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Proctitis - Causes, Symptoms, and Treatment

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Proctitis is the inflammation of the rectum's lining. This article provides a detailed description of proctitis.

Written byDr. P. Saranya

Medically reviewed byDr. Jagdish Singh

Published At December 1, 2022
Reviewed AtSeptember 16, 2024

What Is Proctitis?

The rectum is the lowest part of the digestive tract. The rectum connects the last part of the intestine to the anus. The stool passes through the rectum. Proctitis is the inflammation of the rectal lining. Proctitis can be painful and uncomfortable. It is caused by a bacterial infection or chemicals which damage the inner lining of the rectum.

What Are the Symptoms of Proctitis?

It presents as a short-term or chronic condition. Symptoms of the disease vary greatly.

Signs and symptoms of proctitis include:

  • Rectal pain.

  • Rectal bleeding.

  • A feeling of fullness in the rectum.

  • A frequent feeling of passing stool (tenesmus).

  • Passing mucus through the rectum.

  • Abdominal pain, especially on the left side.

  • Diarrhea.

  • Soreness in the rectal and anal areas.

  • Pain with bowel movements.

What Are the Causes of Proctitis?

Many conditions can cause inflammation of the rectum.

Those include:

  • Inflammatory Bowel Disease: People with ulcerative colitis and Crohn’s disease have rectum inflammation.

  • Radiation Therapy: Radiation therapy given for cancer, directed at the rectum or nearby areas, can cause inflammation of the rectum. Proctitis due to radiation can begin during the treatment or occur a few years after the treatment.

  • Infections: Sexually transmitted infections like genital herpes, chlamydia, and gonorrhea can cause proctitis. Proctitis is more common in homosexual men and people who practice oral-anal or anal intercourse. Salmonella, shigella, and campylobacter infections can also cause proctitis.

  • Food Protein-Induced Proctitis: Breastfed infants who eat dairy products can develop proctitis.

  • Eosinophilic Proctitis: It affects children younger than two. It occurs when eosinophils (white blood cells) build up in the rectal lining.

  • Antibiotics: Some antibiotics kill normal bacteria and allow harmful bacteria to grow, resulting in inflammation.

  • Diversion Proctitis: Some people undergo colon surgery in which the passage of stool is diverted from the rectum to a surgically created opening called a stoma. People who have undergone this surgery have a chance of developing proctitis.

  • Trauma: Proctitis can be caused by trauma to the anorectal area, such as inserting objects or harmful substances into the anus, including enema use.

What Are the Various Types of Proctitis?

Depending on the cause of the disease, proctitis can be acute or chronic. If it occurs suddenly and for a short period, it is acute. If it persists for a long duration, it is chronic. Depending on the cause, proctitis is known by different names. Proctitis due to sexually transmitted infections is called infectious proctitis, and ones due to ulcerative colitis are called ulcerative proctitis.

What Are the Risk Factors?

Risk factors for proctitis include

  • Inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease can increase the risk of rectal inflammation.

  • Radiation therapy given at or near the rectum can increase the risk.

  • Unsafe sex leading to sexually transmitted infections also increases the risk of inflammation.

Is Proctitis a Serious Condition?

In general, proctitis responds well to treatment and is not a fatal condition. However, it may pose some risks if untreated, does not respond to treatment, is present for a long duration, and is severe.

What Are the Complications?

Untreated or unresponded proctitis can lead to some complications, including:

  • Anemia: Continuous bleeding from the rectum for a long time can result in anemia, which reduces the amount of oxygen carried to the body. Anemia may cause tiredness, dizziness, pale skin, shortness of breath, and headache.

  • Ulcers: Proctitis can lead to ulcers on the lining of the rectum.

  • Fistula: Sometimes, ulcers can burrow through the intestinal wall and form an abnormal connection between it and the skin.

  • Abscess: Swollen pus-filled boils, which are painful, caused by proctitis infection.

How to Prevent Proctitis?

Prevention against sexually transmitted infections is to be taken.

The risk of sexually transmitted infections is reduced by:

  • Limiting the number of sexual partners.

  • Using a condom.

  • Avoiding anal intercourse.

  • Avoid sexual contact with persons who have sores or discharge in the genital area.

What Is the Difference Between Proctitis and Colitis?

