Proctitis
Inflammation of the lining of the rectum
Quick Facts
- Type: Inflammatory digestive condition
- Area affected: Rectum (lower large intestine)
- Common symptoms: Rectal pain, bleeding, urgency
- Common causes: Infections, IBD, radiation
Overview
Proctitis is inflammation of the lining of the rectum, the last few inches of the large intestine that connect to the anus. The inflamed tissue becomes irritated and swollen, which leads to discomfort, bleeding, and a frequent feeling of needing to pass stool, even when the bowel is empty. This urgent, unproductive sensation is called tenesmus and is one of the most characteristic features of the condition.
Proctitis can be short-lived or long-lasting, and it has many possible causes, including infections, inflammatory bowel disease, and radiation treatment to the pelvic area. The inflammation may be limited to the rectum or be part of a wider problem affecting more of the colon. Identifying the underlying cause is important because it guides treatment. With proper care, symptoms can usually be controlled, although some forms, such as those linked to inflammatory bowel disease, may require ongoing management.
Symptoms
Common symptoms of proctitis include:
- A frequent or continuous urge to have a bowel movement
- Rectal pain, discomfort, or a feeling of fullness
- Bleeding from the rectum or blood in the stool
- Passage of mucus or pus from the rectum
- Pain during bowel movements
- Diarrhea, in some cases
Symptoms vary in severity depending on the cause and how much of the rectum is inflamed.
Causes
Proctitis can result from several different processes:
- Infections: Including sexually transmitted infections such as gonorrhea, chlamydia, and herpes, as well as foodborne infections.
- Inflammatory bowel disease: Ulcerative colitis and Crohn disease can cause proctitis.
- Radiation therapy: Treatment aimed at the pelvic area for certain cancers can inflame the rectum.
- Other causes: Certain antibiotics that disturb gut bacteria, and, less commonly, injury or other conditions.
Risk Factors
- Sexual practices that increase the risk of rectal sexually transmitted infections
- Inflammatory bowel disease such as ulcerative colitis or Crohn disease
- Radiation therapy to the pelvis or rectum
- Recent antibiotic use
- A weakened immune system
Diagnosis
To diagnose proctitis and find its cause, a doctor may use:
- Medical history and exam: Including questions about symptoms, sexual history, recent antibiotic use, and any radiation treatment.
- Sigmoidoscopy or colonoscopy: A thin camera to view the rectum and lower bowel directly and take small tissue samples (biopsies) for examination.
- Stool and swab tests: To check for bacterial, viral, or parasitic infections, including sexually transmitted ones.
- Blood tests: To look for signs of infection, inflammation, or anemia from bleeding.
The choice of tests depends on the suspected cause, and more than one may be needed to reach a clear diagnosis.
Treatment
Treatment depends on the underlying cause:
- Infections: Treated with appropriate antibiotics or antiviral medications.
- Inflammatory bowel disease: Managed with anti-inflammatory medications, including treatments applied directly to the rectum, and other therapies as needed.
- Radiation proctitis: Managed with medications, stool softeners, and sometimes procedures to treat bleeding.
- Supportive care: Pain relief, dietary measures, and treating any underlying condition.
Treating sexual partners and avoiding reinfection is important when an STI is the cause.
Self-Care and Prevention
- Practice safe sex to reduce the risk of sexually transmitted infections
- Get tested and treated promptly for STIs, and ensure partners are treated
- Follow your treatment plan if you have inflammatory bowel disease
- Use antibiotics only when needed and as prescribed
- Stay hydrated and eat a balanced diet to support bowel health
When to See a Doctor
See a doctor for rectal pain, bleeding, mucus, or a persistent urge to have a bowel movement, so the cause can be identified and treated. Seek prompt or emergency care for heavy rectal bleeding, severe pain, high fever, dizziness or fainting, or signs of significant blood loss, as these can indicate a serious problem that needs urgent attention.
Frequently Asked Questions
What is proctitis?
Proctitis is inflammation of the lining of the rectum, the lower end of the large intestine. It commonly causes rectal pain, bleeding, and a frequent urge to have a bowel movement.
What causes proctitis?
Common causes include sexually transmitted and other infections, inflammatory bowel diseases like ulcerative colitis and Crohn disease, and radiation therapy to the pelvic area. Certain antibiotics and, less often, injury can also cause it.
Is proctitis serious?
Many cases are treatable once the cause is identified, but some causes, like inflammatory bowel disease, need ongoing management. Heavy bleeding, severe pain, or signs of significant blood loss should be treated as urgent.
How is proctitis treated?
Treatment is directed at the cause: antibiotics or antivirals for infections, anti-inflammatory therapies for inflammatory bowel disease, and specific measures for radiation-related proctitis. Pain relief and dietary measures help with symptoms.
Can proctitis be prevented?
Some causes can be reduced by practicing safe sex and getting prompt treatment for sexually transmitted infections. Following treatment plans for inflammatory bowel disease and using antibiotics only as needed also help lower the risk.
References
- Mayo Clinic. Proctitis — Symptoms and causes.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Proctitis.
- Centers for Disease Control and Prevention (CDC). Sexually transmitted infections.
- MedlinePlus, U.S. National Library of Medicine. Proctitis.