Proctitis (Inflammation of the Rectum): Information on Symptoms and Inflammation of the Rectum

A major risk factor for developing proctitis is unprotected, receptive anal intercourse. People who frequently engage in unprotected anal intercourse with multiple sexual partners are therefore more likely to develop the condition. 

Objects inserted into the anus during sexual intercourse also pose a risk. They can transmit pathogens between individuals. In addition, they can cause minor injuries to the intestinal wall, which also contribute to the development of proctitis.

Various sexually transmitted pathogens can trigger proctitis. For example, the sexually transmitted disease gonorrhea (also known as the clap) manifests as purulent proctitis.

The sexually transmitted disease chancroid, on the other hand, is more commonly associated with very painful, soft ulcers. Lymphogranuloma inguinale causes fistulas.

Inflammation of the rectum that does not heal or that oozes fluid may indicate an HIV infection or AIDS. Also,

• genital herpes infections,
• chlamydia infections,
• the human papillomavirus (HPV), and
• donovanosis, a tropical sexually transmitted disease,

can cause proctitis.

These conditions are contagious and can be transmitted to others. Proctitis can then develop in those individuals as well.

Another risk factor for developing proctitis is chronic inflammatory bowel disease (IBD). This includes conditions such as ulcerative colitis and Crohn’s disease. These conditions are not contagious.

Proctitis can also result from an allergic or toxic reaction to

• medications such as suppositories or laxatives, as well as
• condoms or lubricants

.

Radiation therapy, which is primarily used in cancer treatment, is also a risk factor.

Proctitis is limited to the rectum © FGWDesign | AdobeStock

Generally, symptoms depend on the cause of the proctitis. If gonorrhea is the cause, for example, symptoms are often minimal. Proctitis associated with ulcerative colitis, on the other hand, is extremely painful for patients.

At the onset of inflammation, there are hardly any symptoms. At most, those affected may notice that their anal region is slightly more sensitive than usual. Pain during bowel movements may also occur.

Once the inflammation has spread, there is a mucous, purulent, and/or bloody discharge. Additionally, the stool may contain bloody, mucous, and/or purulent elements.

Patients constantly feel the urge to use the restroom, but bowel movements tend to be irregular. Some patients suffer from fecal incontinence, meaning they cannot control their bowel movements. In addition, gas frequently escapes from the intestines. In medical terminology, this is also referred to as flatulence.

The anus itches and appears reddened and swollen.

As the condition progresses, anal fissures may develop. These are very painful tears in the skin or mucous membrane of the anus that radiate outward. Especially after a bowel movement, the fissures cause sharp, stabbing pain and a burning sensation. Occasionally, there may also be slight bright-red bleeding.

Another condition that can occur in connection with proctitis is a fistula. This refers to newly formed channels that lead from the inflamed intestine to the skin’s surface. A discharge often flows from the fistula openings. A bleeding fistula can also cause significant pain.

Based on the symptoms and medical history (anamnesis), the doctor can often make a preliminary diagnosis.

The doctor then inspects the anus and examines the anus and rectum with a finger (digital rectal exam). This allows the doctor to determine whether there is bleeding, mucus, swelling, or other changes in the mucous membrane. These findings also indicate inflammation.

During a rectal examination (rectoscopy), the inside of the rectum is examined using an endoscope. This allows the doctor to determine whether the mucous membrane is inflamed or shows other changes (such as ulcers or fistulas).

In addition, the doctor can take swabs and tissue samples (biopsy). These can then be analyzed in the laboratory to determine whether a bacterial infection or another cause is responsible for the inflammation.

If the proctitis is caused by a pathogen, sexual partners from the past 6 months should also be included in the examination.

Treatment for proctitis varies depending on the cause.

If the inflammation is caused by a bacterial infection, patients are usually prescribed an antibiotic. A cortisone-containing foam applied to the anal area can also help reduce inflammation. To prevent further inflammation and infection, patients should avoid unprotected anal sex in the future.

If the cause is a chronic inflammatory bowel disease, suppositories containing the active ingredient mesalazine are used. If this does not result in improvement, systemic treatment may be indicated. This allows the medication to act not only locally but throughout the entire body. For this purpose, the patient receives the medication in tablet form, possibly in combination with a corticosteroid.

Enemas or foam applications containing mesalazine may also be helpful. However, patients with inflammatory bowel disease often experience relapses. For these patients, lifelong medication may be necessary. The following medications, for example, are used for this purpose:

• Immunosuppressants such as methotrexate or azathioprine
• TNF-α inhibitors (such as infliximab or adalimumab)
• the integrin inhibitor vedolizumab

In very severe cases, surgery may be necessary. The surgeon then removes the inflamed areas of the mucosa or, if necessary, an entire section of the intestine.

If, on the other hand, proctitis is caused by an allergy, treatment consists of strictly avoiding the allergen. Allergic inflammation of the rectum usually resolves on its own. Severe cases, as well as inflammation associated with Crohn’s disease or ulcerative colitis, are treated with mesalazine suppositories.

Radiation-induced intestinal inflammation (radiation proctitis) also generally does not require treatment. It usually resolves on its own.

Regardless of the cause, anti-inflammatory enemas or suppositories can provide relief for patients.

What is the most common cause of proctitis?

Proctitis is often caused by an infection or one of many chronic inflammatory bowel diseases.

Is proctitis contagious?

Yes, if caused by a sexually transmitted infection, especially bacterial or viral infections.

How long does it take to heal?

That depends on the cause; acute forms often clear up within a few weeks.

When should I seek medical help?

If you experience persistent pain, blood in your stool, or a strong urge to have a bowel movement, you should seek medical evaluation promptly.

Can proctitis become chronic?

Yes, a chronic course can develop, particularly in connection with ulcerative colitis and Crohn’s disease.