Proctitis and Anal Ulcerations Associated with Chronic Use of Rectal Suppositories

 

Suppositories:

(1) ergotamine

(2) NSAID (paracetamol/acetaminophen, other)

(3) salicylate

(4) dextropropoxyphene

(5) codeine

 

Epidemiologic features:

(1) often involves middle-aged women

(2) history of migraine headaches or other chronic pain condition

(3) addicted to codeine or other component

(4) psychiatric disorder

 

Clinical findings:

(1) anal pain

(2) fecal incontinence

(3) anal discharge and/or bleeding

(4) tenesmus (painful straining at stool)

(5) bowel obstruction

 

Anorectal lesions:

(1) proctitis

(2) anal and/or rectal ulcerations, typically in a "butterfly" pattern

(3) partial or total anorectal stenosis, sometimes sufficient to necessitate bowel diversion

 

Differential diagnosis:

(1) anal carcinoma

(2) syphilis

(3) amebiasis

(4) Crohn's disease