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Proctitis

Proctitis Overview

Proctitis is defined as inflammation of the anus (the opening) and lining of the rectum (lower part of the intestine leading to the anus). Symptoms of proctitis can vary greatly. One may at first have only minor problems. Proctitis affects the last 6 inches of the rectum and can cause the following:

  • Pain during a bowel movement
  • Soreness in the anal and rectal area
  • Feeling that you didn't completely empty the bowels after a bowel movement
  • Involuntary spasms and cramping during bowel movements
  • Bleeding, and possibly a discharge

Proctitis can last a short time or become a chronic condition (last for weeks or months or longer).

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Causes of Proctitis

Proctitis has many causes, but sexually transmitted diseases (STDs) are the most common. Gonorrhea, syphilis, herpes, anal warts, and chlamydia are the most common cause of sexually transmitted proctitis. Proctitis is increasingly more common in homosexual men and in people engaging in oral-anal or anal intercourse with many partners.

Other causes of proctitis include the following:

  • Nonsexually transmitted infections
  • Autoimmune diseases of the colon such as Crohn's disease and ulcerative colitis
  • Harmful physical agents
    • Chemicals
    • Foreign objects placed in the rectum
    • Trauma to the area
    • Radiation (a side effect from treatment for another illness)
    • Antibiotics (a side effect from treatment for another illness)

Symptoms of Proctitis

Symptoms of proctitis are different depending on the cause.

  • The most common symptom is that you feel a continuing urge to have a bowel movement. The rectum could feel "full." Or you could have constipation (unable to have a bowel movement).
  • You may have minor symptoms such as tenderness in the anal region and mild irritation of the rectum.
  • More serious symptoms may occur, such as pus and blood in discharge accompanied by severe cramps and pain during bowel movements.
  • If you have severe bleeding associated with proctitis, you may develop anemia (from loss of blood). Anemia can cause pale skin, irritability, weakness, dizziness, brittle nails, and shortness of breath.

With sexually transmitted proctitis, you may have these symptoms:

  • Gonorrhea (gonococcal proctitis): The primary cause appears to be anal intercourse. You may not have symptoms. If you have symptoms, you may have soreness or severe pain, itching, bloody or pus-like discharge, or diarrhea. Other rectal problems may be present such as anal warts, which are genital warts, anal tears, fistulas (abnormal passages that connect an organ or natural tube, like the rectum, to another surface), and hemorrhoids (dilated veins in the anus).
  • Syphilis (syphilitic proctitis): Symptoms are similar to those of other causes of infectious proctitis-rectal pain, discharge, and spasms during bowel movements. But you may have no symptoms. Syphilis is called the "great pretender" because it can mimic many diseases. The condition occurs in three stages:
    • Primary stage: A single painless sore with raised borders is rarely found at the site of sexual contact. These sores, or chancres, are less than an inch across. During acute stages of infection, the lymph nodes in your groin become diseased, firm, and rubbery.
    • Secondary stage: Syphilis produces a rash that can look very minor and easily missed, but also severe. It can cause swollen lymph nodes and weight loss resembling cancer.
    • Third stage: This usually appears late in the course of syphilis and affects mostly the heart and nervous system.
  • Chlamydia (chlamydial proctitis): This bacterial form of sexually transmitted proctitis may account for up to 20% of cases. You may show no symptoms, mild symptoms, or severe symptoms. Mild symptoms might be mild rectal pain with bowel movement, anal discharge, and cramping. With a severe case, you may have discharge containing blood and pus, severe rectal pain, and diarrhea. Some people may have rectal strictures, a narrowing of the rectal passageway. This narrowing might cause constipation, straining, and thin stools.

With proctitis caused by viruses, you may have these symptoms:

    • Herpes simplex: The herpes simplex type 2 virus usually causes proctitis, but type 1 also can trigger the disease. As with the other causes, you may show no symptoms. Herpes proctitis is accompanied by anal pain and tenderness, discharge, and constipation. Tiny painful blisters or sores may be seen in clusters around the anus. In contrast to other causes of proctitis, if you have herpes, you also may have urinary retention and a weak stream, impotence, and pain in the buttocks and thigh.
    • Anal warts: A virus known as human papillomavirus (HPV) causes anal warts, which begin as soft, fleshy growths around the anus. These warts can extend to affect the lower part of the rectum. You may have anal itching, varying degrees of pain, and, with time, bleeding and discharge.
  • Anorectal trauma: Trauma to your anus or rectum, in which the anal and rectal linings stretch and tear, can be a potential cause of proctitis. Health care providers usually see such trauma in people who introduce any foreign object into their rectum. Foreign objects include a penis during anal intercourse or sex toys. Tiny cracks may be seen in the anal or rectal linings. It's important to tell your health care provider if you may be at risk for this type of proctitis. Sometimes, the foreign object may still be present in the rectum. People with anorectal trauma also may have an accompanying infection as a result of high-risk sexual behavior.
  • Radiation proctitis: Radiation therapy is used to treat prostate cancer in men and cancers of the female organs such as the cervix and uterus. The rectum is close to these organs and is at risk for damage from the radiation. Radiation-induced injury to the rectum can appear in two ways.

    • You may have diarrhea and tenesmus, which is a painful spasm of the urogenital diaphragm coupled with an urgent desire to urinate or have a bowel movement. Symptoms can occur while you receive radiation therapy or within 6 weeks after completion.

    • You may have more lasting problems from radiation treatment. In addition to rectal pain and diarrhea, you may have bleeding, which signifies chronic changes of the rectal lining. This condition includes the presence of multiple tiny blood vessels on the surface of the mucous membranes in the rectum. These vessels are fragile and bleed easily as a result of minor trauma. If the bleeding is severe, you may have weakness, dizziness, palpitations (feel your heart beating), and tiredness -- all signs of iron deficiency anemia from blood loss.

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