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Definition
Proctitis is an inflammation of the lining of the rectum. The rectum is a muscular tube that's connected to the end of your colon. Stool passes through the rectum on its way out of the body.
Proctitis can cause rectal pain and the continuous sensation that you need to have a bowel movement. Proctitis symptoms can be short-lived, or they may become chronic.
Proctitis has many possible causes, including sexually transmitted diseases, inflammatory bowel diseases and non-sexually transmitted infections. Proctitis may also be a side effect of radiation therapy for cancer.
Symptoms
Proctitis signs and symptoms may include:
- Frequent or continuous sensation that you need to have a bowel movement
- Rectal bleeding
- The passing of mucus through your rectum
- Rectal pain
- Pain on the left side of abdomen
- A feeling of fullness in your rectum
- Diarrhea
- Pain with bowel movements
When to see a doctor
Make an appointment with your doctor if you have any signs or symptoms that worry you.
Causes
Proctitis is inflammation of the lining of the rectum. Several diseases and conditions can cause proctitis.
Examples of causes of proctitis include:
- Infections. Sexually transmitted diseases (STDs) can irritate the lining of the rectum. STDs that can cause proctitis include gonorrhea, genital herpes and chlamydia. Other infections can cause proctitis, including infections associated with food-borne illness, such as salmonella, shigella and campylobacter.
- Inflammatory diseases that affect the colon and rectum. Inflammatory bowel diseases, such as ulcerative colitis or Crohn's disease, can cause proctitis.
- Radiation therapy for cancer. Radiation therapy directed at your rectum or nearby areas can cause irritation of the lining of your rectum. Radiation proctitis can begin during radiation treatment and last for a few months after treatment. Or it can occur months and years after treatment.
Risk factors
Risk factors for proctitis include:
- Behaviors that increase your risk of an STD. Your risk of contracting an STD increases if you have multiple sex partners, don't use condoms and have sex with a partner who has an STD.
- Inflammatory bowel diseases. Having an inflammatory bowel disease, such as ulcerative colitis or Crohn's disease, increases your risk of proctitis.
- Radiation therapy for cancer. Radiation therapy directed at or near your rectum increases your risk of proctitis.
Complications
Proctitis that isn't treated or that doesn't respond to treatment may lead to complications, including:
- Anemia. Chronic bleeding from your rectum caused by proctitis can cause anemia. With anemia, you don't have enough red blood cells to carry adequate oxygen to your tissues. Anemia causes you to feel tired, and you may also experience dizziness, shortness of breath, headache, pale skin and irritability.
- Ulcers. Chronic inflammation in the rectum can lead to open sores (ulcers) on the inside lining of the rectum.
- Fistulas. Sometimes ulcers extend completely through the intestinal wall, creating a fistula, an abnormal connection that can occur between different parts of your intestine, between your intestine and skin, or between your intestine and other organs, such as the bladder and vagina. For women, a recto-vaginal fistula can connect the rectum to the vagina, causing bowel contents to drain from the vagina.
Preparing for your appointment
Start by seeing your family doctor or a general practitioner if you have any signs or symptoms that worry you. If your doctor suspects you may have proctitis, you may be referred to a doctor who specializes in diseases of the digestive system (gastroenterologist).
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared. Here's some information to help you get ready, and what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, as well as any vitamins or supplements, that you're taking.
- Take a family member or friend along. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important, in case time runs out. For proctitis, some basic questions to ask your doctor include:
- Is proctitis causing my symptoms or condition?
- What are possible causes for my proctitis?
- What kinds of tests do I need?
- What are my treatment options?
- What are the benefits and risks of each treatment option?
- I have these other health conditions. How can I best manage them together?
- Are there any restrictions that I need to follow?
- Is there a generic alternative to the medicine you're prescribing?
- Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?
- What will determine whether I should plan for a follow-up visit?
In addition to the questions that you've prepared, don't hesitate to ask questions during your appointment at any time that you don't understand something.
Tests and diagnosis
Tests and procedures used to diagnose proctitis include:
- Stool test. You may be asked to collect a stool sample for testing. A stool test may help determine if your proctitis is caused by a bacterial infection.
