IBD, Medical Tests

Proctitis

by Trellus Health

Definition & Facts 

What is proctitis? 

Proctitis is inflammation of the lining of your rectum. Depending on the cause, proctitis may happen suddenly and last a short time or may be long lasting. 

Who is more likely to develop proctitis? 

You are more likely to develop proctitis if you have: 

  • Engaged in anal sex with a person infected with a sexually transmitted disease (STD) 
  • Infections such as STDs and foodborne illnesses 
  • An inflammatory bowel disease such as ulcerative colitis or Crohn’s disease 
  • Had radiation therapy to your pelvic area or lower abdomen, due to certain types of cancers 
  • Injured your anus or rectum 
  • Taken certain antibiotics 

Men are more likely than women to get acute proctitis. Adults are more likely than children to get acute proctitis. 

What are the complications of proctitis? 

If your proctitis isn’t treated or doesn’t respond to treatment, you may have complications, including: 

  • Abscesses: painful, swollen, pus-filled areas caused by infection 
  • Chronic or severe bleeding that can lead to anemia 
  • Fistulas: an abnormal passage, or tunnel, between two organs or between an organ and the outside of the body 
  • Rectal stricture: an abnormal narrowing of your rectum 
  • Ulcers: sores in the lining of your intestines 

Symptoms & Causes 

What are the symptoms of proctitis? 

The most common symptom of proctitis is tenesmus — an uncomfortable, frequent urge to have a bowel movement. Other symptoms of proctitis may include: 

  • Discharge of mucus or pus from your rectum 
  • A feeling of fullness in your rectum 
  • Pain in your anus or rectum 
  • Pain during bowel movements 
  • Cramping in your abdomen 
  • Pain on the left side of your abdomen 
  • Bleeding from your rectum 
  • Bloody bowel movements 
  • Diarrhea 
  • Constipation 
  • Swollen lymph nodes in your groin 

If you are HIV-positive and have proctitis caused by genital herpes, your symptoms may be worse. 

Seek help right away 

If you have the following symptoms, you should see a doctor right away: 

  • Bleeding from your rectum 
  • Discharge of mucus or pus from your rectum 
  • Severe pain in your abdomen 

What causes proctitis? 

A number of things may cause proctitis. 

Infections 

Sexually transmitted diseases (STDs) can cause proctitis if you have had anal sex with a person infected with an STD. Common STD infection that can cause proctitis include: 

  • Gonorrhea  
  • Chlamydia  
  • Syphilis  
  • Genital herpes 

Infections associated with foodborne illness, such as Salmonella, Shigella, and Campylobacter infections, can also cause proctitis. 

Children with strep throat may sometimes get proctitis. They may infect the skin around their anus while cleaning the area after using the toilet or by scratching with hands that have strep bacteria from their mouth or nose. The bacteria may cause inflammation of the anus. Strep bacteria that get into the rectum may cause proctitis. 

Inflammatory bowel disease 

Two types of inflammatory bowel disease —ulcerative colitis and Crohn’s disease — may cause proctitis. Ulcerative colitis causes inflammation and ulcers in the large intestine. Crohn’s disease causes inflammation and irritation of any part of the digestive tract — most often in the end of the small intestine. However, ulcerative colitis and Crohn’s disease can also affect the rectum and cause proctitis. 

Radiation therapy 

If you have had radiation therapy in your pelvic area or lower abdomen due to certain cancers, you may develop a condition that is similar to proctitis, called radiation proctopathy or radiation proctitis. This condition is different because the intestinal lining does not become inflamed. Up to 75 percent of patients develop radiation proctitis following pelvic radiation therapy. 

Injury to the anus or rectum 

Injury to your anus or rectum from anal sex or from putting objects or substances — including enemas — into your anus or rectum can cause proctitis. 

Certain antibiotics 

Use of certain antibiotics can lead to an infection that can cause proctitis in some people. Antibiotics are medicines that kill bacteria. Even though antibiotics are meant to kill infection-causing bacteria, some antibiotics can kill healthy bacteria that normally live in your digestive tract. 

The loss of beneficial bacteria may let a harmful bacterium called Clostridioides difficile, or C. difficile, grow in the colon and rectum. C. difficile causes proctitis when it infects the lining of the rectum. Antibiotics that can kill beneficial bacteria, leading to C. difficile infection, include: 

  • Clindamycin  
  • Those, such as cephalosporins, that treat a wide range of bacterial infections 
  • Any penicillin-based antibiotic such as amoxicillin  

Diagnosis 

How do doctors diagnose proctitis? 

Your doctor diagnoses proctitis based on your medical history, a physical exam, lab tests, and medical procedures. 

Medical history 

Your doctor will review your symptoms and ask you about your medical history, including 

  • Current and past medical conditions 
  • History of radiation therapy 
  • Current use of antibiotics  

Your doctor will also ask you about your sexual activities, including those that increase your risk of proctitis caused by a sexually transmitted disease (STD). 

Physical exam 

Your doctor will perform a physical exam, which will include a digital rectal exam. During a digital rectal exam, your doctor will check for pain, bleeding, and problems such as internal hemorrhoids, polyps, and ulcers. 

What tests and procedures do doctors use to diagnose proctitis? 

Lab tests 

Your doctor may perform one or more of the following lab tests to diagnose proctitis. 

Blood test 

A health care professional may take a blood sample of your blood and send the sample to a lab to test. A blood test can show signs of certain conditions and diseases that can cause proctitis, such as STDs and other infections. 

