Proctitis

What is proctitis?

Proctitis is a term used to describe irritation of the rectum lining (known as the rectal mucosa). The rectum is the final part of the digestive system, which connects to the colon at one end and the anus at the other. Stools pass from the bowel along the rectum and out of the anus. Proctitis is similar to ulcerative colitis; though proctitis only affects the rectum while ulcerative colitis can affect the rectum and the colon. Proctitis can cause mucus, blood and pus to be discharged and can be an acute (temporary) or chronic (long-standing) condition. Some patients with chronic proctitis can go for long periods of time without any symptoms before experiencing a flare-up.

Proctitis can affect men and women and tends to be more common among white, European populations and is relatively uncommon among Asian populations.

What causes proctitis?

There are many possible causes of proctitis, including:

• Sexually transmitted infections, such as gonorrhoea, Chlamydia, syphilis and herpes; this is the most widespread cause of proctitis.
• Medication, including antibiotics, can cause proctitis as a side-effect.
• Treatment: treatments, including radiotherapy, can cause proctitis.
• Other inflammatory conditions, such as Crohn’s disease and ulcerative colitis.
• Infection.
• Rectal injuries.

As proctitis is more common among certain populations, this may suggest that environmental factors like diet may play a part.

Symptoms of proctitis

The main symptoms of proctitis include:

• Rectal bleeding: blood may be mixed with the stools.
• Needing the toilet suddenly.
• Always needing the toilet (known as tenesmus).
• Mucus discharge mixed with stools.
• Producing small stools on a regular basis.
• Abdominal pain on the left hand side of the abdomen.
• Pain around the rectum and anus.
• Diarrhoea.

If proctitis is left untreated it can lead to complications, which may include:

• Anaemia.
• Dehydration.
• Ulcers.
• Boils.

When should I see a doctor?

You should see your doctor if you develop any of the symptoms listed above, especially if you have a history of having sexual intercourse without using condoms. If you experience severe abdominal pain or you notice blood in your urine or faeces, you should arrange to see your GP as soon as possible or visit your local Accident and Emergency Department

How is proctitis diagnosed?

If you feel unwell or you develop symptoms you should see your GP. When you visit your GP they will ask you questions about your medical history, symptoms and carry out an assessment. If your doctor thinks you have proctitis they will refer you for some tests, which may include:

• Sigmoidoscopy: this test examines the lower part of the colon and allows doctors to see images of the lining of the sigmoid portion of the colon. The test is done using a thin tube, called a sigmoidoscope, which is fitted with a camera and passed up the back passage.
• Colonoscopy: this allows doctors to see detailed images of the colon and rectum using a thin, flexible tube known as a colonoscope. The test can determine the extent of inflammation. During the test a biopsy sample may be taken, which involves taking a very small piece of tissue. This sample is then analysed in the laboratory under a microscope.
• Blood tests: the results of blood tests can show the extent of inflammation.
• Stool sample: this may be analysed to check for underlying infections, which could be causing symptoms such as diarrhoea.

Treatment for proctitis

Treatment for proctitis depends on the cause. If proctitis is a result of an underlying infection or condition, this will be treated first and in most cases the inflammation will go down without further treatment. If proctitis is not caused by an underlying health condition or infection, medication is usually prescribed and drugs are given via enema, foam preparations or suppositories. The most commonly used drugs for proctitis are topical steroids known as 5-ASA. These help to reduce inflammation in the bowel. Most cases of proctitis are caused by sexually transmitted infections and the main solution in this case will be a course of antibiotics.

In rare cases immunosuppressant medication may be given. Surgery is used rarely to treat patients with proctitis and you will only be considered if the condition is causing serious problems and flaring up on a regular basis. Patients with chronic proctitis are advised to see their doctor on a regular basis.

Preventing proctitis

It is not always possible to prevent proctitis, especially if it caused by an underlying health condition, such as Crohn’s disease. But you can reduce your risk of developing proctitis by practising safe sex and avoiding multiple sexual partners. Condoms are available free of charge from sexual health clinics, GP surgeries and GUM (genitourinary medicine) clinics.