Proctitis (rectal inflammation)

What is proctitis?

Proctitis is an inflammation of the lining of the rectum causing discomfort, bleeding, and occasionally, a discharge of mucous or pus.

What are the causes?

There are many causes of proctitis but they can be broken down into several small groups:

• sexually-transmitted diseases
  
• non-sexually transmitted infection
  
• autoimmune disease
  
• noxious agents

Sexual disease related proctitis occurs with high frequency among homosexual men and women who engage in anal intercourse. Sexually-transmitted diseases which can cause proctitis include gonorrhoea, herpes, chlamydia etc. Amoebiasis is another disease which can cause proctitis and can be transmitted by ano-oral sex.

Non-sexually transmitted infections causing proctitis are seen less frequently than STD proctitis. Non-sexually transmitted infection occurs in children and the proctitis is caused by beta-haemolytic streptococcus, the same organism which causes strep throat. Autoimmune proctitis is associated with diseases such as ulcerative colitis or Crohn's disease.

Proctitis may also be caused by physical agents including chemicals inserted into the rectum, medications and radiation. Radiation proctitis is seen in association with radiotherapy as part of cancer treatment.

Risk factors include high-risk sexual practices, homosexuality, and autoimmune disorders. In ulcerative proctitis, a common form of proctitis, ulcers appear in the inflamed rectal lining. The condition may affect 1 to 4 inches of the lower rectum.

What are the symptoms?

Proctitis typically causes painless bleeding or the passage of mucous from the rectum. When the cause is gonorrhoea, herpes simplex, or cytomegalovirus, the anus and rectum may be intensely painful.

• pain, discomfort
  
• rectal bleeding
  
• rectal discharge, pus
  
• bloody stools
  
• constipation

How is it diagnosed?

To make the diagnosis, a doctor looks inside the rectum with a proctoscope or sigmoidoscope and takes a tissue sample of the rectal lining for examination. The laboratory then can identify bacteria, fungi, or viruses that may be causing the proctitis. A doctor also may examine other areas of the intestine using a colonoscope or barium x-rays.

What is the treatment?

Successful treatment of the underlying cause usually cures the problem. Proctitis caused by infection is treated with antibiotics specific for the causative organism. Corticosteroid or mesalamine suppositories may relieve symptoms in Crohn's disease or ulcerative colitis. When the cause is radiation therapy or is not known, the person may get relief from a corticosteroid, such as hydrocortisone, and mesalamine, another anti-inflammatory drug. Both can be taken as an enema or as a suppository. Sulfasalazine or a similar drug may be taken orally at the same time. If these forms of therapy do not relieve the inflammation, oral corticosteroids may help.

What is the prevention?

Safer sex behaviours may prevent the disease from being spread by sexual transmission.