Proctitis

Definition

Proctitis is an inflammation of the rectum that causes discomfort, bleeding, and occasionally, a discharge of mucus or pus.

Alternative Names

Inflammation - rectum; Rectal inflammation

Causes, incidence, and risk factors

There are many causes of proctitis, but they can be grouped in the following categories:

• Autoimmune disease
• Harmful substances
• Non-sexually transmitted infection
• Sexually transmitted disease (STD)

Proctitis caused by STD is common among those who engage in anal intercourse. STDs that can cause proctitis include gonorrhea, herpes, chlamydia, lymphogranuloma venereum, and amebiasis.

Non-sexually transmitted infections causing proctitis are seen less often than STD proctitis. The classical example of non-sexually transmitted infection occurs in children and is caused by the same bacteria that cause strep throat.

Autoimmune proctitis is associated with diseases such as ulcerative colitis or Crohn's disease.

Proctitis may also be caused by certain medications, radiotherapy, and inserting harmful substances into the rectum.

Risk factors include:

• Autoimmune disorders
• High-risk sexual practices such as anal sex

Symptoms

• Bloody stools
• Constipation
• Rectal bleeding
• Rectal discharge, pus
• Rectal pain or discomfort
• Tenesmus (pain with bowel movement)

Signs and tests

• Examination of stool sample
• Proctoscopy
• Rectal culture
• Sigmoidoscopy

Treatment

Successful treatment of the underlying cause usually cures the problem. Proctitis caused by infection is treated with antibiotics. Corticosteroids or mesalamine suppositories may relieve symptoms of proctitis in those with Crohn's disease or ulcerative colitis.

Expectations (prognosis)

The probable outcome is good with treatment.

Complications

• Anal fistula
• Anemia
• Recto-vaginal fistula (women)
• Severe bleeding

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of proctitis.

Prevention

Safer sex behaviors may prevent the disease from being spread during sexual activity.

References

DuPont HL. Approach to the patient with suspected enteric infection. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier. 2007: chap 305.

Giannella RA. Infectious enteritis and proctocolitis and bacterial food poisoning. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2006: chap 104.

Rein MF. Approach to the patient with a sexually transmitted disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier. 2007: chap 307.

Stenson WF. Inflammatory bowel disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier. 2007: chap 144.