Proctitis affects mainly adolescents and adults. It is most common in men around age 30. Proctitis is caused by several different sexually transmitted diseases. Male homosexuals and people who practice anal intercourse are more likely to suffer from proctitis. Patients who have AIDS or who are immunocompromised are also more at risk.
Discharge of blood and mucus and intense pain in the area of the rectum and anus are all signs of proctitis. Patients feel the urge to have frequent bowel movements even when there is nothing present to eliminate. They may also have constipation, diarrhea, fever, and open sores around the anus. Other symptoms include cramping, lower back pain, difficulty urinating, and impotence.
Diagnosis
Proctitis is diagnosed by a patient history and physical examination. It is confirmed by a proctoscopy (examination of the rectum with an endoscope inserted through the anus). Proctoscopy usually shows a red, sore, inflamed lining of the rectum. Biopsies, smears, and lab cultures of rectal material are used to determine the exact cause of the inflammation so that the underlying cause can be treated appropriately.
Since the two problems often occur together, in the presence of proctitis, the large bowel should be examined for ulcerative colitis.
Treatment
Once the underlying cause of the inflammation is diagnosed, appropriate treatment begins. Antibiotics are given for bacterial infections. There is no cure for genital herpes, but the antiviral drug, acyclovir, is often prescribed to reduce symptoms. Corticosteroid suppositories or ointments such as hydrocortisone are used to lessen discomfort, and the patient is encouraged to take warm baths to ease painful symptoms. Ulcerative proctitis often responds well to corticosteroid enemas or foam, or to sulfasalazine and related drugs.
Alternative treatment
Depending on the cause of proctitis, alternative medicine has several types of treatments available. If proctitis is related to gonorrhea, syphilis, or chlamydia, appropriate antibiotic treatment is recommended. Supplementation with Lactobacillus acidophilus is also recommended during and following antibiotic therapy to help rebuild normal gut flora that is destroyed by antibiotics. If proctitis is herpes-related, antiviral herbs taken internally, as well as applied topically, can be be helpful. Sitz baths and compresses of herbal infusions (herbs steeped in hot water) and decoctions (herbal extracts prepared by boiling the herb in water) can be very effective. Among the herbs recommended are calendula (Calendula officinalis), comfrey (Symphytum officinale), and plantain (Plantago major). Proctitis related to candidiasis requires dietary alterations, especially elimination of sugar from the diet. Any immunocompromised person needs close medical attention. If proctitis is related to inflammatory bowel diseases, the resolution of the underlying condition should contribute to resolution of the proctitis. Acupuncture and homeopathic treatment can be very useful in resolving inflammatory bowel diseases.
Prognosis
Proctitis caused by bacteria is curable with antibiotics. Genital herpes is not curable. Although symptoms can be suppressed, proctitis may reoccur. Patients with AIDS are especially susceptible to candidiasis infections, which may be hard to control. Recovering from proctitis caused by inflammatory bowel diseases is variable and depends on successful management of those diseases. Severe proctitis can result in permanent narrowing of the anus.
Prevention
Proctitis is best prevented by using condoms and practicing safer sex to prevent acquiring sexually transmitted diseases. Avoiding anal intercourse also helps prevent damage to the rectum.
BOOKS
Margolis, Simon, ed. "Proctitis." In Johns Hopkins Symptoms and Remedies. New York: Rebus, 1995.
