Proctitis

Overview

Proctitis is irritation and swelling of the muscular tube connected to the end of the colon, called the rectum. Stool passes through the rectum on its way out of the body.

Proctitis can cause rectal pain, diarrhea, bleeding and rectal discharge, as well as the constant feeling that you need to pass stool. Proctitis symptoms can be temporary or constant.

Proctitis is common in people who have inflammatory bowel disease (IBD), such as ulcerative colitis or Crohn's disease. Sexually transmitted infections are another frequent cause. Proctitis also can be a side effect of radiation treatment.

Symptoms

Proctitis symptoms may include:

• A frequent or continuous feeling that you need to pass stool.
• Rectal bleeding.
• Passing of mucus through the rectum.
• Rectal pain.
• Pain on the left side of the belly.
• A feeling of fullness in the rectum.
• Diarrhea.
• Pain with bowel movements.

When to see a doctor

Make an appointment with a healthcare professional if you have any symptoms of proctitis.

Causes

Several conditions, treatments and other factors can cause proctitis, including:

• Inflammatory bowel disease (IBD). About 30% of people with IBD have inflammation of the rectum. This is more common in people with ulcerative colitis than in those with Crohn's disease.
• Infections. Sexually transmitted infections (STIs) can result in proctitis. These infections happen particularly in people who engage in anal intercourse. Types of STIs that can cause proctitis include gonorrhea, genital herpes, monkeypox and chlamydia. Infections associated with foodborne illness, such as salmonella, shigella and campylobacter infections, also can cause proctitis.
• Antibiotics. Sometimes antibiotics used to treat an infection can kill helpful bacteria in the bowels, allowing harmful Clostridioides difficile bacteria to grow in the rectum and the colon.
• Surgery. A type of proctitis called diversion proctitis can happen in people after certain small intestine or colon surgeries. In these surgeries, the passage of stool is diverted from the rectum to a surgically created opening, called a stoma.
• Food proteins. Food protein-induced proctitis can happen in infants who drink either cow's milk- or soy-based formula. Infants breastfed by mothers who eat dairy products also may develop proctitis.
• Buildup of white blood cells. Eosinophilic proctitis happens when a type of white blood cell called an eosinophil builds up in the lining of the rectum. Eosinophilic proctitis more commonly affects children younger than 2 rather than older individuals.

Risk factors

Risk factors for proctitis include:

• Sexual activity. Practices that increase the risk of a sexually transmitted infection (STI) can increase the risk of proctitis. Your risk of getting an STI can increase if you have multiple sex partners, have anal sex, don't use condoms and have sex with a partner who has an STI.
• Radiation therapy for cancer. Radiation therapy directed at the rectum or nearby areas, such as the prostate, can cause rectal inflammation. Radiation proctitis can begin during radiation treatment and last for a few months after treatment. Or it can occur years after treatment.

Complications

Proctitis that isn't treated or that doesn't respond to treatment may lead to complications, including:

• Anemia. Chronic bleeding from the rectum can cause anemia. With anemia, there aren't enough red blood cells to carry oxygen to the tissues. Anemia causes someone to feel tired and possibly have dizziness, shortness of breath, headache, a change in skin color, and irritability.
• Ulcers. Long-lasting inflammation in the rectum can lead to open sores, called ulcers, on the inside lining of the rectum.
• Fistulas. Sometimes ulcers extend completely through the intestinal wall. This can create a fistula, an irregular connection that forms between different parts of the intestine, between the intestine and skin, or between the intestine and other organs, such as the bladder and vagina.

