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Objective: This prospective study aimed to evaluate the efficacy and safety of 4% formalin dab in managing patients with refractory radiation proctitis. Methods: From January 2001 to December 2004, 11 patients with radiation proctitis who did not respond to regular steroid enemas and/or argon plasma coagulation were treated with local application of 4% formalin-soaked gauze (formalin dab). Main outcome measures were control of bleeding, changes in haemoglobin level, hospitalization and blood transfusion requirements, and complications. Results: The mean haemoglobin level before formalin dab was 7.3 ± 2.4 g/dL. Eight patients had required repeated admissions to hospital for blood transfusions (median 4 units; range, 2–27 units). The median number of sessions of formalin dab was two (range, 1–6). The treatment was effective in 10 patients (90.9%): four patients had complete cessation of bleeding and six patients had improvement of symptoms. At a median follow-up of 15.3 months, only three patients required hospital admission once for blood transfusions (range 1–2 units). The mean haemoglobin level after formalin dab was 10.4 ± 2.2 g/dL, which was significantly higher than that before formalin dab ( P = 0.007). No patient developed complications after formalin dab. Conclusions: Formalin dab is an effective and safe treatment modality for refractory radiation proctitis. [ABSTRACT FROM AUTHOR]