Proctitis Condition: What Causes It and How is It Treated?

Proctitis is a condition that should always be treated. Otherwise, it can lead to severe complications. Diet and lifestyle have a decisive influence on the course of this disease.
Proctitis Condition: What Causes It and How is It Treated?

Last update: 04 October, 2021

The proctitis condition is an inflammation of the lining of the rectum, a muscle-like tube at the end of the colon, that connects the large intestine to the anus. In other words, stool passes through this tube as it leaves the body.

Proctitis condition causes several uncomfortable symptoms that are sometimes transient and sometimes become chronic. Proctitis is common in people with inflammatory bowel disease, whether it be Crohn’s disease or ulcerative colitis.

Most commonly, proctitis is treated with medications and lifestyle modifications. Only in the most severe cases is surgery necessary. According to available data, this disease is on the rise in today’s world.

What are the symptoms of Proctitis condition?

proctitis diagram
Proctitis is an inflammation of the lining of the anus that can cause pain and become chronic.

Typical symptoms of proctitis are pain in the rectal area and a continuous urge to defecate. If a recent bowel movement has occurred, there’s a sensation of not having had a complete bowel movement. This is known as “rectal tenesmus.”

Other symptoms include the following:

  • Pain in the anus or the sensation of having something stuck in that area
  • Abdominal pain
  • Rectal bleeding
  • Mucus discharge from the rectum
  • Very loose stools
  • Watery diarrhea, often followed by constipation
  • Pain when defecating

In some cases, proctitis causes bladder dysfunction and weakness, and burning in the legs. Some men may also have difficulty maintaining an erection. Rarely, fever and weight loss may also occur.

The main causes of Proctitis condition

Proctitis can have many different causes. Most commonly, it’s caused by underlying conditions. The main reasons for the appearance of this disease are the following:

  • Sexually transmitted diseases (STDs). It can be the effect of gonorrhea, chlamydia, syphilis, and herpes. They’re usually transmitted through anal sex. In those with HIV, the disease is usually more severe.
  • Common infections. Proctitis may be caused by infection with bacteria such as Salmonella and Shigella, among others. In addition, strep throat can cause strep proctitis in children.
  • Anorectal trauma. Anal sex and insertion of objects in that area sometimes cause injuries that lead to this disease.
  • Inflammatory bowel disease (IBD). This includes ulcerative colitis and Crohn’s disease. Both are common causes of proctitis.
  • Radiation therapy. Those who have received radiation therapy treatment to the pelvic area are at increased risk of developing proctitis. So symptoms usually appear six weeks after treatment begins or nine months after treatment ends.
  • Antibiotics. Some people develop proctitis after treatment with antibiotics. Antibiotics kill bacteria that aren’t harmful, which in turn helps other harmful bacteria to grow.

Risk factors

The main risk factors for proctitis are the following:

  • Unsafe sexual intercourse. These practices increase the risk of contracting a sexually transmitted disease. Sex with multiple partners and without condom use also increases the possibility of contracting these diseases.
  • Inflammatory bowel diseases. Ulcerative colitis and Crohn’s disease also increase the risk of proctitis.
  • Radiation therapy treatments. If the doctor applies it in the pelvic area, they increase the possibility of developing the disease.

How can it be diagnosed?

Diagnosis of proctitis begins with a detailed history taking and also a thorough physical examination. For example, symptoms, family history, and sexual practices, among other aspects, will be taken into account.

The physician will order a rectal examination and will likely order some tests such as the following:

  • Complete blood count. This can detect blood loss and infections.
  • Stool analysis. This allows doctors to establish if there is a bacterial infection.
  • Anoscopy. This is a test to inspect the anal canal and the lower part of the rectum. It’s carried out with an apparatus called an anoscope.
  • Colonoscopy. This allows for the visualization of the entire colon, basically through the use of a thin tube that has a camera. It also makes it possible to take a sample for biopsy.
  • Fibrosigmoidoscopy with a flexible fibre endoscope. This is similar to a colonoscopy, both in procedure and objective.
  • Tests for sexually transmitted diseases. These are usually tests from samples obtained from the rectum or the urethra, therefore, the tube that carries urine.

Anoscopy, colonoscopy, and fibrosigmoidoscopy are invasive tests that may cause some discomfort. However, full recovery is usual within 24 hours.

Available treatments

A table full of pills
The professional will choose the most appropriate treatment according to the cause of the proctitis.

Overall, there are two lines of treatment for proctitis: with drugs or with surgery. Different types of drugs are used, depending on the cause of proctitis:

  • Antibiotics if a bacterial infection caused the proctitis condition.
  • Antivirals when a virus causes the infection.
  • Anti-inflammatory drugs if the disease is caused by radiotherapy or inflammatory bowel disease. They’re administered in the form of pills, suppositories, or enemas.
  • Immunosuppressants. They’re used when the specific cause is Crohn’s disease.
  • Stool softeners and dilators. They’re usually used when proctitis is a consequence of radiotherapy.

However, surgery becomes an option when previous treatments aren’t effective. The purpose is to remove the damaged area of the digestive system. Sometimes, doctors perform it to destroy the abnormal tissue that bleeds with procedures such as argon plasma coagulation, cryoablation, and electrocoagulation.

Diet and lifestyle changes

Changes in diet and lifestyle contribute significantly to alleviating the pain and discomfort caused by proctitis. The most recommended measures are the following:

  • Eat a soft and bland diet.
  • Avoid spicy, fatty, and acidic foods during episodes of diarrhea.
  • Drink plenty of fluids. This facilitates the passage of stool and also prevents dehydration due to diarrhea
  • Avoid caffeine, soft drinks, and milk drinks, (for example, if you’re lactose intolerant).
  • Avoid sweets and sugar-free drinks.

It’s very convenient to keep track of the symptoms. This is a record where you record the moments of exacerbation of the symptoms and the foods consumed previously, since this way you can detect the triggers.

It’s best to limit the number of sexual partners and use a condom every time you have sex. In addition, it’s important to also avoid sexual contact with people who have herpes or secretions in the genital area.

How to handle proctitis condition

Overall, if proctitis is left untreated or if the person doesn’t respond to treatment, some serious complications may develop. For example, this may include heavy bleeding, anemia, abscesses, ulcers in the intestinal lining, and fistulas.

In conclusion, a person with this disease should receive medical attention and follow the prescribed treatment. Follow-up should be continuous, especially to ensure that the cause of the inflammation disappears completely.

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  • Silva, F., Gatica, T., & Pavez, C. (2019). Etiología y fisiopatología de la enfermedad inflamatoria intestinal. Revista Médica Clínica Las Condes, 30(4), 262-272.
  • Serrano Ferrández, E., & Artal Traveria, E. (2020). Proctitis: pensar más allá de la enfermedad inflamatoria y la neoplasia. Medicina de Familia-SEMERGEN, 46(6), 428-430.