Rectal ulcer
Hello Doctor: Two months ago, I experienced significant anxiety due to my mother's major surgery, which led to persistent diarrhea (without blood in the stool).
I went to the hospital for examination and was diagnosed with a gastric ulcer and rectal ulcers.
I am currently being treated with pantoprazole for the gastric ulcers (approximately three superficial ulcers).
However, I am very concerned about the 4.5 rectal ulcers and whether they indicate ulcerative colitis (UC).
My doctor believes that there are only ulcers without erosion and has prescribed a single dose of a saline enema and an antispasmodic medication for the colon.
After taking the medication for two weeks, I experienced abdominal bloating (with occasional mild, sharp pains on both sides of the abdomen).
An X-ray showed fecal impaction, and the doctor prescribed a laxative and Loperamide (half a packet in the morning and evening).
I would like to ask: 1.
The doctor mentioned that the diagnosis is non-specific enteritis; how does this differ from UC? 2.
Is the treatment plan appropriate? (I am somewhat concerned that the laxative may repeatedly irritate the inflamed intestines.) 3.
Can antispasmodic medications cause constipation? I apologize for bothering you, as I know outpatient consultation times are short.
Thank you for taking the time to respond!
chelle, 30~39 year old female. Ask Date: 2012/10/27
Dr. Cai Anshun reply Gastroenterology and Hepatology
Hello:
1.
The UC you mentioned likely refers to Ulcerative Colitis, which is a type of inflammatory bowel disease characterized by inflammation and ulcers in the colon due to autoimmune dysfunction.
Non-specific enteritis can have various causes, such as bacteria, viruses, medications, and bacterial toxins, among others.
2.
The treatment protocol is appropriate, as your mother initially sought medical attention due to persistent diarrhea.
Therefore, antispasmodic medications were used to alleviate intestinal motility, allowing more time for the intestinal mucosa to absorb water from the stool, thus reducing diarrhea.
However, in clinical practice, it is common to encounter post-diarrheal paralytic ileus (where the intestines become inactive).
This may be due to excessive diarrhea leading to electrolyte imbalances or overly strong medication effects (which can vary by individual).
The use of laxatives was indicated because the X-ray showed fecal impaction; if the impaction is not resolved, it could exacerbate the post-diarrheal paralytic ileus.
Laxatives themselves do not irritate the inflamed intestinal mucosa.
3.
The purpose of antispasmodic medications is to reduce intestinal motility and increase the time for the intestinal mucosa to absorb water from the stool, thereby alleviating diarrhea.
Constipation can be a side effect of these medications.
Changhua Hospital is concerned about your health.
Dr.
Tsai An-shun
Reply Date: 2012/10/27
More Info
Understanding rectal ulcers and their treatment can be quite complex, especially when distinguishing them from conditions like ulcerative colitis (UC). Your concerns are valid, particularly given the recent health challenges you've faced with your mother and the anxiety that can accompany such situations. Let's address your questions in detail.
1. Difference Between Non-Specific Colitis and Ulcerative Colitis (UC):
Non-specific colitis is a term that refers to inflammation of the colon that does not fit the criteria for a specific diagnosis, such as UC or Crohn's disease. UC is a chronic inflammatory bowel disease characterized by continuous inflammation of the colon and rectum, leading to ulceration. The inflammation in UC typically involves the mucosal layer and can result in symptoms like bloody diarrhea, abdominal pain, and urgency. In contrast, non-specific colitis may arise from various causes, including infections, medications, or other inflammatory processes, and does not have the same long-term implications as UC. Your physician's assessment that your condition is non-specific suggests that they do not see the characteristic patterns of UC, which is reassuring.
2. Treatment Protocol:
The treatment you are receiving seems appropriate given your symptoms and findings. The use of antispasmodic medications is common to help alleviate abdominal cramping and discomfort associated with bowel movements. The concern about laxatives potentially irritating the inflamed bowel is understandable, but in your case, the presence of fecal impaction (as indicated by the X-ray) necessitates their use to prevent further complications, such as bowel obstruction. It’s important to follow your physician's guidance and report any worsening symptoms, as they may need to adjust your treatment plan based on your response.
3. Antispasmodic Medications and Constipation:
Antispasmodic medications can indeed lead to constipation as a side effect. These medications work by relaxing the muscles of the gastrointestinal tract, which can slow down bowel movements. If you find that you are experiencing significant constipation, it’s crucial to communicate this to your healthcare provider. They may consider adjusting your medication or providing additional strategies to manage this side effect.
In summary, while rectal ulcers can be concerning, understanding their nature and the treatment options available can help alleviate some anxiety. Non-specific colitis is generally less severe than UC, and your current treatment plan appears to be addressing your symptoms effectively. Regular follow-ups with your healthcare provider are essential to monitor your condition and make any necessary adjustments to your treatment. If you have ongoing concerns or if your symptoms change, do not hesitate to reach out for further evaluation. Your health and peace of mind are paramount.
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