What is proctitis?
Proctitis is the medical term for inflammation of the inner lining of the rectum, the portion of the large bowel between the sigmoid colon and anus. The rectum usually fills with feces just before the start of defecation and then contracts to evacuate the feces down the anal canal and out of the anus. Proctitis may be acute or chronic, can involve the colon and usually extends to the anus. Although proctitis may arise due to various causes, the concern lies with sexually transmitted infections, especially if there is anal intercourse. In these cases, patients often delay seeking medical treatment due to embarrassment until the infection spreads or complications arise in the chronic setting.
In proctitis, there is inflammation of the rectal mucosa which is the most superficial lining of the rectum. Depending on the severity, the inflammation may also involve deeper lying tissue of the rectum and damage local blood vessels. Chronic proctitis or severe acute cases, especially due to infectious causes, that remain untreated may lead to ulceration. Anemia due to chronic bleeding, rectal strictures due to fibrosis and the development of a fistula (anorectal, rectovaginal, rectovesical) is generally seen in prolonged and poorly managed cases.
Causes of an Inflamed Rectum
The more common causes of proctitis include infections, particularly sexually transmitted infections, exposure to radiation usually in the treatment of cancer and an extension of colon inflammation (read more on the types of colitis) to the rectum.
Of the sexually transmitted infections, gonorrhea, chlamydia and genital herpes (HSV-1, HSV-2) are the more frequently seen infectious causes. Other infections include cytomegalovirus (CMV), Entamoeba histolytica and various pathogens seen with food-borne infections and infectious colitis. Proctitis is also seen with secondary syphilis and HIV infection.
Non-infectious cause of proctitis include inflammatory bowel disease (ulcerative colitis or Crohn’s disease), bowel ischemia, immunodeficiency disorders and radiation exposure. Radiation proctitis is frequently seen in patient receiving radiation therapy for malignancies in the pelvis and lower abdomen. Enemas, particularly involving the use of toxic substances, may also cause proctitis. A significant number of proctitis cases are idiopathic meaning that is due to unknown causes.
Signs and Symptoms of Proctitis
- Rectal bleeding after a bowel movement or spontaneous bleeding
- Mucus from the rectum with the presence of mucus in the bowel movement
- Frequent bowel movements or diarrhea
- Urging to pass stool and sensation of incomplete bowel movement
- Painful bowel movements
- Rectal and anal pain
- Lower abdominal pain, particularly on the left side
- Itchy rectum and anus