Proctitis is an extremely painful inflammation of the rectum and anus. The causes are often sexually transmitted diseases or systemic diseases such as ulcerative colitis or Crohn’s disease.
What is proctitis?
Proctitis is an inflammation of the rectum.
While other inflammatory bowel diseases usually affect the entire bowel or large sections of the bowel, the inflammation in proctitis only affects the last 16 centimeters of the bowel. The causes of the disease are varied. See gradphysics for Corneal Inflammation in English.
For example, bacterial infections, chronic inflammatory bowel diseases or allergic reactions are possible causes. Patients suffer from bloody discharge, pain and the urge to defecate.
Proctitis can promote the development of anal polyps. These are enlargements of the anal papillae. They can grow up to two centimeters. When you have a bowel movement, they slip out of the anus and then have to be pushed back with your finger. They often also cause a foreign body sensation in the intestine.
Inflammation of the rectum caused by infection occurs primarily in connection with sexually transmitted diseases. For example, gonorrhea (clap) leads to purulent proctitis. Proctitis can also occur in the three stages of syphilis. Other STDs that can be associated with the inflammation include Ulcus molle, Lymphogranuloma inguinale, AIDS, Donovanosis, Chlamydia trachomatis infections and herpes simplex virus infections.
The most common cause of infectious proctitis is unprotected, receiving anal sex. However, chronic inflammatory bowel diseases can also affect the rectum. The best-known chronic inflammatory bowel diseases are ulcerative colitis and Crohn’s disease. Ulcerative colitis spreads continuously from the anus to the mouth. Ulceration of the upper mucosal layers of the intestine occurs.
In Crohn’s disease, the inflammation penetrates all layers of the intestine. However, the spread here is not continuous, but segmental. The disease primarily affects the small intestine and colon. Allergic or toxic reactions can also lead to proctitis. An allergic exanthema of the intestinal mucosa is caused, for example, by suppositories, condoms or lubricants.
A special form of a toxic reaction is ergotism gangrenosus cutaneousus. This is where ulceration occurs after the insertion of ergotamine suppositories. These suppositories are used, for example, by migraine sufferers. Other causes of proctitis are trauma or radiation therapy, for example in the case of cancer.
Symptoms, Ailments & Signs
With proctitis, patients report watery, bloody, or purulent discharge from the anus. The stool can also contain bloody-purulent admixtures. Severe itching occurs in the anal region. Those affected tend to have irregular bowel movements, but constantly have the feeling that they have to go to the toilet.
They are often unable to hold their stool, resulting in faecal incontinence. Even air cannot be held in the intestine and escapes uncontrollably. Here one also speaks of flatulence. The anus appears red and is protruded like a bulge. As the disease progresses, anal fissures or fistulas on the anus can also occur. Anal fissures are tears in the skin or mucous membrane of the anus.
A fistula is a connection between an internal hollow organ and the body surface. In the case of proctitis, a tube-like connection forms from the rectum to the surface of the skin around the anus. Both the anal fissure and the fistula are very painful. Depending on the type of infection, genital warts can also form. Which symptoms actually occur depends on the cause. Proctitis caused by gonorrhea, for example, causes hardly any symptoms apart from a purulent discharge.
Diagnosis & course of disease
The symptoms provide the first clues to proctitis. If an inflammation of the rectum is suspected, the doctor first inspects the anus. You may see bulges, redness, fistulas or fissures here. This is followed by the digital rectal examination (DRE). The rectum is palpated with the finger. If the inflammation is severe, this can be very painful.
A rectoscopy brings definitive certainty. Before the examination, the patient must take a laxative so that the rectum is free of stool residue. The doctor then inserts an endoscope into the anus. This allows him to detect inflammation and bleeding and, if in doubt, to treat it directly. Inflammatory redness and infiltrated intestinal walls are found during rectoscopy. Erosions or ulcers may also be visible.
For further clarification, the doctor can take swabs or biopsies during the rectoscopy. Depending on the position of the endoscope, pain can also occur during the examination.
Although proctitis is a very unpleasant disease, complications are rare. The specific cause plays a role here. Proctitis or inflammation of the rectum can spread to the entire intestine if it persists for a long time. Under certain circumstances, ulcerated and chronic intestinal inflammation develops, which considerably reduces the patient’s quality of life.
In particularly severe forms of proctitis, blood loss can occur due to bleeding in the rectum. This bleeding occurs particularly in connection with hemorrhoids. However, the intestinal inflammation has no influence on the formation and development of hemorrhoids.
