Date:
Patient:
Reason for Visit:
Follow-up for radiation proctitis (RP)
Assessment of symptoms and response to treatment
Management of complications
History:
Presenting Illness:
Date of radiation therapy completion for underlying malignancy (specify cancer type)
Onset, duration, and severity of symptoms suggestive of RP:
Rectal bleeding (bright red blood or passage of blood clots)
Rectal urgency or tenesmus (frequent, uncontrollable urge to have a bowel movement)
Increased stool frequency
Rectal pain or discomfort
Mucus discharge per rectum
Stool characteristics (consistency, presence of blood)
Functional limitations due to symptoms
Past Medical History (PMH):
Underlying malignancy and treatment details (radiation dose, field)
Prior history of bowel conditions (e.g., inflammatory bowel disease)
Past surgeries involving the rectum or pelvis
Physical Exam:
General: Assess for signs of dehydration or malnutrition (possible with chronic diarrhea).
Perianal: Look for signs of skin breakdown, inflammation, or hemorrhoids.
Digital rectal exam (DRE): May be performed with caution to assess for rectal tenderness, strictures, or palpable masses (consider risk of bleeding).
Diagnostic Tests (may be ordered depending on presentation):
Complete Blood Count (CBC): May show anemia if chronic blood loss is present.
Stool tests: To rule out other causes of rectal bleeding or inflammatory bowel disease.
Sigmoidoscopy or colonoscopy (may be considered in some cases): Direct visualization of the rectum and colon to assess for mucosal inflammation, strictures, or malignancy recurrence.
Assessment:
Severity of RP: Based on symptom severity, frequency, and impact on daily life.
Grading systems like the Radiation Therapy Oncology Group (RTOG) scoring can be used.
Presence of complications: Anemia, dehydration, malnutrition, strictures
Plan:
Dietary modifications: Increase fiber intake, maintain hydration, consider lactose restriction if symptoms suggest lactose intolerance.
Medications:
Antidiarrheal medications (e.g., loperamide) for symptom control (use with caution in severe cases).
Rectal suppositories or enemas containing corticosteroids or 5-aminosalicylate (5-ASA) for local anti-inflammatory effects.
Stool softeners or laxatives to manage constipation.
Pain management: Sitz baths, topical analgesics, oral pain medications.
Referral to a gastroenterologist: For complex cases, severe symptoms, or suspected complications (strictures).
Patient education: Provide information about RP, expected course of symptoms, dietary modifications, medication use, and signs and symptoms to watch for (worsening rectal bleeding, fever, abdominal pain).
Discuss the importance of maintaining hydration and good skin care around the anus.
Follow-up:
Schedule for follow-up appointments based on symptom severity.
Discuss potential for improvement or long-term management strategies for chronic RP.
Advise the patient to contact their healthcare provider if symptoms worsen or new concerning symptoms develop.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of radiation proctitis.