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).
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
Symptoms of Proctitis
When to Seek Medical Care for Proctitis
If you have any proctitis symptoms -- especially if you have a history of high-risk sexual behavior that may lead to proctitis -- you should contact your health care provider to be checked. Other minor conditions such as hemorrhoids also can cause similar symptoms. Your doctor can tell the difference and provide the right treatment.
If you have bleeding and mucus in a bowel movement, severe pain, or diarrhea, seek immediate treatment. Complications such as severe bleeding and anemia need immediate medical attention. As a result of severe diarrhea, you also may be dehydrated. Symptoms indicating severe disease include weakness, dizziness, irritability, shortness of breath, and headaches.
Exams and Tests for Proctitis
The diagnosis of proctitis is based on the suspected cause.
- Your health care provider will take a thorough medical history to determine your sexual practices and if you have any high-risk behaviors.
- Most cases of suspected proctitis require a procedure called a proctosigmoidoscopy. A lighted tube with a camera is passed through the anus and used to look at the surface of your rectum. The image is projected on a TV screen and is magnified to identify changes.
- In addition, your doctor also may take a biopsy (small piece of tissue) of your rectum for testing for disease or infection.
- Any discharge present will undergo lab testing to identify any bacteria that may be present.
- Doctors also frequently test your blood for the presence of antibodies to support the diagnosis.
Treatment of proctitis depends on the cause of the disease.
- Because the most common cause of proctitis remains sexually transmitted disease, you may be given antibiotics to kill the organism. The presence of one type of infection also suggests the presence of other types of sexually transmitted diseases, so antibiotic treatment may be directed at two or more infectious organisms at the same time. Some of the medications can be given in a single injection.
- You must use safe sex practices, such as condoms, if you engage in high-risk sexual behavior.
- If you have inflammatory disease causing proctitis, such as ulcerative colitis or Crohn's disease, you will require continuing treatment. Treatments include drugs that suppress the immune system, such as steroids. Your doctor may prescribe steroid suppositories to provide relief in the rectum. In addition you may receive treatment for control of symptoms such as diarrhea.
Surgery for Proctitis
If your proctitis stems from a chronic illness, surgery may be required. A gastroenterologist, a specialist who deals with all the organs from the mouth to the anus, should advise you.
Follow-up for Proctitis
Follow-up is an integral part of treating proctitis. You must finish all the antibiotics prescribed to you. You should abstain from any sexual practice that may irritate the disease. Follow up with a visit to your health care provider after one to two weeks to determine whether the inflammation has cleared or if you should continue therapy. At any point, if the symptoms get worse, either contact your doctor or go to the emergency department, depending on the severity of symptoms.
Prevention of Proctitis
Prevention of proctitis begins with addressing the high-risk sexual behaviors that you may engage in. Sexually safe behaviors include using protection such as the condom, knowing your sexual partner and history, and avoiding anal intercourse. You must use safe sex practices, such as condoms, if you engage in high-risk sexual behaviors such as these:
- Having multiple sexual partners (or changing sexual partners)
- A previous history of any sexually transmitted disease
- Having a partner with a past history of any STD
- Having a partner with an unknown sexual history
- Using drugs or alcohol (these may increase the likelihood of unsafe sexual practices)
- Having a partner who is an IV drug user
- Bisexual or homosexual partners
- Anal intercourse (Anal sex with a condom decreases the risk of proctitis by STDs, but you can still get proctitis from anal trauma)
- Having unprotected intercourse (sex without the use of a condom) with an unknown partner
Outlook for Proctitis
In most cases, anal/rectal problems like proctitis go away with treatment.
- Because most cases of proctitis are caused by sexually transmitted infection, antibiotics may be needed.
- Proctitis caused by other conditions, such as radiation therapy, ulcerative colitis, and Crohn's disease, may last a long time. You may need long-term therapy. Symptoms may return from time to time (in a relapse or flare-up).
- In certain instances, where medications are not effective, you may need surgery to remove the diseased part of your gastrointestinal tract. There can be complications as a result of proctitis, especially if it goes untreated. Some complications include severe bleeding, anemia, ulcers, and fistulas.
- Fistulas may occur in many parts of the body. Women typically may get recto-vaginal fistulas in which a tube grows to connect the rectum to the vagina. Both men and women may get anal fistulas, which connect the rectum to the skin. These fistulas can also become infected and cause complications themselves.