhage requiring emergency blood transfusion
• Radiation-induced fistulas between the rectum and bladder or vagina
• Rectal stricture causing bowel obstruction and defecation difficulty
• Perforation of the rectum requiring emergency life-saving surgery
• Chronic iron deficiency anaemia with progressive fatigue and weakness
• Significant deterioration in quality of life affecting all daily activities