Proctitis, and other causes of rectal pain, is diagnosed and treated by the GI Division of Premier Medical Group. Proctitis is an inflammation of your anus and lining of your rectum. Typically the inflammation only affects the last 6 inches of the rectum and the symptoms can greatly vary. Proctitis can last a short time or become a chronic condition (last for weeks or months or longer). The condition can be uncomfortable, even painful, and can lead to bleeding or mucous discharge.

What is proctitis?

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Proctitis is an inflammation of your anus and rectum including the lining of the rectal canal and underlying mucous membrane. Typically, the inflammation only affects the last 6 inches of the rectum. Some type of rectal pain is almost always involved especially during bowel movements, but the symptoms can vary greatly. Proctitis can last for a short time or become a chronic condition (lasting for weeks or months or longer). The condition can be uncomfortable, even painful, and can lead to bleeding or mucous discharge.

What causes proctitis?

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The most common causes of proctitis are ulcerative colitis, Crohn’s disease, antibiotics, sexually transmitted diseases (STDs), non-STD infections, and radiation therapy.

  • Ulcerative colitis: Ulcerative colitis: UC, or ulcerative colitis, is a chronic disease in the inner lining of the large intestine. It can cause inflammation and sores, called ulcers, in the intestine and rectum.
  • Sexually transmitted diseases (STDs): The most common STDs that can be passed when a person is receiving anal sex include gonorrhea, chlamydia, syphilis, and herpes. Herpes-induced proctitis may be particularly severe in people who are also infected with the HIV virus.
  • Non-STD infections: Infections that are not sexually transmitted also can cause proctitis. Salmonella and Shigella are examples of foodborne bacteria that can cause proctitis. Streptococcal proctitis sometimes occurs in children who have strep throat.
  • Antibiotics:Proctitis can be a side effect from antibiotic treatment for another illness. The antibiotic treatments can let an infection take hold by harming protective organisms in the GI tract. An additional course of antibiotics should be able to clear the infection causing the proctitis.
  • Anorectal trauma: This can happen with anal sex, or with the insertion of objects or harmful substances into the rectum.
  • Radiation therapy: People who have had radiation therapy that targets the pelvic area also may develop proctitis. Examples of those at risk are people with rectal, ovarian, or prostate cancer who have received radiation treatment directed to those areas. Symptoms of radiation proctitis, most commonly rectal bleeding, will typically occur within 6 weeks after beginning radiation therapy or more than 9 months after its completion.

What are the symptoms of proctitis?

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The most common symptom of proctitis is an uncomfortable and frequent urge to have a bowel movement. Symptoms can vary. You may at first have only minor problems, such as tenderness in the anal region and mild irritation of the rectum. Your rectum could feel “full,” or you could be constipated. Other common symptoms include but are not limited to:

  • bloody bowel movements
  • rectal bleeding
  • a feeling of rectal fullness and incomplete evacuation
  • anal or rectal pain
  • soreness in your anal and rectal area
  • severe cramps or pain during bowel movements
  • rectal discharge of mucus or pus
  • involuntary spasms and cramping during bowel movements
  • diarrhea or frequent passage of loose or liquid stools

With sexually transmitted proctitis, you may have these symptoms:

  • Gonorrhea (gonococcal proctitis): The primary cause of gonorrhea appears to be anal intercourse and you may or may not have symptoms. The most common symptoms include soreness, itching, bloody or pus-like discharge, and diarrhea.
  • Syphilis (syphilitic proctitis): The symptoms are similar to those of other causes of infectious proctitis—rectal pain, discharge, and spasms during bowel movements, or you may have no symptoms.
  • Chlamydia (chlamydial proctitis): This STD accounts for up to 20% of sexually related cases of proctitis. Some people have no symptoms, while others have mild or severe symptoms. These include mild to severe rectal pain with bowel movement, anal discharge, with or without blood and pus, cramping, and diarrhea.

What is acute vs. chronic proctitis?

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Once treatment begins, acute proctitis shows marked improvement within a couple weeks, if not days. Sometimes, however, chronic proctitis may continue to show symptoms for several weeks, months, or even years. Typically, the likelihood of experiencing chronic proctitis depends on the cause. Chronic proctitis is much more likely when caused by ulcerative colitis or Crohn’s disease, for example, than an STD that responds well to treatment.