- Using a scope to examine the final portion of your colon. During a flexible sigmoidoscopy, your doctor uses a slender, flexible, lighted tube to examine the sigmoid — the last two feet (61 centimeters) of your colon — including the rectum. During the procedure, your doctor can also take small samples of tissue (biopsy) for laboratory analysis. Sometimes a tissue sample can help confirm a diagnosis.li>
- Using a scope to examine your entire colon. A colonoscopy allows your doctor to view your entire colon using a thin, flexible, lighted tube with an attached camera. Your doctor also can take a biopsy during this test.
- Testing for sexually transmitted diseases. This involves obtaining a sample of discharge from the tube (urethra) that drains urine from your bladder or from your rectum. If the cause of your proctitis is likely to be an STD, your doctor may insert a narrow swab into the end of your urethra or anus to obtain the sample, which is then tested for the presence of bacteria or other infectious organisms. The results can be used to select the most effective treatment.
Treatments and drugs
Treatment for proctitis depends on the underlying cause of the inflammation.
Treatment for proctitis caused by an infection
Your doctor may recommend medications to alleviate the cause of your infection. Options may include:
- Antibiotics. For proctitis caused by bacterial infections, your doctor may recommend an antibiotic.
- Antivirals. For proctitis caused by viral infections, such as the sexually transmitted virus herpes, your doctor may prescribe an antiviral medication.
Treatment for proctitis caused by radiation therapy
Mild cases of radiation proctitis may not require treatment. In other cases, radiation proctitis can cause severe pain and bleeding that requires treatment. Your doctor may recommend treatments such as:
- Medications to control bleeding. Steroids and other anti-inflammatory drugs can be administered in pill, suppository or enema form. These medications can help control inflammation and reduce bleeding.
- Treatment to destroy damaged tissue. These techniques improve proctitis symptoms by destroying abnormal, bleeding tissue. Ablation procedures used to treat proctitis include laser therapy and argon plasma coagulation (APC). Laser therapy uses a hot beam of light (laser) inserted in the rectum to burn away lesions, while APC uses a jet of argon gas along with an electric current.
Proctitis caused by inflammatory bowel disease
Treatment of proctitis related to Crohn's disease or ulcerative colitis is aimed at reducing the inflammation in your rectum. Treatment may include:
- Medications to control rectal inflammation. Your doctor may prescribe anti-inflammatory medications, such as mesalamine (Asacol, Canasa, others) or corticosteroids. These drugs are available in pill, suppository or enema form. Steroid suppositories or enemas may ease inflammation in your rectum.
- Surgery. If drug therapy doesn't relieve your signs and symptoms, your doctor may recommend surgery to remove a damaged portion of your digestive tract.
Lifestyle and home remedies
For temporary relief of mild pain and inflammation, try the following self-care measures:
- Ask your doctor before using over-the-counter (OTC) diarrhea medicines. Don't take OTC anti-diarrhea drugs, such as loperamide (Imodium A-D), without your doctor's OK.
- Avoid food just before bedtime. Eating just before going to bed may stimulate your digestive system and cause you to have bowel movements and discomfort at night.
- Take over-the-counter pain relievers. Acetaminophen (Tylenol, others), aspirin or ibuprofen (Advil, Motrin, others) may relieve your discomfort. However, if you have colitis, pain relievers such as aspirin or ibuprofen could make your condition worse. Talk to your doctor before taking them.
- Use a sitz bath with warm water. A sitz bath fits over the toilet. You can get one at a medical supply store or some pharmacies. This may provide some comfort if you experience anal inflammation.
Prevention
To reduce your risk of proctitis, take steps to protect yourself from sexually transmitted diseases. The surest way to prevent sexually transmitted diseases is to abstain from sex.
If you choose to have sex, reduce your risk of sexually transmitted diseases by trying to:
- Limit your number of sex partners.
- Use a latex condom during each sexual contact.
- Don't have sex with anyone who has any unusual sores or discharge in the genital area.
If you're diagnosed with a sexually transmitted disease, stop having sex until after you've completed treatment. That way you can avoid passing the disease to your partner. Ask your doctor when it's safe to have sex again.
Last Updated: 2010-04-03
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