Proctitis Causes, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies

Proctitis Causes, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies

What is Proctitis?

Proctitis is an inflammation of the lining of the rectum, the end of the large intestine where stool passes through. It causes pain, soreness, bleeding, and a discharge of mucus or pus. It can also make you feel like you need to have a bowel movement all the time.

Proctitis can last a long (chronic) or a short (acute) amount of time. When the inflammation spreads beyond the rectum, the condition is often called proctocolitis.

Proctitis is common in people who have inflammatory bowel diseases. Sexually transmitted infections are another frequent cause. Proctitis also can be a side effect of radiation therapy for certain cancers.

Your doctor can usually treat proctitis successfully. Treatment depends on what's causing the inflammation. Sometimes proctitis can be treated the same way as inflammatory bowel disease, a condition where the lining of other parts of the digestive tract get inflamed.

Proctitis Causes

Proctitis has many causes, but sexually transmitted diseases (STDs) are the most common. Gonorrhea, syphilis, herpes, anal warts, and chlamydia are the most common cause of sexually transmitted proctitis. Proctitis is increasingly more common in homosexual men and in people engaging in oral-anal or anal intercourse with many partners.

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)
  • Antibiotics (a side effect from treatment for another illness)

Proctitis in children

Proctitis sometimes occurs in breast-fed children and in children who have strep throat. A form of proctitis caused by accumulation of a kind of white blood cell (eosinophil) in the lining of the rectum affects only children younger than 2.

Risk factors of Proctitis

Risk factors for proctitis include:

  • Behaviors that increase your risk of a sexually transmitted infection (STI). Your risk of contracting an STI increases if you have multiple sex partners, don't use condoms and have sex with a partner who has an STI.
  • 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 (such as for rectal, ovarian or prostate cancer) increases your risk of proctitis.

Symptoms of Proctitis

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. The rectum could feel "full." Or you could have constipation (unable to have a bowel movement).

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 pale skin, irritability, weakness, dizziness, brittle nails, and shortness of breath.

With sexually transmitted proctitis, you may have these symptoms

Gonorrhea (gonococcal proctitis): The primary cause appears to be anal intercourse. You may not have symptoms. If you have symptoms, you may have soreness or severe pain, itching, bloody or pus-like discharge, or diarrhea. Other rectal problems may be present such as anal warts, which are genital warts, anal tears, fistulas (abnormal passages that connect an organ or natural tube, like the rectum, to another surface), and hemorrhoids (dilated veins in the anus).

Syphilis (syphilitic proctitis): Symptoms are similar to those of other causes of infectious proctitis-rectal pain, discharge, and spasms during bowel movements. But you may have no symptoms. Syphilis is called the "great pretender" because it can mimic many diseases. The condition occurs in three stages:

  • Primary stage: A single painless sore with raised borders is rarely found at the site of sexual contact. These sores, or chancres, are less than an inch across. During acute stages of infection, the lymph nodes in your groin become diseased, firm, and rubbery.
  • Secondary stage: Syphilis produces a rash that can look very minor and easily missed, but also severe. It can cause swollen lymph nodes and weight loss resembling cancer.
  • Third stage: This usually appears late in the course of syphilis and affects mostly the heart and nervous system.
Chlamydia (chlamydial proctitis): This bacterial form of sexually transmitted proctitis may account for up to 20% of cases. You may show no symptoms, mild symptoms, or severe symptoms. Mild symptoms might be mild rectal pain with bowel movement, anal discharge, and cramping. With a severe case, you may have discharge containing blood and pus, severe rectal pain, and diarrhea. Some people may have rectal strictures, a narrowing of the rectal passageway. This narrowing might cause constipation, straining, and thin stools.

With proctitis caused by viruses, you may have these symptoms

Herpes simplex: The herpes simplex type 2 virus usually causes proctitis, but type 1 also can trigger the disease. As with the other causes, you may show no symptoms. Herpes proctitis is accompanied by anal pain and tenderness, discharge, and constipation. Tiny painful blisters or sores may be seen in clusters around the anus. In contrast to other causes of proctitis, if you have herpes, you also may have urinary retention and a weak stream, impotence, and pain in the buttocks and thigh.

Anal warts: A virus known as human papillomavirus (HPV) causes anal warts, which begin as soft, fleshy growths around the anus. These warts can extend to affect the lower part of the rectum. You may have anal itching, varying degrees of pain, and, with time, bleeding and discharge.

Anorectal trauma: Trauma to your anus or rectum, in which the anal and rectal linings stretch and tear, can be a potential cause of proctitis. Health care providers usually see such trauma in people who introduce any foreign object into their rectum. Foreign objects include a penis during anal intercourse or sex toys. Tiny cracks may be seen in the anal or rectal linings. It's important to tell your health care provider if you may be at risk for this type of proctitis. Sometimes, the foreign object may still be present in the rectum. People with anorectal trauma also may have an accompanying infection as a result of high-risk sexual behavior.

Radiation proctitis: Radiation therapy is used to treat prostate cancer in men and cancers of the female organs such as the cervix and uterus. The rectum is close to these organs and is at risk for damage from the radiation. Radiation-induced injury to the rectum can appear in two ways.

You may have diarrhea and tenesmus, which is a painful spasm of the urogenital diaphragm coupled with an urgent desire to urinate or have a bowel movement. Symptoms can occur while you receive radiation therapy or within 6 weeks after completion.

