Proctitis: Symptoms, Causes, Treatment

What are the symptoms of proctitis?

Proctitis is inflammation of the lining of the rectum and can cause a range of symptoms, including:

• Rectal Pain: Discomfort or pain in the rectal area, which can vary in intensity.
• Rectal Bleeding: Presence of blood in the stool, on toilet paper, or in the toilet bowl.
• Discharge: Mucous or pus-like discharge from the rectum.
• Urgency to Defecate: A frequent and urgent need to have bowel movements.
• Rectal Pressure or Fullness: A sensation of pressure or fullness in the rectum.
• Diarrhea or Constipation: Changes in bowel habits, including diarrhea or constipation.
• Itching or Irritation: Sensation of itching or irritation around the rectal area.
• Abdominal Discomfort: General discomfort or cramping in the lower abdomen.

The symptoms can vary depending on the underlying cause of the proctitis, which might include infections, inflammatory bowel disease (such as ulcerative colitis or Crohn’s disease), radiation therapy, or sexually transmitted infections. If you experience these symptoms, it’s important to seek medical evaluation to determine the cause and appropriate treatment.

What are the causes of proctitis?

Proctitis, or inflammation of the rectum lining, can be caused by various factors, including:

• Infections: Bacterial infections (such as gonorrhea, chlamydia, or tuberculosis), viral infections (such as cytomegalovirus or herpes simplex virus), and parasitic infections (such as Entamoeba histolytica) can lead to proctitis.
• Inflammatory Bowel Disease: Conditions like ulcerative colitis and Crohn’s disease can cause inflammation of the rectum as part of broader gastrointestinal inflammation.
• Radiation Therapy: Radiation treatment for cancers in the pelvic region, such as prostate cancer or cervical cancer, can lead to radiation proctitis.
• Sexually Transmitted Infections (STIs): STIs, including syphilis and herpes, can cause proctitis, particularly if transmitted through anal intercourse.
• Autoimmune Conditions: Autoimmune diseases such as Behçet’s disease can lead to proctitis as part of a broader systemic inflammatory response.
• Medications: Certain medications, especially those used for cancer treatment, can cause proctitis as a side effect.
• Trauma or Injury: Physical trauma or injury to the rectal area can result in inflammation.
• Allergic Reactions: Allergies or sensitivities to certain substances or medications can lead to proctitis.
• Radiation Therapy: Proctitis can occur as a side effect of radiation therapy used to treat cancers of the pelvic region.

Identifying the underlying cause of proctitis is crucial for effective treatment and management.

How is the diagnosis of proctitis made?

Diagnosing proctitis involves a combination of clinical evaluation, physical examination, and diagnostic tests to identify the underlying cause of the inflammation. The process typically includes:

• Medical History and Symptoms Review: A detailed discussion of symptoms, including duration, severity, and any related factors or recent exposures, helps guide diagnosis.
• Physical Examination: An examination may include a digital rectal exam (DRE) to assess for tenderness, bleeding, or other abnormalities in the rectal area.
• Endoscopy:
• Sigmoidoscopy: This procedure uses a flexible tube with a camera (sigmoidoscope) to view the rectum and lower colon. It helps visualize inflammation, ulcers, or other abnormalities.
• Colonoscopy: A more comprehensive examination using a colonoscope to view the entire colon and rectum, especially if inflammatory bowel disease is suspected.
• Biopsy: During endoscopy, a small sample of tissue from the rectum may be taken for histological examination to identify inflammation, infection, or cancer.
• Stool Tests: Stool samples may be tested for pathogens, such as bacteria, viruses, or parasites, to identify infections.
• Blood Tests: Blood tests can help assess overall health, check for signs of infection or inflammation, and evaluate the presence of conditions like inflammatory bowel disease.
• Imaging Studies: In some cases, imaging studies like a pelvic ultrasound or CT scan may be used to rule out other conditions or assess the extent of inflammation.
• Tests for STIs: If a sexually transmitted infection is suspected, specific tests for these infections may be performed.

Accurate diagnosis often requires a combination of these methods to determine the exact cause of proctitis and guide appropriate treatment.

What is the treatment for proctitis?

Treatment for proctitis varies depending on its underlying cause. If the inflammation is due to a bacterial infection, antibiotics will be prescribed. For viral or fungal infections, appropriate antiviral or antifungal medications will be used. To address inflammation, especially in conditions like inflammatory bowel disease, anti-inflammatory medications such as corticosteroids or 5-ASA compounds might be administered. Pain relievers, either over-the-counter or prescribed, can help manage discomfort.

Topical treatments may include the use of suppositories or enemas to deliver medication directly to the rectum, which can help reduce inflammation and manage symptoms. Dietary changes might be recommended, such as avoiding irritants or allergens and following a bland diet. Ensuring adequate hydration is important, particularly if diarrhea is present.

In severe cases, especially when conservative treatments are ineffective, surgical intervention may be necessary to address underlying conditions, such as those caused by inflammatory bowel disease or cancer. For patients experiencing trauma or radiation-induced proctitis, proper wound care and preventive measures are essential. Additionally, psychosocial support, including counseling or support groups, can help individuals cope with the chronic impact of the condition on their quality of life.

Overall, treatment plans are tailored to the individual based on the cause of proctitis, the severity of symptoms, and the patient’s overall health, with regular follow-up to monitor progress and adjust treatment as needed.