Even acute proctitis, particularly those caused by infection, may linger without the proper diagnosis and treatment. Both acute and chronic proctitis can present with symptoms that are milder or more severe in nature. It’s also true that some causes of proctitis can create very different timelines for symptoms to emerge. As previously mentioned, radiation therapy can cause proctitis within weeks of treatment or after a period of 9 months of more.

How is proctitis diagnosed?

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The diagnosis of proctitis is typically based on symptoms of the patient. If your health care provider suspects proctitis, he or she will first take complete medical history. It’s important to be honest with your health care provider about your sexual practices, high-risk behaviors, and the nature of your rectal pain and other symptoms. You will need to share your current and past medications, and family history. The exam will include abdominal exam, vital signs and a rectal exam. Other procedures may include:

  • Proctosigmoidoscopy: This is a tiny lighted tube which is passed through the anus to see the exterior of the rectum. A TV screen will show the doctor the images.
  • Biopsy: The doctor may take a small sample of tissue from your rectum and send it to the lab for analysis. Any discharge will also be tested.
  • Blood test: The doctor will check for the presence of antibodies
  • Stool sample: This helps to identify bacteria in the stool.
  • Rectal culture: A small sample is taken by inserting a cotton swab into the rectum. This is sent to the lab.
  • Anoscopy: This is a special instrument that opens the anal canal and lower rectum to provide a better examination.
  • Flexible sigmoidoscopy and colonoscopy: This test allows the doctor to see the entire colon and rectum.

What else causes rectal pain?

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From constipation to cancer, there are numerous conditions which may cause rectal pain, bloody bowel movements and/or abdominal cramping. Because the symptoms of proctitis can be mild or severe and varied in general, these conditions may mimic proctitis in one way or another.

Without any other symptoms, mild spotting of blood in the stool may be something relatively minor. However, many conditions which cause bloody bowel movements are quite serious or even life-threatening, and you should seek out immediate medical attention, especially when a considerable amount of blood is present.

Even when it comes to the basic symptoms of pain, soreness, cramping, and/or burning in the rectal area, there are other conditions that may need to be considered. Anusitis, for example, is inflammation that’s confined to the lining of the rectal canal, whereas proctitis includes inflammation of the rectum’s mucous membrane. Anusitis is almost always caused by diet, especially coffee, beer, citrus, and spicy foods. Rather than inflammation of the tissue, hemorrhoids are swollen veins in the anus or rectum which may cause pain, swelling, itching, and bleeding.

How is proctitis treated?

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The treatment for proctitis will depend on its cause. The primary goal is to reduce inflammation, control symptoms, and eliminate infection, if there is one. The most important thing is to get the proper diagnosis and medical attention. Since the most common cause is STDs (sexually transmitted diseases) the doctor will prescribe a course of antibiotics. Sometimes there is more than one type of infection and you may need more than one type of medication; either way if infection is present with proctitis, antibiotics can be used to kill bacteria and antiviral medications can treat viral infections. You will be instructed to practice safe sex using condoms.

If you have Crohn’s or ulcerative colitis that is causing the proctitis, the treatment will be ongoing. This type of treatment generally includes medications that suppress the immune system, such as steroids. Your health care provider or gastroenterologist may also prescribe steroid suppositories. These will provide you some relief in your rectum. If you have diarrhea, the medications to control symptoms will be different. With proper medical attention, proctitis can be successfully treated.

Surgical treatment

Sometimes surgery is required, especially if the disease stems from a chronic illness. Your health care provider will refer you to a gastroenterologist, a specialist who deals with all the organs from the mouth to the anus.

Helpful Tips for Proctitis

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  • Avoid caffeine.
  • Drink plenty of fluids when diarrhea occurs.
  • Avoid fatty foods and ones high in fiber.
  • Limit dairy products.
  • Avoid food before bedtime (it stimulates your digestive system and may cause a bowel movement and or discomfort at night).
  • Taking over-the-counter pain relievers such as acetaminophen (Tylenol), aspirin, or ibuprofen (Advil, Motrin, etc.) may help to relieve your discomfort. If you suffer from colitis, aspirin or ibuprofen could irritate your condition and make it worse. Discuss any medications with your health care provider before taking them.
  • Use a sitz bath with warm water.You can get one that fits over the toilet at a medical supply store or pharmacy. This may provide some comfort with inflammation.
  • Use a condom during anal sex.
  • Stop any activity which led to the proctitis.
  • Remember, prevention starts with evaluating any high-risk sexual behaviors that you may engage in. Using condoms, knowing your partner’s history and avoiding anal intercourse will help avoid infections.