Proctitis: Causes, Symptoms, Treatment, Diagnosis

Proctitis is the inflammation of the rectum lining. The rectum is the lowest part of the intestine and waste passes from here just before exiting through the anus.

Inflammation of the rectum lining can lead to pain, discharge, and other unusual symptoms. The inflammation maybe just a short bout of proctitis, which is known as acute proctitis, or a long-term issue known as chronic proctitis. The severity of the symptoms depends on the underlying cause of proctitis.

There are various causes of proctitis that may lead to either acute or chronic proctitis.

The possible causes include:

• Sexually transmitted diseases which include syphilis, gonorrhea and chlamydia.
• Injuries from anal sex
• Viral infections such as herpes
• Other infections that include salmonella or bacterial infections
• Complications from radiation treatment for cancer in the pelvic region
• Inflammatory bowel disease, which includes the disease such as ulcerative colitis and Crohn’s disease

The symptoms of proctitis depend on the underlying cause. Tenesmus is the most common symptom of proctitis that leads to needing to poop. It is an uncomfortable feeling that stays even after the person has used the washroom.

Other symptoms of proctitis include:

• Blood in stool
• Pain in rectum
• Pain during bowel movement
• Constipation
• Loose watery stool
• Swelling in lymph nodes

In case of anal pain, blood, or discharge, a doctor should be consulted.

For diagnosis, the doctor takes the history of the patient and the symptoms experienced. The sexual history is also enquired about.

A physical examination is done to check for the signs of inflammation. Lab tests are ordered, which include a blood test, stool test, and rectal culture. All these are done to check for the signs of infection.

If more congestive digestive disorders or complications are suspected, colonoscopy and proctoscopy are ordered. During these procedures, a thin tube is passed through the anus to examine the bowel, rectum, and colon.

Although a thorough diagnosis may take time, but is important, as a correct treatment is essential.

The treatment of proctitis may depend on the cause of the condition. In case of acute inflammation, direct treatment may be needed.

If a chronic disorder is the cause of proctitis, a mixture of medical treatment and long-term changes in diet and lifestyle is needed.

Corticosteroids, immunomodulators, and aminosalicylates are prescribed as they help in controlling and treating inflammation.

Infection: If proctitis is due to infection such as bacterial or viral, antibiotics and antivirals are prescribed.

Medications: If the inflammation is due to any particular medication, the person needs to stop the medication and a doctor prescribes alternatives so that the treatment continues while healing.

Injury: If proctitis is due to injury due to anal sex or anal play, the person is advised to stop the activity and is prescribed anti-inflammatories. It is observed by the National Institute of Diabetes and Digestive and Kidney Disease that healing of the rectum takes 4-6 weeks.⁽¹⁾

Radiation Therapy: Radiation therapy is a common cause of proctitis. In a study done in 2015, it was observed that 75% of people who underwent radiation therapy in the pelvis developed proctitis, while 20 % experienced chronic long-lasting symptoms.⁽²⁾ Those with mild symptoms of proctitis may not need any treatment, while in the case of severe symptoms corticosteroid enema may be needed to reduce the inflammation. Sucralfate, a drug for the treatment of ulcers is recommended as it may ease symptoms.

Inflammatory bowel disease: It is a chronic cause of proctitis and may require consistent treatment to control the symptoms. The treatment goal is to keep the inflammation in check, prevent flare-ups, and put the body in remission.

Proctitis Diet: Dietary changes are also recommended as a part of treatment. An anti-inflammatory diet is advised to help in reducing symptoms.

Eating a variety of fruits and vegetables is advised to ensure sufficient fiber uptake, making the stool easier to pass through. Sometimes high-fiber food may worsen the symptoms. Therefore taking dietary advice from a professional is necessary.

Some potential irritants such as alcohol, spicy foods, fructose, milk products, caffeine, and sugar alcohols are recommended to be avoided.

Certain supplements such as vitamin C, probiotics, and omega-3 fatty acids should be included in the diet as they help with inflammation and other symptoms. Any drastic changes in the diet should be brought to the doctor’s notice.

Lifestyle Changes: To treat and prevent further proctitis, a lifestyle change may be needed. If proctitis is due to anal trauma or sexually transmitted disease, precautions such as using a condom for anal sex, avoiding rough play, and communicating with any partners about sexual health are advised.

Most cases clear within a few weeks with correct treatment and some may require long-term treatment and some dietary and lifestyle change.