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Proctitis Treatment: How It Works

Written on July 28, 2023 by Lori Mulligan, MPH. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.


Table of contents


Proctitis is inflammation of the lining of the rectum, and it can be acute or chronic. Experts have identified several types of proctitis, including proctitis in inflammatory bowel disease (IBD), infectious proctitis, radiation proctitis, and diversion proctitis.

Common Causes of Proctitis

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)

STIs can reach your rectum through your anus, including:

  • Gonorrhea
  • Chlamydia
  • Herpes simplex 2
  • Syphilis
  • Human papillomavirus (HPV)

These infections can affect people 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 (also known as 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 it.

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 breast milk if their breastfeeding parent ingested them.

Radiation Therapy for Cancer

Radiation can cause radiation mucositis anywhere in your gastrointestinal tract. That means that the mucous lining inside your gastrointestinal (GI) tract becomes inflamed.

Radiation Enteritis and Radiation Colitis

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.[1]

Symptoms

Common symptoms of proctitis include diarrhea or constipation, pain, and passing blood, mucus, or pus with your stool. It may also cause tenesmus, which is the feeling that you need to pass stools even though your bowels are already empty. It may involve straining, pain, and cramping.

Diagnosis

Healthcare providers will ask about your medical history, perform a physical exam, and order tests to diagnose proctitis and find the cause. Tests for proctitis may include blood tests, stool tests, a rectal culture, and endoscopy tests such as colonoscopy or flexible sigmoidoscopy.[2]

Treatment

Treatment for proctitis depends on the underlying cause of the inflammation.

Proctitis caused by an infection

Your provider may recommend medications to treat your infection. Options may include:

  • Antibiotics. For proctitis caused by bacterial infections, your doctor may recommend an antibiotic, such as doxycycline (Oracea, Vibramycin, others).
  • Antivirals. For proctitis caused by viral infections, such as the sexually transmitted virus herpes, your doctor may prescribe an antiviral medication, such as acyclovir (Sitavig, Zovirax, others).

Private STD consultations

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 provider may recommend treatments such as:

  • Medications that include sucralfate (Carafate), mesalamine (Asacol HD, Canasa, others), sulfasalazine (Azulfidine), and metronidazole (Flagyl). These medications can help control inflammation and reduce bleeding.
  • Stool softeners and dilation. These can help open up obstructions in the bowel.
  • Damaged tissue removal or destruction. These techniques improve proctitis symptoms by destroying abnormal tissue (ablation) that is bleeding. Ablation procedures used to treat proctitis include argon plasma coagulation (APC), cryoablation, electrocoagulation, and other therapies.

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[3]:

  • Medications to control rectal inflammation. Your doctor may prescribe anti-inflammatory medications, either by mouth or as a suppository or enema, such as mesalamine or corticosteroids. Inflammation in people with Crohn's disease often requires treatment with a medication that suppresses the immune system, such as azathioprine or infliximab.
  • 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.

Complications

Proctitis that isn't treated or that doesn't respond to treatment may lead to complications, including[4]:

  • Anemia. Chronic bleeding from your rectum can cause anemia. With anemia, you don't have enough red blood cells to carry adequate oxygen to your tissues, causing you to feel tired. 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 between different parts of your intestine, between your intestine and skin, or between your intestine and other organs, such as the bladder and vagina.

How Everlywell Can Help

Researchers have found that a high detection rate of asymptomatic radiation proctitis suggests the utility of a total colonoscopy to screen for early-stage colorectal cancer prior to or following radiotherapy for prostate cancer. [5]

To increase awareness of potential colorectal cancer, Everlywell offers an at-home screening kit. Your test results will show you if you are negative or positive for blood in your stool. A positive result does not mean that you have colon cancer—it simply means you need to share the results with your healthcare provider to discuss the next steps, which may include a colonoscopy.

Everlywell’s Fecal Immunochemical Test (FIT) looks for hidden (also called occult) blood in your stool. Since colorectal polyps (which may be precancerous) can leak blood during the passage of stool, this non-invasive screening method is recommended by many physicians and public health organizations as an important way to catch colon cancer early so it can be treated.

Everlywell also offers a telehealth option that gives you quick access to an online STD consultation with a clinician to discuss testing, treatment, and more.

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References

  1. Proctitis. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/5964-proctitis. Accessed on July 21, 2023.
  2. Proctitis. National Institute of Diabetes and Digestive Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/proctitis. Accessed on July 21, 2023.
  3. Proctitis: Diagnosis and Treatment. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/proctitis/diagnosis-treatment/drc-20376938. Accessed on July 21, 2023.
  4. Proctitis: Symptoms and Causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/proctitis/symptoms-causes/syc-20376933. Accessed on July 21, 2023.
  5. Nakamura Y, Soma T, Izumi K, Sakai Y, Ushijima H, Kudo S, Saito Y, Kageyama Y. Screening of chronic radiation proctitis and colorectal cancer using periodic total colonoscopy after external beam radiation therapy for prostate cancer. Jpn J Clin Oncol. 2021 Aug 1;51(8):1298-1302. doi: 10.1093/jjco/hyab056. PMID: 33889961.
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