What Is Proctitis? How to Recognize, Treat, and Prevent It
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Key Facts
- Proctitis is the inflammation of the rectum and can cause significant discomfort.
- Common symptoms include rectal bleeding, urgency, tenesmus, and sometimes pain.
- There are several types of proctitis, including infectious, ulcerative, and radiation proctitis, each with different causes.
- Proctitis can be caused by infections (including STIs), inflammatory bowel disease, radiation therapy, and other factors.
- Diagnosis involves medical history, physical exams, endoscopy, and various lab tests to determine the underlying cause.
Proctitis may be a small word but it’s a big discomfort for those who have it. At its core, proctitis is inflammation of the rectum—the last part of the digestive tract, right before the anus. It’s more common than you think and can be caused by infections, inflammatory bowel disease (IBD), or even radiation therapy. It’s usually diagnosed via endoscopy which gives doctors a direct view of the inflamed tissue [1] [2].
Let’s dive deeper into what proctitis is, why it happens, how it shows up in the body and—most importantly—how it can be treated.
Table of Contents
- Proctitis Symptoms
- Types of Proctitis
- What Causes Proctitis?
- How Is Proctitis Diagnosed?
- Proctitis Living
- Closing Thoughts
- References
Proctitis Symptoms
Proctitis symptoms are rarely subtle. People usually notice something is off pretty quickly and for good reason. Common symptoms include:
- Rectal bleeding – often the first red flag
- Urgency – an overwhelming need to have a bowel movement even when there’s nothing to pass
- Tenesmus – the feeling of needing to go even after a bowel movement
- Diarrhea or constipation
- Rectal pain – occasional but often uncomfortable [2]
Symptoms can range from mild to severe pain and depends on the type of proctitis and its cause. Other symptoms such as fever, tiredness, nausea, joint pain, skin rashes and weight loss may also occur and should be acknowledged in the overall management of the condition. This is different from other related diseases such as Crohn’s Disease and Irritable Bowel Syndrome.
Types of Proctitis
Proctitis isn’t a one size fits all condition. There are several types and each has its own cause and treatment.
Eosinophilic Proctitis
Eosinophilic proctitis is a type of proctitis that affects children under 2 years old. It’s associated with eosinophilic gastrointestinal disorders where the immune system produces an excessive number of eosinophils [3]. This leads to chronic inflammation in the gastrointestinal tract often triggered by food allergies.
Ulcerative Proctitis
This is a localized form of ulcerative colitis—an inflammatory bowel disease. It’s inflammation that’s limited to the rectum. Symptoms are often similar to other types of colitis but less extensive indicating a milder form of the disease.
Infectious Proctitis
This is on the rise especially in high risk groups such as men who have sex with men (MSM) and individuals with HIV. It’s often caused by sexually transmitted infections (STIs) such as:
- Neisseria gonorrhoeae
- Chlamydia trachomatis
- Herpes Simplex Virus (HSV)
- Treponema pallidum (syphilis)
Chronic Proctitis
This includes several long term inflammatory conditions and chronic conditions with chronic inflammation:
- Ulcerative proctitis (idiopathic)
- Radiation proctitis – often occurs after pelvic radiation therapy
- Diversion proctitis – results from surgical diversion of fecal flow, common in colostomy patients [8]
Ischemic Proctitis
Though rare, ischemic proctitis occurs when blood flow to the rectum is restricted. Diagnosing this can be tricky because the rectum has a strong blood supply and can mask signs of reduced circulation [12].
What Causes Proctitis?
Proctitis can occur for many reasons often falling into one or more of the following categories:
- Inflammatory bowel diseases (IBD) – like ulcerative colitis and Crohn’s disease
- Sexually transmitted infections (STIs) – including gonorrhea, chlamydia, herpes and syphilis [1]
- Radiation therapy – especially pelvic radiation
- Ischemia – when blood flow to the rectum is insufficient
- Diversion of stool – after certain surgical procedures
- Physical trauma – from medical instruments or foreign objects
- Bacterial infections – from gastrointestinal infections or food poisoning
- Viral infections – often sexually transmitted and through anal-receptive sexual contact
- Anal trauma – which can lead to inflammation and more severe conditions like ulcerative proctitis [11]
Understanding the underlying cause is important—it guides the treatment. Causes of proctitis include infections, inflammatory bowel disease, sexual transmission and specific physiological changes related to surgical procedures.
Risk Factors
Several risk factors can increase a person’s chance of getting proctitis. These include high risk sexual practices, history of STIs, radiation therapy to the pelvic area, inflammatory bowel disease (IBD), weakened immune system, history of digestive diseases and family history of IBD [5]. Be aware of these risk factors and take steps to prevent proctitis by practicing safe sex and a healthy lifestyle.
How Is Proctitis Diagnosed?