Proctitis is inflammation of the rectum, and colitis is inflammation of the rectum and colon. Proctitis can become ulcerative proctitis if the inflammation causes ulcerative changes in the rectal lining. It has been found that people with ulcerative colitis have ulcerative proctitis, which is a less severe form of ulcerative colitis.

What Are the Diagnostic Methods?

Tests used to diagnose proctitis include:

  • Medical History: Thorough medical history to determine the sexual practices and high-risk behavior.

  • Blood Tests: Blood tests can rule out anemia or infections.

  • Stool Test: The stool is examined to check for bacterial infection.

  • Rectal Culture: A cotton swab is inserted into the rectum to take a sample, which is used to isolate and identify disease-causing organisms.

  • Flexible Sigmoidoscopy: A slender flexible tube attached to a light is used to examine the sigmoid colon and rectum. During this procedure, a tissue sample (biopsy) is also taken for microscopic examination.

  • Colonoscopy: A thin, flexible tube with a camera views the entire colon. A biopsy sample can also be taken during the procedure.

  • Anoscopy: Anoscope is used to examine the rectum and anal canal.

What Is the Treatment of Proctitis?

Treatment depends on the underlying cause.

1. Proctitis Due to Infection:

  • Antibiotics: Antibiotics such as Doxycycline are prescribed for proctitis caused by bacterial infections.

  • Antivirals: Antivirals such as Acyclovir are prescribed for proctitis caused by viral infections.

2. Proctitis Due to Radiation Therapy: Mild cases of proctitis due to radiation therapy do not require treatment. In severe cases, thermal therapy is given to stop bleeding and inflammation. Argon plasma coagulation is the commonly used thermal therapy used in patients with proctitis due to radiation therapy. Medications such as Sucralfate, Mesalamine, Metronidazole, and Sulfasalazine are given. Common side effects of Sulfasalazine and Mesalamine oral use include nausea, vomiting, diarrhea, heartburn, and headache.

3. Proctitis Due to Inflammatory Bowel Disease: Treatment is focused on reducing inflammation. Medications such as Prednisone or Budesonide are given. Medicines that suppress the immune system are also used to treat proctitis. The most commonly used medication is 6-Mercaptopurine or Azathioprine. The side effects of these medications include nausea, vomiting, and diarrhea, and lower a person’s resistance to infection.

4. Proctitis Due to Antibiotic Use: A different antibiotic is suggested if antibiotic use triggers proctitis.

5. Proctitis Due to Anorectal Trauma: Stopping the activity that caused the inflammation will treat the symptoms of proctitis and prevent the recurrence of the disease.

6. Sitz Bath: Placing the buttock area in warm water can reduce pain. Stool softeners are given to clear obstruction in the bowel. Drinking plenty of fluids is necessary if diarrhea is present. Avoiding caffeine and avoiding foods high in fiber or sweets may reduce diarrhea. A soft, bland diet can reduce pain. Avoid spicy, fatty, and acidic foods during diarrhea.

Does Proctitis Resolve on Its Own?

It will resolve on its own, but it is always better to get it treated. If it is infectious, antibiotics or antivirals can help to treat it. If it is not infectious, physicians advise the management of steroids by decreasing the inflammation. If it is due to radiation, it will resolve after a week or two following the completion of radiation therapy.

What Is the Prognosis?

The prognosis of proctitis is generally favorable. Acute proctitis will be resolved in a few weeks. If it is chronic due to certain conditions, like inflammatory bowel disease, it will take time to heal, and anti-inflammatory drugs help in the healing process.

Conclusion:

Proctitis is a condition that causes inflammation of the rectum's lining. Many patients recover with mild treatment within a few weeks, but chronic patients require long-term treatments. Sometimes, proctitis resolves independently, but individuals must consult a doctor to avoid further complications.

