Proctitis

Proctitis is an inflammation of the rectum that causes urgency and frequency of bowel actions, bleeding, and may be associated with the discharge of mucus or pus.

What is proctitis?

Proctitis is an inflammation of the rectum that causes bleeding ,discomfort and sometimes a discharge of mucus or pus.  It is the least serious of the inflammatory bowel diseases and only involves a portion of the rectum.  The other irritable bowel diseases are Crohn’s Disease and Ulcerative Colitis.

Although there are a few known specific causes of proctitis, the common form is called “Non Specific Proctitis”  and the cause is unknown.

What are the effects of proctitis?

Non-specific proctitis involves the rectum above the anus and spreads for a variable distance upwards and is like a “burn” of the bowel lining.  Crohn’s proctitis varies from small scattered ulcers through to deep, large irregularly placed ulcers.  Irradiation proctitis tends to occur next to the organ that was irradiated, for example, the inflammation is close to the anus after prostate cancer irradiation and higher up after irradiation for cervical cancer.  The effects of irradiation vary from diffuse burnlike damage to discrete bleeding areas due to the development of multiple small fragile abnormal blood vessels in response to the irradiation.

Symptoms

The main symptoms are urgency to pass stool, passage of blood and mucus, and looseness of stool, although some of these symptoms may be absent.  Pain is not common, but can occur with some sexually transmitted infections and fever may be present.  Anal irritation is common.  Because bleeding is a major symptom of proctitis, anaemia may result.  Symptoms may last days, weeks or even years, and may be intermittent or constant.

Diagnosis

Diagnosis is based on clinical features and the appearance of the bowel lining at sigmoidoscopy. Sigmoidoscopy is necessary to exclude other conditions that may mimic proctitis, such as rectal cancer or haemorrhoids.  Colonoscopy is used to exclude inflammation that is more extensive.  Biopsies may be helpful and bacteriology cultures may reveal the cause in infectious proctitis.

Treatment

Only in very rare circumstances is surgery used.  Proctitis is frequently treated with suppositories or rectal foam containing cortisone compounds.  Failure to respond to these treatments may lead to the use of oral medications.  Infective proctitis may resolve spontaneously.  Should  a particular germ be isolated, a course of the appropriate antibiotics would be prescribed.

Irradiation proctitis is difficult to treat.  Bleeding can be improved with instillation of formalin-soaked packs in the rectum or with laser ablation of the bleeding points.  Both these procedures require hospitalisation.  Rarely is part or the entire rectum surgically removed for stubborn, severe bleeding due to irradiation proctitis.

Other problems

It is very rare for other symptoms to occur with nonspecific proctitis.  Irradiation proctitis may be associated with symptoms of cancer.

Prognosis

Proctitis is usually a “nuisance” rather than a serious problem and frequently has no effect on your health. 90% of cases will resolve either spontaneously or with simple treatment.  The remaining 10% will proceed to Ulcerative Colitis or, rarely, Crohn’s Disease.

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