Proctitis is an inflammation of the rectum that causes discomfort, bleeding, and occasionally, a discharge of mucus or pus.A.D.A.M.

Causes, incidence, and risk factors

There are many causes of proctitis, but they can be grouped in the following categories:

• Autoimmune disease
• Harmful substances
• Non-sexually transmitted infection
• Sexually transmitted disease (STD)

Proctitis caused by STD is common among those who engage in anal intercourse. STDs that can cause proctitis include gonorrhea, herpes, chlamydia, and lymphogranuloma venereum.

Non-sexually transmitted infections causing proctitis are seen less often than STD proctitis. The classical example of non-sexually transmitted infection occurs in children and is caused by the same bacteria that cause strep throat.

Autoimmune proctitis is associated with diseases such as ulcerative colitis or Crohn's disease.

Proctitis may also be caused by certain medications, radiotherapy, and inserting harmful substances into the rectum.

Risk factors include:

• Autoimmune disorders
• High-risk sexual practices such as anal sex

Symptoms

• Bloody stools
• Constipation
• Rectal bleeding
• Rectal discharge, pus
• Rectal pain or discomfort
• Tenesmus (pain with bowel movement)

Signs and tests

• Examination of stool sample
• Proctoscopy
• Rectal culture
• Sigmoidoscopy

Treatment

Successful treatment of the underlying cause usually cures the problem. Proctitis caused by infection is treated with antibiotics.

Corticosteroids or mesalamine suppositories may relieve symptoms of some patients.

Expectations (prognosis)

The probable outcome is good with treatment.

Complications

• Anal fistula
• Anemia
• Recto-vaginal fistula (women)
• Severe bleeding

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of proctitis.

Prevention

Safer sex behaviors may prevent the disease from being spread during sexual activity.

References

1. Coates WC. Disorders of the anorectum. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 94.
2. Czito BG, Willett CG. Radiation injury. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 39.
3. Giannella RA. Infectious enteritis and proctocolitis and bacterial food poisoning. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 107.
4. Osterman MT, Lichtenstein GR. Ulcerative colitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 112.

Review Date: 4/17/2011.

Reviewed by: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.