What to know about proctitis

Proctitis is inflammation of the rectum’s lining. The rectum is a muscular tube of the large intestine, where waste passes through. Symptoms of proctitis include pain, discharge, and a constant, urgent need to poop.
This inflammation has a range of causes, which may result in either a short bout of proctitis or a more long-term issue.
Anyone who suspects they have proctitis or notice unusual symptoms should contact a doctor. The type of treatment for proctitis will depend on the underlying cause.
This article discusses proctitis in more detail, including symptoms, causes, treatment, and frequently asked questions.
Definition and types
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Proctitis is a form of inflammation that affects the lining of the rectum.
Proctitis
Proctitis may be acute, meaning that the person has symptoms for a short period due to a single specific cause. It may also be chronic, in which case the person will experience symptoms over a longer period.
The type and severity of the symptoms will often depend on the underlying cause of the inflammation. In any case, proctitis requires treatment to prevent complications.
Symptoms
The symptoms of proctitis may vary slightly depending on the underlying cause.
The most common symptom of proctitis is tenesmus, which is the feeling of needing to poop. This feeling is usually uncomfortable and will persist even after the person uses the bathroom.
tenesmus
Other symptoms include:
include
blood in the stool or bleeding from the anus
blood in the stool
pain in the rectum, abdomen, or anus
pain in the rectum
abdomen
pain during bowel movements
pain during bowel movements
anal discharge or mucus
anal discharge
loose, watery stools or diarrhea
diarrhea
constipation
constipation
swollen lymph nodes in the groin
swollen lymph nodes in the groin
Anyone experiencing symptoms such as anal discharge, blood, or pain, should contact a doctor immediately.
Causes
Proctitis has various causes, which may result in either acute or chronic proctitis.
various causes
Possible causes include:
sexually transmitted infections (STIs), such as gonorrhea, chlamydia, and syphilis
sexually transmitted infections (STIs)
gonorrhea
chlamydia
syphilis
viral infections, such as genital herpes
genital herpes
other infections, such as salmonella or bacterial infections that occur after antibiotic treatment
salmonella
bacterial infections
antibiotic
injuries from anal sex or anal play
anal sex
complications from radiation treatment for cancer in the pelvic area
inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn’s disease
inflammatory bowel disease (IBD)
ulcerative colitis (UC)
Crohn’s disease
Diagnosis
To diagnose proctitis, a doctor will ask about a person’s symptoms, including how long they have been experiencing them. They will ask about the person’s medical history and sexual activities. They may also perform a physical exam of the rectum to check for signs of inflammation.
will ask
physical exam
signs of inflammation
Additionally, a doctor may order tests, such as blood tests, stool tests, and a rectal culture, which checks for signs of infection.
blood tests
stool tests
If the doctor suspects a more chronic digestive disorder or complications, they may order a colonoscopy or proctoscopy. These procedures involve a doctor inserting a thin, flexible tube into the anus to examine the bowels, rectum, and colon.
colonoscopy
proctoscopy
A thorough diagnosis may take time, but it is important to find the correct treatment for each person.
Treatments
The most effective treatment for proctitis will vary depending on its underlying cause. Acute cases of inflammation may require more direct treatments that can cure proctitis.
will vary
If a chronic disorder is causing proctitis, the person will likely have to rely on a mixture of medical treatment and long-term changes to their diet and lifestyle.
If doctors find that an infection is the cause of proctitis, they will prescribe medications to treat that particular infection.
Antibiotics can help clear bacterial infections, including STIs, whereas antiviral medications treat viral infections, such as genital herpes.
antiviral medications
viral infections
genital herpes
If a particular drug, such as an antibiotic, is causing the inflammation, the person will need to stop taking it. Doctors can prescribe alternative medications to allow the person to continue treatment while healing.
Proctitis due to injury, such as from anal sex or anal play, requires the person to stop the activity responsible for the inflammation. A doctor may also prescribe or recommend medications to treat pain and relieve diarrhea.
Proctitis from radiation therapy is common. A 2015 paper notes that close to 75% of people who have radiation therapy in the pelvis will develop acute proctitis symptoms, while 20% may experience chronic symptoms.
radiation therapy
75%
Doctors will treat radiation proctitis on a person-by-person basis. If the person has mild proctitis symptoms due to radiation therapy, they may need no treatment, and the symptoms may resolve on their own.
Sometimes, doctors may use corticosteroid enemas to help with severe symptoms or pain. These medications reduce inflammation in the rectum.
corticosteroid
enemas
A doctor may also recommend other medications, such as sucralfate. This drug primarily treats stomach ulcers but may help with proctitis symptoms.
stomach ulcers
Inflammatory bowel disease is a long-term cause of proctitis, and people with this condition will require consistent treatment to manage the symptoms.
There is no cure for IBD, so the treatment goal is to keep inflammation in check, prevent flare-ups, and help put the body in remission.
To achieve these goals, doctors may recommend several different types of drugs, including:
including
Different forms of corticosteroids may help reduce immune system activity in the area, decreasing inflammation. These include steroids, such as:
corticosteroids
hydrocortisone
prednisone
prednisone
methylprednisolone
methylprednisolone
budesonide
budesonide
Immunomodulators reduce the overall activity of the immune system. As autoimmune factors often seem to play a role in chronic disorders, such as Crohn’s disease, this treatment often helps reduce and manage symptoms.