This happens especially in chronic inflammatory processes. In severe cases, the loss of blood sometimes also leads to anemia (low blood count). Typical symptoms are general paleness, weakness, shortness of breath or dizziness. If the proctitis is left untreated, adhesions in the area of the rectum can also occur. The development of chronic fecal incontinence is also possible.
If the proctitis is caused by the so-called human papillovirus, genital warts sometimes form. Although these usually heal completely, they can also break open and lead to bleeding. Some forms of proctitis are caused by sexually transmitted pathogens and are therefore highly contagious if left untreated.
When should you go to the doctor?
Irregularities in the area of the anus should be presented to a doctor. If symptoms persist for several days or if they increase in intensity, the person concerned needs medical help. Itching, pain, trouble going to the toilet or a feeling of pressure in the intestines must be examined and treated. Those affected often report a foreign body sensation. This should be examined more closely by a doctor. In many cases, proctitis occurs as a side effect of a sexually transmitted disease. If this has not yet been diagnosed, a doctor should be contacted as soon as possible for clarification.
Swelling, trouble getting around or in a sitting position are signs of an irregularity. A doctor’s visit is necessary so that the cause of the symptoms can be found. If warts, growths or fistulas develop in the anal region, they should be examined by a doctor. Treatment is necessary to avoid complications.
In the event of bleeding, impaired sphincter muscle activity or a loss of control over sphincter muscle activity, it is advisable to consult a doctor. Patients suffering from proctitis are often no longer able to independently regulate the timing of the excretions. Therefore, they should seek medical help. If there are disturbances within the sexual act or a decrease in libido, these are also indications of a health impairment.
Treatment & Therapy
The therapy depends on the cause. Bacterial infections are treated with antibiotics. The therapy of chronic inflammatory bowel diseases is somewhat more difficult. This is where immunosuppressants, TNF-alpha blockers and other drugs come into play.
In severe cases, pieces of the intestine may need to be surgically removed. If the proctitis is based on an allergic reaction, the trigger should be avoided urgently in the future. Anti-inflammatory enemas or suppositories are used for symptomatic treatment.
Infectious proctitis can be prevented with condoms. In particular, people who frequently have anal intercourse with different people should always use condoms. Inserting objects into the anus can also lead to inflammation due to small tears in the intestinal mucosa. Sex toys should therefore only be used with extreme caution in this area. If allergies to certain medications or substances (e.g. latex) are known, these should of course be avoided as much as possible.
Whether follow-up treatment is necessary also depends on the severity and cause of the disease. For example, if it is an infection-related proctitis, some check-ups may be necessary. Depending on the severity of the proctitis, these are still carried out regularly.
If the disease has only taken a mild course, no further checks by the doctor are necessary. However, if the course is moderate or severe, the doctor should check after the treatment whether it was successful. The first of these examinations usually takes place one to two weeks after the start of therapy. For this purpose, further swabs are taken from the intestinal wall and checked.
If no infection can then be detected in these patients, the therapy was successful. Until success is confirmed, no further sexual intercourse that could irritate the anus or rectum should be attempted. Otherwise, after the successful treatment of infectious proctitis, no further follow-up treatment is necessary.
However, if the proctitis is caused by an inflammatory bowel disease such as ulcerative colitis, patients can be affected for a longer period of time. This means that they need to be treated with medication over the long term. Meanwhile, those affected should also visit their doctor regularly and have check-ups carried out.
You can do that yourself
Proctitis is an acute or chronic inflammation of the rectum. The mucous membrane of the rectum is considered to be very sensitive, which should be taken into account in any type of self-treatment or self-help. In many cases, proctitis is caused by bacteria, so antibiotics are usually required. Those affected often make the mistake of not carrying out antibiotic therapy for long enough or at too low a dosage. Since irregular intake of antibiotics can cause resistance to pathogens, this often leads to chronic disease progression. In addition to antibiotics, other medicines prescribed by a doctor, such as immunosuppressants or antiallergics for chronic proctitis, should always be taken strictly according to medical instructions.
In rare cases, the proctitis is based on an allergic event. In this case, the allergic trigger should be avoided as far as possible in the future. Suppositories or so-called enemas can also be used for symptomatic treatment. Infectious proctitis often occurs in people who regularly practice anal intercourse. Condoms should therefore always be used as a preventive measure, especially if you frequently change sex partners. Inserting sex toys into the anal canal can also lead to micro tears in the sensitive mucous membrane and thus to proctitis. If you are allergic to latex, only sex toys that are guaranteed latex-free should be used.