Proctitis

• Proctitis is characterized by inflammation of the rectal lining, leading to symptoms like rectal pain and bleeding.
• Causes vary widely, including infections, inflammatory bowel disease, radiation therapy, and certain medications.
• Diagnosis typically involves a physical examination, endoscopy with biopsy, and stool tests.
• Treatment focuses on addressing the underlying cause and managing symptoms through medications and lifestyle adjustments.

What is Proctitis?

Proctitis refers to the inflammation of the inner lining of the rectum. This condition can manifest acutely, appearing suddenly and lasting for a short period, or chronically, persisting over an extended duration. The rectum plays a crucial role in storing stool before defecation, and its inflammation can disrupt normal bowel function and lead to various uncomfortable symptoms.

The inflammation can range from mild to severe, affecting only a small portion of the rectal lining or extending throughout. Understanding the nature and extent of this inflammation is key to effective management, as it guides diagnostic approaches and therapeutic interventions. According to the Crohn’s & Colitis Foundation, proctitis is a common manifestation of inflammatory bowel disease, particularly ulcerative colitis, where inflammation is often confined to the rectum.

Proctitis Symptoms and Causes

The symptoms of proctitis can vary depending on the severity and underlying cause, but they commonly involve discomfort and changes in bowel habits. Recognizing these signs is important for early diagnosis and treatment.

Common symptoms of proctitis include:

• Rectal pain, which can range from a dull ache to severe cramping.
• Tenesmus, a persistent feeling of needing to pass stool, even when the bowels are empty.
• Rectal bleeding, often noticed as bright red blood on toilet paper or in the stool.
• Passage of mucus or pus from the rectum.
• Urgency to have a bowel movement.
• Diarrhea or constipation, or alternating patterns of both.
• Abdominal pain or discomfort.

The causes of proctitis are diverse and can include:

• Inflammatory Bowel Disease (IBD): Conditions like ulcerative colitis and Crohn’s disease are frequent causes, with inflammation often localized to the rectum.
• Infections: Sexually transmitted infections (STIs) such as gonorrhea, chlamydia, herpes simplex virus, and syphilis can cause infectious proctitis. Other bacterial infections (e.g., Salmonella, Shigella, Campylobacter) and viral infections (e.g., cytomegalovirus) can also be culprits.
• Radiation Therapy: Radiation proctitis can develop after radiation treatment for cancers in the pelvic area, such as prostate or rectal cancer, due to damage to the rectal lining.
• Medications: Certain antibiotics or other drugs can sometimes trigger proctitis as a side effect.
• Diversion Proctitis: This occurs in individuals who have undergone a colostomy or ileostomy, where the fecal stream is diverted from the rectum, leading to inflammation in the unused rectal segment.
• Trauma: Injury to the rectum, for instance, from anal intercourse or foreign objects, can lead to inflammation.

Diagnosis and Treatment Options for Proctitis

Diagnosing proctitis involves a thorough evaluation to identify the specific cause, which is crucial for determining the most effective course of action. The diagnostic process typically begins with a review of the patient’s medical history and a physical examination, including a digital rectal exam to check for tenderness, abnormalities, or blood.

Further diagnostic tests may include:

• Endoscopy: A sigmoidoscopy or colonoscopy allows a doctor to visualize the lining of the rectum and lower colon directly. During this procedure, biopsies can be taken to examine tissue samples under a microscope for signs of inflammation, infection, or other conditions.
• Stool Tests: These tests can help identify bacterial, viral, or parasitic infections that might be causing the inflammation.
• Blood Tests: Blood tests may be performed to check for signs of inflammation, anemia, or specific antibodies associated with inflammatory bowel diseases.

Once a diagnosis is confirmed and the underlying cause is identified, various proctitis treatment options are available. The goal of treatment is to reduce inflammation, alleviate symptoms, and address the root cause of the condition. Treatment approaches vary widely:

For infectious proctitis, antibiotics, antivirals, or antiparasitic medications are prescribed to eliminate the specific pathogen. For proctitis caused by inflammatory bowel disease, anti-inflammatory drugs such as mesalamine (administered orally or rectally as suppositories or enemas), corticosteroids, or immunosuppressants may be used to control the inflammation. In cases of radiation proctitis, treatments might include anti-inflammatory medications, sucralfate enemas, or in severe cases, endoscopic therapies to stop bleeding or repair damaged tissue. Diversion proctitis often responds to short-chain fatty acid enemas or, in some instances, surgical rejoining of the bowel.

Lifestyle modifications, such as dietary adjustments to avoid irritants or increase fiber intake, can also support recovery and symptom management, particularly for chronic forms of proctitis. It is important for patients to work closely with their healthcare provider to develop a personalized treatment plan and monitor its effectiveness.