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Frequently Asked Questions

If left untreated, proctitis can worsen the symptoms and may cause serious damage to the digestive tract with sores and scars. This can also result in chronic pain and malnutrition. Proctitis can also cause chronic bleeding leading to anemia.
Mild proctitis may resolve on its own or require cream or foam application, but no long-term pharmacotherapy is required. Whereas people with severe proctitis borne out of serious etiologies do not respond well to treatment. Ideally, with treatment, healing occurs within 4 to 6 weeks.
Proctitis can cause systemic symptoms like fever, fatigue, nausea, and weight loss.  Additionally, it can cause rectal pain, diarrhea, bleeding, discharge from the rectum, and frequent feeling of defecation. Diarrhea, nausea, and weight loss can further worsen fatigue. Hence, diet management, nutrient replacement, and ORS (oral rehydration solution) are recommended.
Untreated proctitis can lead to serious complications like anemia. Although rare, other complications might occur, including irritation in the anal and rectal regions, hemorrhoids, abscesses, and extra-intestinal manifestations involving the joints, eyes, and skin.
Stress has not been reported to be etiologic to proctitis as it is a condition borne out of infections transmitted through sexual contact. However, stress has been reported to trigger flare-ups of the presenting symptoms.
Proctitis has very evident clinical presentations. Individuals with proctitis have rectal pain, bleeding, and discharge from the rectum and constantly feel the need to have a bowel movement. These presentations may be confused with Crohn’s disease or ulcerative colitis.
To manage or control proctitis, one needs to make certain lifestyle choices and modifications:
- Keep a note of the diet to isolate any potential dietary triggers.
- Limit fibers in the diet to less than two grams per meal.
- Eat small meals.
- Exercise regularly.
- Reduce stress.
Additionally, the best way to prevent any future flare-ups is to remove the damaged tissue surgically.
Proctitis flare-ups may last for several days to a few weeks. The individual may cycle between mild and severe flare-ups. Remission might last anywhere between a few months to several years or may even spread to other parts of the colon.
The dietary management of proctitis not just includes watching the food to consume but also requires keeping a note of what is consumed in order to isolate any potential dietary flare-up triggers. The recommended dietary management protocol advises
  - Multiple small meals rather than large few meals.
- Plenty of fluid intake.
- Avoid caffeine, alcohol, and caffeinated drinks.
- Nutritional supplements.
- Limit fibers in the diet to less than two grams per meal.
- Eat white bread, refined cereals, white rice, low-fiber pasta and noodles, cooked vegetables, lean meat, fish, and eggs.
- Avoid non-whole grain products, seeds, and stalks of vegetables.
 
Proctitis can be differentiated from colitis as it is a type of colitis limited only to the rectum. Colitis is caused due to habits, familial history, and certain medications, whereas proctitis mostly occurs due to an infectious etiology, even sexually transmitted. Both conditions are types of inflammatory bowel disease, but colitis may begin as proctitis in the rectum and later spread to other parts of the bowel as ulcerative colitis.
Proctitis is an STD (sexually transmitted disease) commonly seen in individuals who have anal intercourse. Microbiologically, the cause is attributed to gonorrhea, herpes, chlamydia, and lymphogranuloma venereum. Non-STD proctitis is less common.
About 30 % of colitis is restricted only to the rectum and is termed proctitis. Of individuals undergoing cancer radiation therapy, about 75 % of them develop acute, and 20 % develop chronic proctitis. Individuals who do not have their rectum removed during ostomy surgery develop proctitis. The condition is most frequently found in women and homosexual men practicing anal intercourse.
Proctitis, initially, does not show flatulence as a primary symptom. The condition, post-treatment, might remit and show recurrence after a few years. Patients have reported that a change in passing gas is the first sign of relapsing proctitis. The smell of the flatus (gas) changes which is due to their bowel progressively becoming more constipated.
Proctitis is caused by infections and cancer therapy. Constipation does not cause proctitis; rather, it is caused by constipation following a stage of diarrhea and tenesmus (a constant urge to have a bowel movement). Constipation may be accompanied by severe spasms and rectal pain.
Proctitis causes loose and thin stools (diarrhea). After a period, the person may become constipated due to rectal stricture (narrowing of the rectum passageway) and also cause straining and thin stools.
Colitis and proctitis patients are treated with rectal 5-ASA (aminosalicylic acid) or rectal steroids, primarily. If the individual does not respond positively to these medications, oral 5-ASA and Prednisone (oral steroid) are prescribed. Prednisone can be especially useful during acute flare-ups.
Inflammation of the rectum is termed proctitis. The condition results in symptoms like itching, burning, rectal bleeding, pelvic pressure, and foul-smelling discharge from the rectum. These symptoms put the individual in a state of discomfort.
Ulcerative proctitis is not a predictable disease and undergoes cycles of remission and relapse. It is better categorized into active disease and remission periods with a lifelong prevalence. The inflammation, if left untreated, may progress into other parts of the bowel where the nomenclature of the disease changes to ulcerative colitis.
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Dr. Jagdish Singh

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