Proctitis

Inflammation of the mucosal lining of the rectum is defined as proctitis, whereas anusitis is simply inflammation of the anal canal. Inflammation in these areas can cause symptoms, such as itching, burning, rectal bleeding, pelvic pressure, and foul-smelling discharge. The distinction between proctitis and anusitis is not overly pertinent, in that the etiology and the treatment of anusitis and proctitis are similar. For the purposes of this article, the term proctitis will be understood to include anusitis.

Several different etiologies exist, including inflammatory bowel disease (IBD), infectious organisms (eg, Neisseria gonorrhoeae, Salmonella, Shigella), noninfectious causes (eg, radiation, ischemic, diversion), and idiopathic causes. For convenience, these etiologies may be divided into three broad categories: IBD, infectious proctitis, and noninfectious proctitis

A frequent or continuous feeling that you need to have a bowel movement.

Rectal bleeding.

Passing mucus through your rectum.

Rectal pain.

Pain on the left side of your abdomen.

A feeling of fullness in your rectum.

Diarrhea.

Pain with bowel movements.

Proctitis has many causes, including acute, or sudden and short-term, and chronic, or long-lasting, conditions. Among the causes are the following:

Sexually transmitted diseases (STDs). STDs that can be passed when a person is receiving anal sex are a common cause of proctitis. Common STD infections that can cause proctitis include gonorrhea, chlamydia, syphilis, and herpes. Herpes-induced proctitis may be particularly severe in people who are also infected with the HIV virus.

Non-STD infections. Infections that are not sexually transmitted also can cause proctitis. Salmonella and Shigella are examples of foodborne bacteria that can cause proctitis. Streptococcal proctitis sometimes occurs in children who have strep throat.

Anorectal trauma. Proctitis can be caused by trauma to the anorectal area—which includes the rectum and anus—from anal sex or the insertion of objects or harmful substances into the rectum, including the chemicals in some enemas.

Ulcerative colitis and Crohn’s disease. Two forms of inflammatory bowel disease (IBD)—ulcerative colitis and Crohn’s disease—can cause proctitis. Ulcerative colitis causes irritation and ulcers, also called sores, in the inner lining of the colon—part of the large intestine—and rectum. Crohn’s disease usually causes irritation in the lower small intestine—also called the ileum—or the colon, but it can affect any part of the GI tract.

Radiation therapy. People who have had radiation therapy that targets the pelvic area also may develop proctitis. Examples of those at risk are people with rectal, ovarian, or prostate cancer who have received radiation treatment directed to those areas. Symptoms of radiation proctitis, most commonly rectal bleeding, will typically occur within 6 weeks after beginning radiation therapy or more than 9 months after its completion.

Antibiotics. Use of antibiotics may be associated with proctitis in some people. While meant to kill infection causing bacteria, antibiotics can also kill nonharmful, or commensal, bacteria in the GI tract. The loss of commensal bacteria can then allow other harmful bacteria known as Clostridium difficile to cause an infection in the colon and rectum.

Risk factors for proctitis include:

Unsafe sex. Practices that increase your risk of a sexually transmitted infection (STI) can increase your risk of proctitis. Your risk of contracting an STI increases if you have multiple sex partners, don't use condoms and have sex with a partner who has an STI.

Inflammatory bowel diseases. Having an inflammatory bowel disease (Crohn's disease or ulcerative colitis ) increases your risk of proctitis.

Radiation therapy for cancer. Radiation therapy directed at or near your rectum (such as for rectal, ovarian or prostate cancer) increases your risk of proctitis.

Proctitis that isn't treated or that doesn't respond to treatment may lead to complications, including:

Anemia. Chronic bleeding from your rectum can cause anemia. With anemia, you don't have enough red blood cells to carry adequate oxygen to your tissues. Anemia causes you to feel tired, and you may also experience dizziness, shortness of breath, headache, pale skin and irritability.

Ulcers. Chronic inflammation in the rectum can lead to open sores (ulcers) on the inside lining of the rectum.

Fistulas. Sometimes ulcers extend completely through the intestinal wall, creating a fistula, an abnormal connection that can occur between different parts of your intestine, between your intestine and skin, or between your intestine and other organs, such as the bladder and vagina.

To reduce your risk of proctitis, take steps to protect yourself from sexually transmitted infections (STIs). The surest way to prevent an STI is to abstain from sex, especially anal sex. If you choose to have sex, reduce your risk of an STI by:

Limiting your number of sex partners

Using a latex condom during each sexual contact

Not having sex with anyone who has any unusual sores or discharge in the genital area