Definition

Proctitis is the inflammation of the lining of the rectum. The rectum, a part of the lower gastrointestinal tract, is a section of the colon that is connected to the anus. Stool passes through the rectum when exiting the body. Proctitis can cause symptoms such as diarrhea, pain in the rectum, bleeding or discharge from the anus, and a constant urge to have a bowel movement (BM). Proctitis symptoms can be short-lived or become chronic (long-term).

Proctitis often occurs in individuals with inflammatory bowel diseases such as Crohn's disease or ulcerative colitis. Sexually transmitted diseases are also another common cause of proctitis. Additionally, proctitis can result as a side effect of radiotherapy for certain cancers.

Causes

Proctitis can result from various diseases and conditions, including:

• Inflammatory Bowel Disease (IBD): Approximately 30% of individuals with IBD experience proctitis, which involves inflammation of the rectum.
• Infections: Sexually transmitted infections (STIs), such as gonorrhea or herpes genitalis, transmitted through anal intercourse, can cause proctitis. Additionally, bacterial infections like Salmonella, Shigella, and Campylobacter, often contracted through contaminated food, may lead to proctitis.
• Cancer Radiotherapy: Radiation therapy targeting the rectum or adjacent areas, such as in prostate cancer treatment, can induce rectal inflammation. Radiation-induced proctitis may persist for months or even years post-treatment.
• Antibiotic Use: Antibiotics, while effective against infections, can disrupt the balance of beneficial bacteria in the intestine, allowing Clostridium difficile bacteria to proliferate and cause proctitis.
• Colon Surgeries: Procedures involving diversion of the fecal stream, such as colostomies, can lead to proctitis as a complication.
• Food Protein Sensitivity: In some cases, proctitis may result from sensitivity to food proteins, such as cow's milk or soy formula in infants. Breastfed infants whose mothers consume dairy products may also develop proctitis.
• Eosinophilic Proctitis: This condition involves the accumulation of eosinophils, a type of white blood cell, in the rectal lining. Eosinophilic proctitis commonly affects children under 2 years of age.

Risk factor

Risk factors for proctitis include:

• Unsafe Sexual Practices: Engaging in behaviors that increase the risk of sexually transmitted infections (STIs), such as having multiple sexual partners, not using condoms, and engaging in sexual activity with partners who have STIs, can elevate the risk of proctitis.
• Inflammatory Bowel Disease (IBD): Individuals diagnosed with IBD, such as Crohn's disease and ulcerative colitis, are at an increased risk of developing proctitis.
• Radiotherapy for Cancer: Undergoing radiation therapy targeted at the rectum or the surrounding area as part of cancer treatment, particularly for anal, ovarian, or prostate cancer, can raise the likelihood of developing proctitis.

Symptoms

Symptoms and signs of proctitis may include:

• Urgency to have a bowel movement
• Rectal bleeding
• Passage of mucus through the rectum
• Pain in the anus or lower left abdomen
• Feeling of fullness around the rectum
• Diarrhea
• Pain during bowel movements

Diagnosis

Starting with the patient's symptoms and health history, the diagnostic process for proctitis typically proceeds with a physical examination. If deemed necessary based on the initial assessment, diagnostic tests will be recommended to confirm the diagnosis. These tests may include:

• Blood tests: to detect infections or signs of blood loss.
• Stool tests: to determine if proctitis is caused by bacterial infection.
• Sigmoidoscopy: a procedure to visualize the sigmoid area and rectum using a flexible, illuminated tube. Tissue samples (biopsies) may be taken for further analysis.
• Colonoscopy: a similar procedure to sigmoidoscopy, but examining the entire large intestine.
• STD testing: a series of tests conducted using urine, blood, or swab samples from the genitals.

Management

The treatment approach for proctitis hinges on identifying and addressing the underlying cause of inflammation, whether due to infection, inflammation, or ongoing treatment.

Treatment for proctitis caused by infection

Treatment for proctitis attributed to infection typically involves medications targeting the specific infectious agent. This may include:

• Antibiotics: Prescribed to combat bacterial infections contributing to proctitis. It's crucial to take antibiotics exactly as directed by a healthcare professional.
• Antiviral drugs are administered to address viral infections like herpes, which can be transmitted through sexual contact. A healthcare provider should prescribe these medications.

Treatment for proctitis caused by Radiation Therapy

Mild radiation proctitis typically does not necessitate treatment. However, in severe cases where it causes significant pain and bleeding, medical intervention may be required. Treatment options may include:

• Medications that can be administered orally, in suppository form (inserted into the rectum), or as enemas (administered into the large intestine through the anus). These medications aim to control inflammation and reduce bleeding.
• Stool softeners to address bowel obstruction.
• Ablation or tissue destruction procedures involve destroying abnormal bleeding tissue to alleviate proctitis symptoms. Ablation methods may include argon plasma coagulation therapy, cryoablation, electrocoagulation, and other similar therapies.

Proctitis caused by inflammatory bowel disease

Proctitis caused by inflammatory bowel disease, such as Crohn's disease or ulcerative colitis, requires treatment to reduce inflammation in the rectum. The treatment options include:

• Anti-inflammatory drugs to control inflammation in the rectum. More potent medications like immunosuppressive drugs may be necessary in cases of inflammation associated with conditions like Crohn's disease.
• Surgery may be considered if medications fail to alleviate symptoms. In such cases, the doctor may recommend surgical intervention to remove damaged parts of the rectum and improve symptoms.

Complications

Untreated proctitis or cases not responding to therapy can lead to complications such as:

• Anemia which may result from chronic rectal bleeding. Anemia occurs when insufficient red blood cells transport oxygen to body tissues. Symptoms of anemia include fatigue, dizziness, shortness of breath, headaches, pale skin, and irritability.
• Ulcers or open sores may develop due to chronic inflammation in the rectum, affecting the inner layer of the rectal wall.
• Fistulas, abnormal channels between two organs that should not be connected, can arise when ulcers extend into the intestinal wall. Fistulas can develop between the intestines and the skin or between the intestines and other organs such as the bladder and vagina.

Prevention

Prevention measures to reduce the risk of proctitis include practicing prevention steps for STIs. The most reliable way to prevent STIs is to avoid sexual activities that carry a risk of infection, especially anal sex. If you choose to engage in sexual activity, reduce the risk of STIs by:

• Avoiding multiple sexual partners.
• Using a condom for every sexual encounter.
• Avoiding sexual contact with anyone who has sores or abnormal discharge in the genital area.
• If diagnosed with an STI, refrain from sexual activity until you are fully healed.
• Consult with your doctor to determine when it's safe to resume sexual activity.

When to see a doctor?

If you experience any signs or symptoms of proctitis, as mentioned above, consulting a doctor is crucial. Prompt and appropriate treatment can reduce the risk of complications and ensure proper condition management. Your doctor can provide an accurate diagnosis and recommend the most suitable treatment plan based on your specific situation.

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