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Proctitis involves the inflammation of the rectal lining—a muscular tube that links to the colon’s end, guiding stool out of the body.
This condition can lead to symptoms such as pain in the rectal area, diarrhea, bleeding, discharge, and a persistent urge to defecate. The manifestations of proctitis might be temporary or evolve into a long-standing issue.
It’s frequently observed in individuals with inflammatory bowel diseases like Crohn’s disease or ulcerative colitis. Sexually transmitted infections (STIs) are also a common cause. Moreover, proctitis can arise as an adverse effect of undergoing radiation treatment for certain type of cancer.
Symptoms
The following sign and symptoms of proctitis may include:
- Constant or frequent feeling that you need go toilet.
- Constipation.
- Diarrhea.
- Fullness or swelling in your rectum.
- Pain on the left side of your abdomen.
- Rectal bleeding or blood in the stool.
- Rectal pain or pain during bowel movement.
In case you experience any proctitis signs or symptoms, schedule a visit with your healthcare provider.
Causes
The rectal lining may become inflamed due to several diseases and conditions. Among them include the following:
- Inflammatory bowel disease: This is the most common cause of proctitis overall. The rectal inflammation affects about 30% of patients with inflammatory bowel disease, which includes ulcerative colitis and Crohn’s disease.
- Infections: Proctitis can be caused by sexually transmitted infections, which are primarily transferred through anal intercourse. Sexually transmitted diseases such as chlamydia, gonorrhea, and genital herpes can result in proctitis. Proctitis can also result from foodborne illness-related illnesses such salmonella, shigella, and campylobacter infections.
- Radiation therapy: Inflammation of the rectum or surrounding tissues, like the prostate, may result with radiation therapy. A few months following radiation therapy, radiation proctitis may start throughout the course of treatment. It may also happen years after treatment.
Radiation mucositis can occur anywhere in the gastrointestinal tract as a result of cancer radiation therapy. This indicates an inflammation of the mucosa lining your gastrointestinal tract. When you receive targeted radiation to your upper or lower abdomen, you may develop radiation enteritis or radiation colitis. If you have received targeted radiation to the pelvic region, you may develop radiation proctitis.
- Antibiotics: Antibiotics used to treat infections can occasionally destroy good bacteria in the intestines, allowing the dangerous Clostridium difficile bacteria to proliferate in the rectum.
- Food protein-induced proctitis: Infants who consume formula made of soy or cow’s milk may experience proctitis. Proctitis can also develop in breastfed infants whose moms consume dairy products.
- Diversion proctitis: Those who have had an ileostomy or colostomy in which a surgically made opening (stoma) that diverts the stool away from their rectum may have this negative effect.
- Eosinophilic proctitis: This disorder develops when the body produces an excessive amount of eosinophilia, which accumulates in the rectum’s lining. When you have eosinophilic gastrointestinal problems, your immune system infiltrates a specific area of your gastrointestinal tract with an excessively high concentration of eosinophils, which results in persistent inflammation. Eosinophilic proctitis exclusively affects children under the age of two.
- Idiopathic proctitis: There are a small number of cases where proctitis has no known cause. Changes in nutrition, however, frequently resolve these situations. Idiopathic proctitis often recurs, behaving nearly like a chronic illness. Ulcerative colitis develops in about 10% of cases over time.
- Trauma: Inflammation in the anus and rectum may result from an object or chemical being introduced into it. It could be caused by chemicals present in some enemas.
Risk factors
The following factors may increase the risk of proctitis:
- Unprotected sex: Proctitis risk can be elevated by behaviors that raise the risk of a sexually transmitted infection (STI). Having several sexual partners, not using condoms, and having sex with someone who has a STI increase your chance of getting a sexually transmitted infection (STI).
- Inflammatory bowel diseases: Proctitis is more common in those with inflammatory bowel diseases (such as Crohn’s disease or ulcerative colitis).
- Radiation therapy: Proctitis is more likely to occur if you have radiation therapy near or at your rectum (for example, for rectal, ovarian, or prostate cancer).
Diagnosis
Proctitis can be diagnosed using the following tests and procedures:
- Physical examination: A healthcare provider will first interview you about your symptoms before performing a physical examination to check for proctitis (digital rectal exam and anoscopy). If proctitis seems likely, they will explore more to determine the type and possible source of the condition.
- Blood tests: Proctitis can be caused by infections and other disorders that can be detected by a blood test. It may also be a sign of hemorrhage or an excess of white blood cells.
- Stool test: A sample of your stool may be tested by a healthcare provider to check for signs of bleeding, infection, or an overabundance of white blood cells.
- Rectal culture: Using a cotton swab, a healthcare provider will collect a sample from the inside of your rectum and place it in a culture to look for bacteria or viruses.
- Flexible sigmoidoscopy: In this test, your healthcare provider looks at the rectum and the sigmoid, the last section of your colon, using a thin, flexible, lighted tube. If your colon is affected, you may have a gastrointestinal infection or inflammatory bowel disease. Your healthcare provider may also recommend biopsy—take tiny samples of tissue—during the process to be examined in a lab.
- Colonoscopy: This enables your healthcare provider to see your entire colon through the use of a light-attached, thin, flexible tube. During this examination, your healthcare provider may also take a biopsy.
- Tests for sexually transmitted infections: A sample of your rectum’s discharge or the urine-draining tube from your bladder (the urethra) is taken for these tests.
Treatment
The underlying cause of the inflammation determines how proctitis should be treated.
Your healthcare provider might suggest taking medicine to address your infection. Among the options are:
- Antibiotics: For proctitis resulting from bacterial infections, your healthcare provider might recommend an antibiotic like doxycycline.
- Antivirals: Your healthcare provider might recommend an antiviral medication like acyclovir for proctitis caused on by viral infections, such as the STD herpes virus.
In mild cases, treatment may not be necessary for radiation proctitis. However, in more severe instances where there is significant pain and hemorrhaging, medical attention is required. Your healthcare provider may recommend various treatments such as:
- Medications: Medication is administered as an enema, suppository, or tablet. These consist of metronidazole, sulfasalazine, sucralfate, and mesalamine. These medications can lessen bleeding and help regulate inflammation.
- Stool softeners and dilation: These could help in clearing intestinal blockages.
- Damaged tissue: These methods reduce the bleeding abnormal tissue (ablation), which alleviates proctitis symptoms. Proctitis is treated with argon plasma coagulation (APC), cryoablation, electrocoagulation, and other ablation techniques.
The goal of treating proctitis associated with ulcerative colitis or Crohn’s disease is to lessen rectal inflammation. The following course of treatment includes:
- Medications to control rectal inflammation: Patients with Crohn’s disease may receive corticosteroids such as prednisone or budesonide, along with anti-inflammatory drugs like mesalamine, which can be administered orally or as suppositories or enemas. For those experiencing frequent inflammation, immune-suppressive medications like infliximab or azathioprine may be necessary.
- Surgery: If medication treatment proves ineffective in alleviating your symptoms, your healthcare provider may recommend surgical intervention to remove a damaged portion of your digestive system.