Diagnosis involves more than a symptom checklist. Doctors use a multi-step approach:
- Patient medical history – recent sexual activity, past medical treatments and IBD history
- Physical exam
- Endoscopy – using a sigmoidoscope or colonoscope to visualize rectal tissue [2] [4]
- Lab tests and cultures – to pinpoint infections especially when STIs are suspected
- Blood tests – to check for signs of infection or inflammation
- Stool tests – to check inflammation levels and intestinal infections [10]
- Rectal culture – to identify specific infections
- Flexible sigmoidoscopy – to examine the lower colon for abnormalities
If a doctor suspects proctitis they may order tests to confirm the diagnosis and determine the underlying cause. This comprehensive approach ensures the best treatment plan is chosen. [9]
Because proctitis symptoms can mimic other gastrointestinal conditions, getting the right diagnosis is key to choosing the right treatment [7].
Proctitis Living
Living with proctitis can be tough but there are ways to manage the condition and relieve symptoms. Eating a balanced diet, staying hydrated and avoiding foods that irritate the digestive tract can help reduce symptoms. Practicing good hygiene, avoiding anal intercourse and using protection during sex can help prevent STIs and proctitis [7].
Working with a healthcare provider to develop a treatment plan that addresses the underlying cause of the inflammation and symptoms is key []. With treatment and lifestyle changes proctitis can be managed and prevented. Regular follow up with a healthcare provider can help monitor the condition and adjust the treatment plan as needed.
By taking an active role in managing proctitis individuals can reduce symptoms, improve quality of life and prevent long term complications [6].
Closing Thoughts
Proctitis may be confined to a small part of the body but it can have a big impact on daily life. Proctitis is inflammation of the rectal lining which can cause severe pain, constant urge to have a bowel movement and other symptoms. Whether it’s related to inflammatory bowel disease, infection or prior radiation, recognizing the signs early and getting the right diagnosis is important.
Rectal inflammation can affect the lining of the rectum and can extend to other parts of the large intestine and affect the whole digestive system. With rising rates of infectious proctitis in certain populations, timely intervention and education is more important than ever. Managing flare ups and addressing symptoms like weight loss is key to overall health.
Once the underlying cause is clear proctitis can often be managed effectively – restoring comfort and preventing complications down the line.
References
[1] Rizza, S., Mistrangelo, M., Ribaldone, D. G., Morino, M., Astegiano, M., Saracco, G. M., & Pellicano, R. (2020). Proctitis: a glance beyond inflammatory bowel diseases. Minerva gastroenterologica e dietologica, 66(3), 252–266. https://doi.org/10.23736/S1121-421X.20.02670-7
[2] Regueiro M. D. (2004). Diagnosis and treatment of ulcerative proctitis. Journal of clinical gastroenterology, 38(9), 733–740. https://doi.org/10.1097/01.mcg.0000139178.33502.a3
[3] Coelho, R., Ribeiro, T., Abreu, N., Gonçalves, R., & Macedo, G. (2023). Infectious proctitis: what every gastroenterologist needs to know. Annals of gastroenterology, 36(3), 275–286. https://doi.org/10.20524/aog.2023.0799
[4] McNeil, C. J., Barroso, L. F., 2nd, & Workowski, K. (2024). Proctitis: An Approach to the Symptomatic Patient. The Medical clinics of North America, 108(2), 339–354. https://doi.org/10.1016/j.mcna.2023.09.002
[5] Høie, S., Knudsen, L. S., & Gerstoft, J. (2011). Lymphogranuloma venereum proctitis: a differential diagnose to inflammatory bowel disease. Scandinavian journal of gastroenterology, 46(4), 503–510. https://doi.org/10.3109/00365521.2010.537681
[6] Tytgat, G. N., Fockens, P., Schotborgh, R. H., & Hofer, S. O. (1990). Proctitis. The Netherlands journal of medicine, 37 Suppl 1, S37–S42. https://pubmed.ncbi.nlm.nih.gov/2234233/
[7] Santos, A. L., Coelho, R., Silva, M., Rios, E., & Macedo, G. (2019). Infectious proctitis: a necessary differential diagnosis in ulcerative colitis. International journal of colorectal disease, 34(2), 359–362. https://doi.org/10.1007/s00384-018-3185-5
[8] Wu, X. R., Liu, X. L., Katz, S., & Shen, B. (2015). Pathogenesis, diagnosis, and management of ulcerative proctitis, chronic radiation proctopathy, and diversion proctitis. Inflammatory bowel diseases, 21(3), 703–715. https://doi.org/10.1097/MIB.0000000000000227
[9] Kent, A., & Keshav, S. (2014). Managing intractable proctitis and the problematic pouch. Digestive diseases (Basel, Switzerland), 32(4), 427–437. https://doi.org/10.1159/000358149
[10] Strobel, T. M., Desai, N. A., & Arrington-Sanders, R. (2023). Acute Infectious Proctitis in Adolescents. Pediatrics in review, 44(9), 491–497. https://doi.org/10.1542/pir.2022-005862
[11] Whitlow C. B. (2004). Ulcerative proctitis. Clinics in colon and rectal surgery, 17(1), 21–27. https://doi.org/10.1055/s-2004-823067
[12] Sharif, S., & Hyser, M. (2006). Ischemic proctitis: case series and literature review. The American surgeon, 72(12), 1241–1247. https://pubmed.ncbi.nlm.nih.gov/17216829/
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