Proctitis is inflammation of the lining of the rectum and anus. The rectum is the last part of the digestive tract that connects the colon to the anus. Proctitis usually involves the last 6 inches of the rectum. It is often associated with an underlying condition and produces discomfort and a frequent urge to defecate.
Proctitis is commonly caused by sexually transmitted diseases such as syphilis, gonorrhoea, chlamydia and herpes. Those who participate in unsafe sexual practices are at high risk. Other causes for proctitis include trauma, inflammatory bowel disease such as Crohn’s and ulcerative colitis, and non-sexually transmitted infections such as salmonella and shigella. It can also develop following antibiotic use, radiation therapy targeted at the rectum or surrounding tissues, and after surgery to divert stool from the rectum which may be performed after colon surgery.
Proctitis can result in irritation, pain and a change in bowel habits that can affect normal life.
Towards the end of the digestive tract is the rectum which leads to the anal canal and anus. The rectum is lined by mucous membrane while the anal canal transitions to a skin-like lining. The lining in the lower portion of the canal is keratinized and consists of hair and glands. Blood vessels and nerves surround the rectal and anal passage. The urge to defecate is produced when nerves sense pressure and pain as stool enters the rectum. Muscles around the anal canal expand and contract to help with the passage of stool. Skin folds in the anal opening allow the skin to stretch without tearing.
Symptoms of proctitis include a continuous urge to have a bowel movement, irritation or tenderness of the anal or rectal tissues, pain and spasms with bowel movements, abdominal pain, constipation or diarrhea, discharge of mucus, and bleeding. Other symptoms may also be present depending on the underlying cause. Symptoms can last a short time or become chronic lasting weeks or months. You should contact your doctor if you have severe, persistent or recurrent symptoms.
Your doctor will review your medical history and social habits and perform a physical examination. A proctosigmoidoscopy may be performed to examine the anal and rectal passages. In this procedure an illuminated tube with a camera is introduced through the anus and rectum. Anal discharge or a sample of tissue may be obtained from the rectum or anus for evaluation in the laboratory. Bloods tests may also be performed.
Proctitis is usually associated with an underlying condition such as a sexually transmitted disease that should be treated to avoid complications. Untreated proctitis can result in ulcers or open sores due to chronic inflammation of the rectal lining. Infection can result in an abscess. There may be severe bleeding and anaemia which can lead to tiredness, dizziness, headaches, irritability and pale skin. An abnormal communication called a fistula may develop between the anal canal and an adjacent organ, passage or skin. Fistulas can get infected leading to further complications.
The goals of treatment are to control pain, inflammation and infection. Most cases of proctitis are managed by treating the underlying cause or condition. Your doctor may recommend antibiotics to treat sexually transmitted disease and other infections. A sitz bath where the area is immersed in warm water can relieve inflammation. You are advised a soft bland diet and plenty of water to ease the passage of stools. Certain conditions are managed by making lifestyle changes such as avoiding unsafe sex and injury to the anal canal. Anti-inflammatory drugs help control pain and inflammation. Immunosuppressant medication may be prescribed to relieve symptoms associated with autoimmune disease such as Crohn’s disease and ulcerative colitis. Medications such as rectal suppositories or rectal foam are applied topically. An enema may be used to deliver medication. Oral or intravenous medications may also be administered. Surgery may be necessary to remove damaged tissue. This is performed in rare cases of severe or frequent proctitis such as due to Crohn’s disease or ulcerative colitis.
Proctitis usually responds well to treatment and lifestyle changes. Symptoms may last longer or relapse when caused by autoimmune conditions or following radiation therapy. Resistant disease can lead to complications and may need surgical intervention.
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Research articles on Proctitis:
Allez M, Braegger F, Kempf C, Michetti P. P727 Efficacy of vedolizumab (VDZ) by disease localisation in Crohn’s disease. Journal of Crohn's and Colitis, Volume 12, Issue supplement_1, 16 January 2018, Pages S479, https://doi.org/10.1093/ecco-jcc/jjx180.854
Lamba MJ, Tharayil VS, Gearry RB. Editorial: does disease extension lead to disease progression in proctitis? Aliment Pharmacol Ther. 2017 Jul;46(2):205-206. doi: 10.1111/apt.14129.
Jensen MM, Jia W, Isaacson KJ, Schults A, Cappello J, Prestwich GD, Oottamasathien S, Ghandehari H. Silk-elastinlike protein polymers enhance the efficacy of a therapeutic glycosaminoglycan for prophylactic treatment of radiation-induced proctitis. J Control Release. 2017 Oct 10;263:46-56. doi: 10.1016/j.jconrel.2017.02.025. Epub 2017 Feb 21.