Rectal culture 

A rectal culture can show signs of infections that cause proctitis. 

Stool test 

A stool test can show signs of bleeding from the rectum and signs of infections that cause proctitis. 

Medical procedures 

Your doctor may perform one or more of the following medical procedures to diagnose proctitis. Your doctor can also diagnose some causes of proctitis, such as Crohn’s disease and ulcerative colitis, and some complications of proctitis with these procedures: 

  • Colonoscopy 
  • Flexible sigmoidoscopy 
  • Proctoscopy — a procedure to look inside the rectum and anus using a proctoscope 

Treatment 

How do doctors treat proctitis? 

Treatment of proctitis depends on its cause and the severity of your symptoms. 

Proctitis caused by infection 

If lab tests confirm that your proctitis is due to an infection, your doctor will prescribe medicine based on the type of infection. A doctor may prescribe: 

  • Antibiotics to treat bacterial infections such as sexually transmitted diseases and foodborne illnesses 
  • Antiviral medicines to treat viral infections such as genital herpes  

Proctitis caused by inflammatory bowel disease 

When inflammatory bowel disease such as Crohn’s disease or ulcerative colitis causes proctitis, the goals of treatment are to decrease the inflammation in your intestines, prevent flare-ups of your symptoms, and keep you in remission. Your doctor may prescribe one of the following medicines: 

Aminosalicylates 

These medicines contain 5-aminosalicylic acid (5-ASA), which helps control inflammation. Aminosalicylates include: 

  • Balsalazide  
  • Mesalamine  
  • Olsalazine  
  • Sulfasalazine  
Corticosteroids 

Corticosteroids, also known as steroids, help reduce the activity of your immune system. Corticosteroids include: 

  • Budesonide  
  • Hydrocortisone  
  • Methylprednisolone  
  • Prednisone  
Immunomodulators 

These medicines reduce immune system activity, resulting in less inflammation in your digestive tract. Immunomodulators include: 

  • 6-mercaptopurine  
  • Azathioprine  
  • Cyclosporine  
  • Methotrexate  

Proctitis caused by radiation therapy 

Doctors treat symptoms caused by radiation therapy in your pelvic area based on the severity of your symptoms. If you have mild symptoms, such as occasional bleeding or tenesmus, your proctitis may heal without treatment. Your doctor may prescribe medicines such as sucralfate (Carafate) or corticosteroid enemas to ease your pain and reduce symptoms. 

Proctitis caused by injury to your anus or rectum 

When injury to your anus or rectum is the cause of your proctitis, you should stop the activity causing the injury. Healing most often occurs in 4 to 6 weeks. Your doctor may recommend antidiarrheal medicines and pain relievers. 

Proctitis caused by certain antibiotics 

When the use of certain antibiotics results in Clostridioides difficile (C. difficile) infection and causes your proctitis, your doctor will stop the antibiotic that triggered the C. difficile infection. He or she will prescribe a different antibiotic such as metronidazole (Flagyl), vancomycin  (Vancocin), or fidaxomicin  (Dificid). 

How can I prevent proctitis? 

Doctors don’t know how to prevent all types of proctitis. To prevent STD-related proctitis you should: 

  • Use a condom during anal sex 
  • Don’t have sex with anyone who has any symptoms of an STD, such as pain or burning sensation during urination or discharge from the penis 
  • Reduce your number of sex partners 

If injury to your anus or rectum caused your proctitis, stopping the activity that caused the injury often will stop the inflammation and keep proctitis from coming back. 

How do doctors treat the complications of proctitis? 

If you have continual or severe bleeding, your doctor may use colonoscopy or flexible sigmoidoscopy to perform procedures that destroy rectal tissues to stop the bleeding. These procedures include: 

  • Thermal therapy, which uses a heat probe, an electric current, or a laser 
  • Cryoablation, which uses extremely cold temperatures 

A surgeon may perform surgery to treat other complications of proctitis, such as abscesses, fistulas, rectal stricture, and ulcers in your intestine. Your doctor may recommend surgery to remove your rectum when other medical treatments fail, the side effects of medicines threaten your health, or your complications are severe. 

Eating, Diet, & Nutrition 

How can my diet help reduce symptoms of proctitis? 

Depending on the cause of your proctitis, changing your diet can help reduce symptoms. 

Your doctor may recommend that you eat more foods that are high in fiber. Eating foods that are high in fiber can make stools softer and easier to pass and can help prevent constipation. Your Care Team can help you learn how to add more high-fiber foods to your diet. 

If your proctitis is caused by ulcerative colitis or Crohn’s disease, a high-fiber diet may make symptoms worse. If you have ulcerative colitis or Crohn’s disease, talk with your doctor about what foods are right for you. 

If you have diarrhea, you may need to avoid certain foods that can make diarrhea worse: 

  • Caffeine 
  • Fructose, a sugar found in fruits, fruit juices, and honey and added to many foods and soft drinks as a sweetener called high-fructose corn syrup 
  • Lactose, a sugar found in milk and milk products 
  • Sugar alcohols, sweeteners used in food products that are labeled “sugar-free” 

Talk with your doctor or Care Team before changing your diet. 

For safety reasons, talk with your doctor or Care Team before using dietary supplements or any other complementary or alternative medicines or medical practices. 

Source: National Institute of Diabetes and Digestive and Kidney Diseases