Proctitis

What is Proctitis?

Proctitis is an inflammation of the anus (the opening) and lining of the rectum (lower part of the intestine leading to the anus). It can last a short time or become a chronic condition (lasting for weeks or months or longer). Symptoms of proctitis can vary greatly. You may have only minor problems at first.

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, including some that you can pick up from contaminated food such as salmonella, shigella and campylobacter. 
  • Autoimmune diseases of the colon (also called inflammatory bowel diseases) such as Crohn's disease, and ulcerative colitis.
  • Food diversion after bowel surgery (when your bowel movements are removed via another opening such as a stoma)
  • A reaction to cow’s milk or soy milk as a baby, either after drinking it directly or breastfeeding from a mom who drinks cow or soy milk.
  • White cells (eosinophils) building up in the rectum in children under the age of 2
  • 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

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

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 doctor 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 that indicate severe disease include weakness, dizziness, irritability, shortness of breath, and headaches.

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Proctitis Diagnosis

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 will undergo lab testing to identify any bacteria that may be present.
  • Doctors also often test blood for the presence of antibodies to support the diagnosis.

Proctitis Treatment

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 (immunosuppressant drugs), 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.

Lifestyle changes to relieve proctitis

  • Try sitz baths: submerging your bottom in a container with warm water to ease the pain.
  • Keep track of your episodes and what you eat to see if you can find a connection. For instance, foods that are high in fiber can help some people with proctitis but make it worse for others. Foods with a lot of fat or sugar can also make your diarrhea worse.

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Surgery for Proctitis

If your proctitis stems from a chronic illness, you may need surgery. 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 important 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 a week or two. They’ll see 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.

Proctitis Prevention

Prevention of proctitis begins with addressing any high-risk sexual behaviors that you may engage in.

Ways to lower your risk of proctitis include:

  • Using condoms
  • Knowing your sexual partners and their history
  • Avoiding anal intercourse

It is especially important to practice safe sex practices, such as using condoms, if you:

  • Have or continue to have multiple sexual partners (or changing sexual partners)
  • Have a previous history of any sexually transmitted disease
  • Have partner with a past history of any STD
  • Have partner with an unknown sexual history
  • Use drugs or alcohol (these may increase the likelihood of unsafe sexual practices)
  • Have a partner who is an IV drug user
  • Engage in anal intercourse (anal sex with a condom decreases the risk of proctitis by STDs, but you can still get proctitis from anal trauma)
  • Have unprotected intercourse (sex without the use of a condom) with an unknown partner

Outlook for Proctitis

In most cases, problems like proctitis go away with treatment.

  • Because most cases of proctitis are caused by sexually transmitted infection, you may need antibiotics.
  • 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 problems as a result of proctitis, especially if it goes untreated. Some complications include severe bleeding, anemia, ulcers, and fistulas.
  • You may develop fistulas -- tunnels that run from inside the anus to the skin around it. Women typically may get recto-vaginal fistulas in which a tube grows to connect the rectum to the vagina. Fistulas can also become infected and cause complications that need treatment.
WebMD Medical Reference Reviewed by Neha Pathak, MD on September 21, 2020

Sources

SOURCES: 

American College of Gastroenterology.

Mayo Clinic: “Proctitis," “Inflammatory Bowel Disease.”

“Cleveland Clinic: Proctitis.”

“NCH Healthcare System: “Proctitis.”

National Institute of Diabetes and Digestive and Kidney Diseases: “Eating, Diet, and Nutrition for Proctitis.”

 

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