Proctitis
Sutter Davis Hospital Gastroenterology

Definition
Proctitis is an inflammation of the lining of your rectum. Sexually transmitted diseases (STDs) are the most common cause, but other causes include inflammatory bowel diseases and non-sexually transmitted infections.  Proctitis may also be a side effect of some medical treatments, including radiation therapy, or antibiotic use.

Causes
Sexually transmitted proctitis is most common in people who engage in anal or oral-anal intercourse, particularly if they have multiple partners. Proctitis in general mainly affects adult males.  Other causes include the following: nonsexually transmitted infections, autoimmune diseases of the colon such as Crohn disease and ulcerative colitis, Harmful physical agents, Chemicals, Foreign objects placed in the rectum, trauma to your anorectal area, radiation (a side effect from treatment for another illness), and antibiotics (a side effect from treatment for another illness).

Symptoms
The symptoms of proctitis are different depending on the cause.

• The most common symptom is that you feel a continuing urge to have a bowel movement. Your rectum could feel "full." Or you could have constipation.
• You may have minor symptoms such as tenderness in the anal region and mild irritation of the rectum.
• More serious symptoms may occur, such as pus and blood in discharge accompanied by severe cramps and pain during bowel movements.
• If you have severe bleeding associated with proctitis, you may develop anemia (from loss of blood). Anemia can cause you to have pale skin, irritability, weakness, dizziness, brittle nails, and shortness of breath.

Treatment

• Lifestyle Changes:  Because the most common cause of proctitis remains sexually transmitted disease, you must use safe sex practices, such as condoms, if you engage in high-risk sexual behavior.
  
• Medications:  Because the most common cause of proctitis remains sexually transmitted disease, you may be given antibiotics to kill the organism. If you have inflammatory disease causing proctitis, such as ulcerative colitis or Crohn disease, you will require continuing treatment. Treatments include medications that suppress the immune system, such as steroids. Your doctor may prescribe steroid suppositories to provide relief in your rectum. In addition you may receive treatment for control of symptoms such as diarrhea.
• Surgery:  If the disease stems from a chronic illness, surgery may be required.  For patients with ulcerative colitis requiring surgical therapy, a total proctocolectomy should be performed and reconstruction with an ileal pouch may be offered. In patients with severe Crohn colitis or proctitis, options range from fecal diversion, proctectomy, and total proctocolectomy based on the extent of the disease process.  In the infectious causes of proctitis, surgical treatment is rarely required.