Proctitis

What is proctitis?

Proctitis is inflammation inside your rectum, which is the lower end of your large intestine just before your anus. “Procto” means “rectum,” and “itis” means “inflammation”. Your rectum can become inflamed if bacteria or chemicals irritate the inner lining, or if it’s affected by inflammatory bowel disease. It can cause uncomfortable symptoms, such as pain, rectal bleeding and poop changes.

What are the different types of proctitis?

Proctitis can be chronic or acute, depending on the cause. Acute means sudden and temporary, while chronic disease lasts a long time. Different causes of proctitis produce different types that sometimes go by different names. For example, sexually-transmitted infections (STIs) can cause “infectious proctitis,” radiation therapy can cause “radiation proctitis” and ulcerative colitis can cause “ulcerative proctitis.”

What are the symptoms of proctitis?

Common symptoms include:

• Anorectal pain.
• Pain in your abdominal left quadrant.
• Blood or mucus in your poop.
• Swelling or fullness in your rectum.
• Continuous feeling like you need to have a bowel movement (tenesmus).
• Difficult or painful bowel movements (dyschezia).
• Constipation.
• Diarrhea.

What are the first signs of proctitis?

The first signs are likely to appear when you go to the bathroom. You may find pooping uncomfortable with tenderness, burning or cramping. You may feel like you have to go urgently but then feel like you have trouble getting everything out. Diarrhea, bleeding or mucus in your poop are common early signs.

What are the causes of proctitis?

Proctitis has several possible causes, some more common than others.

Common causes of proctitis include:

Inflammatory bowel disease (IBD). Crohn’s disease and ulcerative colitis cause chronic inflammation in different parts of your bowels. Up to 30% of people affected by one of these diseases experience inflammation primarily in their rectum. This is the most common cause of proctitis overall.

Sexually-transmitted infections (STIs). Sexually-transmitted viral infections and bacterial infections can reach your rectum through your anus, including:

• Gonorrhea.
• Chlamydia.
• Herpes simplex 2.
• Syphilis.
• Human papilloma virus (HPV).

These infections can affect women and people assigned female at birth (AFAB) as well as men and people assigned male at birth (AMAB) who have anal-receptive sexual contact.

Gastrointestinal infections. Bacterial infections from food poisoning in your intestines may occasionally affect your rectum, including:

• Salmonella.
• Shigella.
• Campylobacter.

The bacterium clostridioides difficile (C. diff) may infect your intestines, including your rectum, if you’ve recently finished a course of antibiotics. C. diff lives in your intestines already, but antibiotics can upset the balance of your gut microbiome by killing off the other bacteria that would normally help to control C. diff.

Infant food protein allergies. Infants who have an intolerance to certain food proteins — usually, dairy milk or soy — may develop inflammation anywhere in their intestines, including in their rectum. Babies may ingest these proteins through infant formulas or through breastmilk if their breastfeeding (chestfeeding) parent ingested them.

Radiation therapy for cancer can cause radiation mucositis anywhere in your gastrointestinal tract. That means that the mucous lining inside your GI (gastrointestinal) tract becomes inflamed. Radiation enteritis and radiation colitis are common when you have targeted radiation to your upper or lower abdomen. You can get radiation proctitis if you have targeted radiation to your pelvic area.

Some less common causes of proctitis include:

Diversion proctitis. This side effect can occur in people who’ve had a colostomy or ileostomy that diverted their poop away from their rectum. The theory is that diverting poop away from your rectum deprives it of nutrients and short-chain fatty acids that usually keep the rectum lubricated and healthy. This causes inflammation in the rectum no longer being used. Only a minority have symptoms.

Intestinal ischemic syndromes. Similar to ischemic colitis, ischemic proctitis can occur when something stops the blood flow to your rectum, depriving the tissues of oxygen. Ischemia is usually caused by a blockage in your blood vessels, such as a blood clot, aneurysm or plaque.

Anorectal trauma. A foreign object or chemical inserted through your anus can cause inflammation in your anus and rectum. Chemicals found in some enemas may have this effect.

Eosinophilic gastrointestinal disorders (EGID). Eosinophilia is when your body produces an abnormally high number of white blood cells (eosinophils). White blood cells help your immune system produce an inflammatory response. In eosinophilic gastrointestinal disorders, your immune system sends an abnormally high number of eosinophils to some part of your gastrointestinal tract, causing chronic inflammation there. Researchers think it might be an overreaction to a food allergy. Eosinophilic proctitis mostly affects children under 2.

Idiopathic proctitis. In a small percentage of people, no direct cause for proctitis can be found. However, these cases often respond to dietary changes. Idiopathic proctitis tends to occur in repeat episodes, almost like a chronic condition. About 10% of cases eventually develop into ulcerative colitis.

Is proctitis a serious condition?

Under normal circumstances, proctitis isn’t life-threatening and responds well to treatment. But it could lead to more serious complications if it:

• Is severe.
• Lasts a long time.
• Goes untreated.
• Doesn’t respond to treatment.