You may have more lasting problems from radiation treatment. In addition to rectal pain and diarrhea, you may have bleeding, which signifies chronic changes of the rectal lining. This condition includes the presence of multiple tiny blood vessels on the surface of the mucous membranes in the rectum. These vessels are fragile and bleed easily as a result of minor trauma. If the bleeding is severe, you may have weakness, dizziness, palpitations (feel your heart beating), and tiredness - all signs of iron deficiency anemia from blood loss.

When to Seek Medical Care for Proctitis

If you have any proctitis symptoms - especially if you have a history of high-risk sexual behavior that may lead to proctitis - you should contact your health care provider to be checked. Other minor conditions such as hemorrhoids also can cause similar symptoms. Your doctor can tell the difference and provide the right treatment.

If you have bleeding and mucus in a bowel movement, severe pain, and diarrhea, seek immediate treatment. Complications such as severe bleeding and anemia need immediate medical attention. As a result of diarrhea, you also may be dehydrated. Symptoms indicating severe disease include weakness, dizziness, irritability, shortness of breath, and headaches.

Treatments and drugs for Proctitis

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. Anti-inflammatory drugs such as sucralfate can be administered in pill, suppository or enema form. These medications can help control inflammation and reduce bleeding.
  • Stool softeners and dilation can help open up obstructions in the bowel.
  • 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 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. Inflammation in people with Crohn's disease often requires treatment with a medication that suppresses the immune system, such as infliximab (Remicade).
  • 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.

Eosinophilic proctitis 

Removing different nutrients from the diet, and then reintroducing them later, is an effective treatment strategy for this problem.

Prevention of Proctitis

Prevention of proctitis begins with addressing the high-risk sexual behaviors that you may engage in. Sexually safe behaviors include using protection such as the condom, knowing your sexual partner and history, and avoiding anal intercourse. You must use safe sex practices, such as condoms, if you engage in high-risk sexual behaviors such as these:

  • Having multiple sexual partners (or changing sexual partners)
  • A previous history of any sexually transmitted disease
  • Having a partner with a past history of any STD
  • Having a partner with an unknown sexual history
  • Using drugs or alcohol (these may increase the likelihood of unsafe sexual practices)
  • Having a partner who is an IV drug user
  • Bisexual or homosexual partners
  • Anal intercourse (Anal sex with a condom decreases the risk of proctitis by STDs, but you can still get proctitis from anal trauma)
  • Having unprotected intercourse (sex without the use of a condom) with an unknown partner

Lifestyle and home remedies for Proctitis

For temporary relief of mild pain and inflammation, try the following self-care measures:

  • Some simple lifestyle changes may relieve proctitis pain.
  • A soft, bland diet can reduce proctitis pain. Avoid spicy, acidic, or fatty foods during bouts of diarrhea.
  • Drink plenty of fluids, but avoid caffeinated sodas, coffees, and teas. Drinking eases the passage of stool. It also prevents dehydration from frequent, loose stools. Caffeine can irritate the digestive system.
  • 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.

Nutrition and Dietary Supplements

A comprehensive treatment plan for proctitis may include complementary and alternative therapies. Ask your team of health care providers about how to bring these therapies into your treatment plan. Always tell your health care provider about the herbs and supplements you are using or considering using.

These tips can keep you in good health overall:

  • Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
  • Eat foods high in B-vitamins, calcium, and magnesium, such as almonds, beans, whole grains, and dark leafy greens (such as spinach and kale).
  • Avoid refined foods such as white breads, pastas, and especially sugar.
  • Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
  • Use healthy oils, such as olive oil or vegetable oil.
  • Reduce or eliminate trans fats, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
  • Avoid caffeine, alcohol, and tobacco.
  • Drink 6 - 8 glasses of filtered water daily.
  • Exercise at least 30 minutes daily, 5 days a week.

These nutritional supplements may help with some symptoms of proctitis:

Getting more soluble fiber in your diet may help you have easier, more solid bowel movements. That may help if your proctitis is caused by inflammatory bowel disease. But you should talk to your doctor first, because some people with IBD find that fiber makes their symptoms worse. Soluble fiber is found in apples, steel cut oats, and flax seeds. Insoluble fiber (such as Metamucil or psyllium husks) can irritate some people's intestines.

Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day. Taking antibiotics can kill both friendly and unfriendly bacteria, upsetting the balance your body needs for healthy digestion. Probiotics, or "friendly" bacteria, can help restore the right balance of bacteria in your intestines. People who have inflammatory bowel disease should check with their doctor about whether probiotics would help them. Some studies have found that probiotics help reduce symptoms, but other studies haven't found any effect. Some people with weakened immune systems might need to avoid probiotics. Your doctor can help you figure out if probiotics are right for you.

Vitamin C, 500 mg; and vitamin E, 400 IU; three times daily. One study found that taking vitamin C and E helped reduce symptoms of proctitis caused by radiation therapy. Taking large doses of vitamin E can increase your risk of bleeding, especially if you take blood thinners like warfarin (Coumadin), clopidogrel (Plavix), or aspirin. Talk to your doctor before taking vitamin E for proctitis.

Omega-3 fatty acids, such as those found in fish oil (2.7 g per day) -- may help fight inflammation. One study found that people who took fish oil reduced their symptoms of proctocolitis. Fish oil may increase your risk of bleeding, so ask your doctor before taking it.