Proctitis is inflammation of the lining of the rectum, the lower end of the large intestine leading to the anus. The large intestine and anus are part of the gastrointestinal (GI) tract. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The movement of muscles in the GI tract, along with the release of hormones and enzymes, allows for the digestion of food. With proctitis, inflammation of the rectal lining—called the rectal mucosa—is uncomfortable and sometimes painful. The condition may lead to bleeding or mucous discharge from the rectum, among other symptoms.
What causes proctitis?
Proctitis has many causes, including acute, or sudden and short-‐term, and chronic, or long-‐lasting, conditions. Among the causes are the following:
Sexually transmitted diseases (STDs). STDs that can be passed when a person is receiving anal sex are a common cause of proctitis. Common STD infections that can cause proctitis include gonorrhea, chlamydia, syphilis, and herpes. Herpes-‐induced proctitis may be particularly severe in people who are also infected with the HIV virus.
Non-STD infections. Infections that are not sexually transmitted also can cause proctitis. Salmonella and Shigella are examples of foodborne bacteria that can cause proctitis. Streptococcal proctitis sometimes occurs in children who have strep throat.
Anorectal trauma. Proctitis can be caused by trauma to the anorectal area—which includes the rectum and anus—from anal sex or the insertion of objects or harmful substances into the rectum, including the chemicals in some enemas.
Ulcerative colitis and Crohn’s disease. Two forms of inflammatory bowel disease (IBD)—ulcerative colitis and Crohn’s disease—can cause proctitis. Ulcerative colitis causes irritation and ulcers, also called sores, in the inner lining of the colon—part of the large intestine—and rectum. Crohn’s disease usually causes irritation in the lower small intestine—also called the ileum—or the colon, but it can affect any part of the GI tract. Radiation therapy. People who have had radiation therapy that targets the pelvic area also may develop proctitis. Examples of those at risk are people with rectal, ovarian, or prostate cancer who have received radiation treatment directed to those areas. Symptoms of radiation proctitis, most commonly rectal bleeding, will typically occur within 6 weeks after beginning radiation therapy or more than 9 months after its completion.
Antibiotics. Use of antibiotics may be associated with proctitis in some people. While meant to kill infection causing bacteria, antibiotics can also kill nonharmful, or commensal, bacteria in the GI tract. The loss of commensal bacteria can then allow other harmful bacteria known as Clostridium difficile to cause an infection in the colon and rectum.
What are the symptoms of proctitis?
- Tenesmus—an uncomfortable and frequent urge to have a bowel movement—is one of the most common symptoms of proctitis. Other symptoms may include
- Bloody bowel movements
- Rectal bleeding
- A feeling of rectal fullness
- Anal or rectal pain
- Crampy abdominal pain
- Rectal discharge of mucus or pus
- Diarrhea or frequent passage of loose or liquid stools
How is proctitis treated?
Treatment of proctitis depends on its cause. The goal of treatment is to reduce inflammation, control symptoms, and eliminate infection, if it is present. Only a doctor can determine the cause of proctitis and the best course of treatment. With proper medical attention, proctitis can be successfully treated.
What if proctitis is not treated?
- Proctitis that is not treated or does not respond to treatment may lead to complications, including severe bleeding and anemia—a condition in which red blood cells are fewer or smaller than normal, which means less oxygen is carried to the body’s cells.
- Abscesses—painful, swollen, pus-‐filled areas caused by infection
- Ulcers on the intestinal lining.
- Fistulas—abnormal connections between two parts inside the body
People with proctitis symptoms need medical attention. If diagnosed with proctitis, patients should take all medications as prescribed and see their doctor for a follow-‐up appointment to be sure the cause of the inflammation has been treated successfully.