For example, an ulcer that doesn’t heal might bleed too much, or might erode your rectum wall. Rarely, proctitis can affect nearby nerves, causing neuropathy.

Complications from prolonged inflammation can include:

• Excessive bleeding, leading to anemia.
• Fistulas (tunnels through your rectum wall).
• Stricture or stenosis (scarring of the tissues, causing your rectum to narrow).

Complications involving your nervous system are rare, but can include:

• Neurogenic bladder dysfunction.
• Numbness, tingling or burning in your lower limbs (paresthesia).
• Erectile dysfunction.

How is proctitis diagnosed?

A healthcare provider will begin by asking you about your symptoms, then physically examine your rectum for signs of proctitis (digital rectal exam and anoscopy). If proctitis appears likely, they’ll ask you further questions to help get an idea of what might have caused it or what type it is. They might ask:

• What medications you’ve taken lately.
• Whether you have a family history of autoimmune diseases.
• Whether you have unprotected sex or sex with unscreened partners.
• Whether you’ve recently traveled abroad.

Based on your answers and what they can see, they’ll decide which additional tests you might need.

Tests might include:

• A blood test. A blood test can identify infections and other conditions that may cause proctitis. It can also indicate blood loss or an excess of white blood cells.
• A stool test. A healthcare provider may test a sample of your poop for evidence of infection, bleeding or an excess of white blood cells.
• A rectal culture. For this test, a healthcare provider swipes the inside of your rectum with a cotton swab and then places it in a culture to identify bacteria or viruses in the sample.
• Proctoscopy. A proctoscopy is an examination of the inside of your rectum with a short, rigid scope. The proctoscope is a hollow tube with a lighted camera at the end. If needed, a healthcare provider can pass an instrument through the tube to take a tissue sample for biopsy.
• Flexible sigmoidoscopy. Your provider might use a slightly longer scope called a flexible sigmoidoscope if they want to see a little further in to examine the end part of your colon where it meets your rectum (your sigmoid colon). If your colon is involved, it might indicate inflammatory bowel disease or a gastrointestinal infection. This test will require a bowel prep.

Does proctitis go away by itself?

It can, but there’s no reason to tough it out. If you have an infection, antibiotics or antivirals will help end it quickly. If it’s not infectious, your provider can still treat it with steroids to clear up the inflammation. If you have radiation proctitis, it’ll usually go away several weeks after your radiation therapy is finished, but in the meantime, topical pain medications can help. If you have chronic IBD, proctitis may come and go on its own, but dedicated medications can help when it flares up.

How long does proctitis last?

This varies depending on the cause and on the person. It’ll go away quicker with treatment. In general, healing takes about four to six weeks after whatever caused the inflammation has stopped. While proctitis is healing, you may want to take over-the-counter (OTC) medications for pain or diarrhea.

What is the treatment for proctitis?

Treatment depends on the cause and how severe it is. It may include:

• Discontinuing whatever caused the inflammation.
• Antibiotics or antivirals to treat infections.
• Immunosuppressants for autoimmune-related proctitis.
• Sulfasalazine or mesalamine for ulcerative colitis/proctitis.
• Infliximab for Crohn’s-related proctitis.
• Topical corticosteroids for pain and inflammation.
• Sucralfate enemas to treat rectal ulcers.
• Endoscopic procedures to stop gastrointestinal bleeding.

Is proctitis preventable?

You can reduce your risk of STIs by screening your partners before sex. Protection, such as condoms, helps in some cases, but some infections can spread orally. Dental dams can decrease your chance of spreading or contracting an STI through oral sex. You can reduce your risk of gastrointestinal infection from food poisoning by observing safe food handling practices and being cautious of what you eat, especially when traveling abroad. Unfortunately, there’s no way to prevent IBD or radiation proctitis.

What is the outlook if I have proctitis?

Most cases of proctitis respond well to treatment. If it’s an acute case, it should resolve within four to eight weeks for adults or months for infants. If you have chronic proctitis associated with IBD, you may notice the inflammation comes and goes. You can treat flare-ups with anti-inflammatory drugs as needed. A small percentage of people develop chronic radiation proctitis that persists for a long time. Chronic cases are more likely to involve complications, which may be trickier to treat.

When should I see a healthcare provider about proctitis?

Always see a healthcare provider for symptoms of proctitis. It’s important to identify and treat the cause to prevent it from worsening. Keep in touch with your healthcare provider if you’re receiving treatment but it doesn’t seem to be working yet. Some types of proctitis may take some trial and error to manage effectively. Rarely, some cases don’t respond to any standard treatment. These may require surgery.

A note from Cleveland Clinic

The symptoms of proctitis are distressing, whether they’re temporary or ongoing. Treatment for proctitis focuses on the cause of the inflammation and the symptoms directly. In some cases, like with radiation proctitis, treating the symptoms is all you can do. In other cases, like an infection, it’s important to get tested to identify the specific bacteria or virus that’s causing your symptoms.