Diagnosis

Tests and procedures used to diagnose proctitis include:

• Blood tests. These can test for blood loss or infection.
• A stool test. A stool sample may be collected for testing. A stool test may help find out if proctitis is caused by a bacterial infection.
• Flexible sigmoidoscopy. Flexible sigmoidoscopy involves a scope exam of the last portion of the colon, called the sigmoid colon. During this test, a slender, flexible, lighted tube called a sigmoidoscope is used to examine the sigmoid colon as well as the rectum. During the procedure, small samples of tissue may be collected for laboratory analysis. This is called a biopsy.
• Colonoscopy. A colonoscopy involves using a thin, flexible lighted tube called a colonoscope to view the entire colon. A biopsy may be taken during this test.
• Tests for sexually transmitted infections. These tests involve collecting a sample of discharge from the rectum or from the tube that drains urine from the bladder, called the urethra.

Treatment

Treatment for proctitis depends on the cause of the condition.

Treatment for proctitis caused by an infection

For proctitis caused by infection, medicines may be recommended. Options may include:

• Antibiotics. For proctitis caused by certain bacterial infections, an antibiotic such as doxycycline (Oracea, Vibramycin, others) may be given.
• Antivirals. For proctitis caused by viral infections, such as the sexually transmitted herpesvirus, an antiviral medicine such as acyclovir may be prescribed.

Treatment for proctitis caused by radiation therapy

Mild radiation proctitis may not need treatment. But radiation proctitis also can cause serious pain and bleeding that need treatment. A healthcare professional may recommend treatments such as:

• Medicines. Medicines are given in pill, suppository or enema form. They include sucralfate, mesalamine, sulfasalazine and metronidazole. These medicines can help control inflammation and reduce bleeding.
• Stool softeners and dilation. These can help stool pass easier, decreasing pain.
• Ablation. Ablation improves proctitis symptoms by destroying damaged, bleeding tissue. Ablation procedures used to treat proctitis include argon plasma coagulation and other therapies.

Proctitis caused by inflammatory bowel disease

Treatment of proctitis related to ulcerative colitis or Crohn's disease focuses on reducing inflammation in the rectum. Treatment may include:

• Medicines to control rectal inflammation. A healthcare professional may prescribe anti-inflammatory medicines, either by mouth or as suppositories or enemas. These include mesalamine or corticosteroids. Corticosteroids include prednisone or budesonide.

  Inflammation in people with inflammatory bowel disease often needs treatment with a medicine that suppresses the immune system, such as azathioprine or infliximab.

• Surgery. If medicine doesn't relieve symptoms, surgery to remove a damaged portion of the digestive tract may be done.

Prevention

To reduce the risk of proctitis, take steps to protect yourself from sexually transmitted infections (STIs). The surest way to prevent an STI is to abstain from sex, especially anal sex. If you choose to have sex, you can reduce your risk of an STI if you:

• Limit your number of sex partners.
• Use a latex condom during each sexual contact.
• Don't have sex with anyone who has sores or discharge in the genital area.

If you're diagnosed with a sexually transmitted infection, stop having sex until after you've completed treatment. Ask a healthcare professional when it's safe to have sex again.

Preparing for your appointment

Start by seeing your healthcare team if you have rectal pain or bleeding, or if you constantly feel the need to pass stool. If your care team suspects that you have proctitis, you may be referred to a doctor who specializes in diseases of the digestive system, called a gastroenterologist.

Here's some information to help you get ready and to know what to expect.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any don't seem related to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medicines, as well as any vitamins or supplements, that you're taking.
• Take a family member or friend along to help you remember everything you and your healthcare team talk about.
• Write down questions to ask during your appointment.

Questions to ask your doctor

• Is proctitis causing my symptoms?
• What are possible causes for my proctitis?
• What kinds of tests do I need?
• What are my treatment options?
• What are the benefits and risks of each treatment option?
• I have other medical conditions. How can I best manage them while also managing proctitis?
• Are there any restrictions that I need to follow?
• Is there a generic alternative to the medicine you're prescribing?
• Are there any brochures or other printed material that I can take with me?
• What websites do you recommend?
• Should I plan for a follow-up visit?

Don't hesitate to ask other questions that you think of during the appointment.