Crohn’s disease
Common immunomodulators include:
methotrexate
methotrexate
cyclosporine
cyclosporine
6-mercaptopurine
azathioprine
Aminosalicylates, also called 5-ASA drugs, help manage inflammation. These include:
mesalamine
mesalamine
balsalazide
balsalazide
olsalazine
sulfasalazine
UC is a chronic form of IBD that can cause inflammation in the linings of the colon, rectum, or both. In people with severe cases, tiny ulcers or open sores can develop.
There is no cure for UC, but a combination of treatment options can help manage symptoms.
Treatment for UC can include a multifaceted approach to help prevent or reduce the intensity of flare-ups and maintain remission.
can include
Issues in the immune system can cause UC. Medications that target the way the immune system works, such as biologics and immunomodulators, may be part of the treatment plan.
These may include:
may include
anti-integrin agents, such as vedolizumab (Entyvio)
(Entyvio)
interleukin 12/23 antagonists, such as ustekinumab (Stelara)
(
Stelara
immunomodulators, such as methotrexate
TNF-α antagonists, such as adalimumab or infliximab
janus kinase (JAK) inhibitors, such as upadacitinib or tofacitinib
A doctor may prescribe other medications, including aminosalicylates and steroids.
steroids
While there is no evidence that a particular diet can help cure UC, some foods can aggravate symptoms. High fiber and spicy foods can worsen symptoms in some people.
High fiber and spicy foods
A doctor may recommend maintaining a well-balanced diet that helps reduce symptoms and promote healing.
well-balanced diet
Medications and other interventions may not work for some people. According to a 2021 review, approximately 20–30% of people with UC will require surgery to improve their condition.
20–30%
Some surgical options include:
include
ileostomy, where a surgeon connects an external pouch to the small intestine to collect waste
ileostomy
colectomy, the removal of the colon
colectomy
ileoanal pouch, where a surgeon creates an internal pouch to connect the small intestine to the anal muscles
ileoanal pouch
Proctitis diet
Many doctors treating people with chronic disorders, such as IBD, will recommend dietary changes to support proctitis treatment.
Many people may find that an anti-inflammatory diet can help reduce symptoms.
anti-inflammatory diet
Additionally, incorporating certain types of food into the diet may be helpful for people with proctitis as they heal. The general advice is to eat a varied diet rich in vegetables and other plant foods to ensure a sufficient intake of fiber, which makes stool easier to pass.
plant foods
fiber
However, in people with a chronic condition, high fiber diets may worsen symptoms. Therefore, people should consult with a doctor before making dietary changes.
Some people may also need to avoid potential irritants, such as:
such as
alcohol
alcohol
spicy foods
caffeine
caffeine
fructose
fructose
milk products
sugar alcohols, including xylitol and sorbitol
sugar alcohols
xylitol
Doctors may also recommend certain supplements that may help reduce inflammation and other symptoms. These include:
include
vitamin C and vitamin E
vitamin C
vitamin E
probiotics
probiotics
omega-3 fatty acids
omega-3
A person should always talk with a doctor before adding any supplements to their diet or making any drastic dietary changes.
Treating and preventing future cases of proctitis may require lifestyle changes, especially if the proctitis is due to anal trauma or STIs. These lifestyle changes may include:
using a condom during anal sex
avoiding rough anal play
communicating openly with any partners about their sexual health
communicating openly
Proctitis vs. colitis
Proctitis generally refers to temporary rectal inflammation or chronic inflammation as part of a larger condition.
Proctitis
If people only have inflammation in the rectum, it is proctitis. If the inflammation is in the rectum and colon, it is colitis.
Proctitis can progress to ulcerative proctitis if inflammation causes ulcers to form on the rectal lining. Ulcerative proctitis is a mild form of UC.
Proctitis may eventually progress to other parts of the colon and become UC. Estimates suggest that about 25–30% of people with UC have ulcerative proctitis.
25–30%
Treatment for these conditions is similar to other forms of IBD. Doctors will prescribe medications to reduce symptoms, and they may recommend dietary and lifestyle changes to keep symptoms in remission.
Frequently asked questions
The following are some of the most common questions and answers about proctitis:
A person might notice the first signs of proctitis when they go to the bathroom. They may feel a constant urge to have a bowel movement even though their bowel is empty. Diarrhea, bleeding, or mucus in poop are also early signs of proctitis.
first signs of proctitis
There are several causes of proctitis. The most common causes are IBD and STIs. Radiation therapy to treat cancer in the pelvic area or lower abdomen can also cause proctitis.
several causes
Most of the time, proctitis will resolve by treating the cause. In proctitis due to an infection, antibiotics or antiviral medication will usually clear it. In proctitis caused by IBD, medications such as corticosteroids can help reduce inflammation.
resolve
Summary
Proctitis is inflammation of the rectum’s lining and often causes symptoms such as pain and a constant, urgent need to poop. There are several different causes of proctitis.
While many instances of proctitis may resolve with only mild treatments, it is still important to report any symptoms to a doctor to avoid complications.
People with acute cases may recover within a few weeks with the correct treatment. Chronic issues may require more long-term treatments, including dietary and lifestyle changes.