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Rectal Inflammation / Proctitis

Definition :
Proctitis is an inflammation of the lining of the rectum (rectal mucosa). Sexually transmitted diseases are the most common cause, but other causes include inflammatory bowel diseases, such as ulcerative colitis, and non-sexually transmitted infections.

Proctitis also may be a side effect of some medical treatments, including radiation therapy directed at or near the rectum for conditions such as prostate, cervical or uterine cancer, or antibiotic use.

Sexually transmitted proctitis is most common in people who engage in anal or oral-anal intercourse, particularly if they have multiple partners. Proctitis in general mainly affects adult males.

Proctitis may be short-lived, or it may become chronic, lasting for months or longer. In most cases, proctitis clears up with treatment. Treatment for proctitis depends on the cause.

The causes of proctitis fall into several categories :
  • Sexually transmitted infections. The most common type, sexually transmitted proctitis, is contracted through anal or oral-anal intercourse. Sexually transmitted diseases (STDs) that can cause proctitis include gonorrhea, syphilis, genital herpes, anal warts and chlamydia.
  • Non-sexually transmitted bacterial infections. Proctitis is rare in children, but it can occur as a result of the same organism that causes strep throat (streptococcus). Salmonella, shigella and campylobacter, which are usually associated with food-borne illnesses, are other bacteria that can cause proctitis.
  • Inflammatory bowel disease (IBD). If you have ulcerative colitis or Crohn's disease, you may be more vulnerable to proctitis. Ulcerative colitis involves inflammation of the inner lining of the large intestine, often including the rectum, the lowest portion of your colon. Crohn's disease involves chronic inflammation of any part of the gastrointestinal tract.

Other causes
Proctitis can result from a number of agents that can damage the rectal mucosa. These may include :

  • Chemicals, such as hydrogen peroxide enemas, medications or objects placed inside the rectum
  • Trauma to the anal-rectal area
  • Radiation therapy directed at or near the rectum, such as for treatment of rectal or prostate cancer
  • Antibiotic use for another ailment, which can destroy protective bacteria in the gastrointestinal tract

Risk Factor :
High-risk sexual behaviors put you at risk of sexually transmitted proctitis. They include :

  • Being the recipient of anal and oral-anal sex
  • Having multiple sex partners
  • Having anal sex with a partner who has an STD
  • Having anal sex without a condom

Risk factors for non-sexually transmitted proctitis include :

  • Having an inflammatory bowel disease, such as ulcerative colitis or Crohn's disease
  • Using antibiotics for another ailment
  • Having radiation therapy directed at or near the rectum

When to seek medical advice :
If you have any of the signs or symptoms of proctitis, especially if you engage in high-risk sexual behavior, contact your doctor. Severe bleeding, anemia from blood loss and dehydration from diarrhea require immediate treatment. If you have any of these signs and symptoms, or if you experience severe pain, seek immediate care.

Symptoms :
Signs and symptoms of proctitis may include :

  • Frequent or continuous urge to have a bowel movement
  • Rectal bleeding
  • Passing mucus through the rectum
  • Anal and rectal pain
  • Pain in the lower left abdomen
  • A feeling of rectal fullness
  • Diarrhea, usually frequent, small amounts

Your doctor will take a history of your condition, including your sexual history, and conduct a physical exam. The exam may include the following :

  • Blood tests. Your doctor may suggest blood tests to check for signs of infection or anemia, if you've lost blood.
  • Colonoscopy. This test allows your doctor to view your entire colon using a thin, flexible, lighted tube with an attached camera. During the procedure, your doctor can also take small samples of tissue (biopsy) for laboratory analysis. Sometimes a tissue sample can help confirm a diagnosis. Risks of this procedure include perforation of the colon wall and bleeding, especially when a biopsy is taken.
  • Flexible sigmoidoscopy. In this procedure, your doctor uses a slender, flexible, lighted tube to examine the sigmoid, the last 2 feet of your colon, including the rectum. Your doctor also can take a biopsy during this test. The test usually takes just a few minutes. It's somewhat uncomfortable, and there's a slight risk of perforating the colon wall.
  • STD screening. This involves obtaining a sample of discharge from the tube (urethra) that drains urine from your bladder. If the cause of your proctitis is likely to be an STD, your doctor may insert a narrow swab into the end of your penis or anus to obtain the sample, which is then tested for the presence of bacteria or other infectious organisms. The results can be used to select the most effective antibiotic for treatment.

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

  • Anemia. If you have severe bleeding, you could develop anemia. With anemia, you don't have enough healthy 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 can lead to open sores (ulcers) in 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. For women, a fistula can connect the rectum to the vagina (recto-vaginal), causing bowel contents to drain from the vagina. Anal fistulas, which occur in men and women, connect the rectum to the skin. In those cases, bowel contents may drain to the skin. Fistulas can lead to life-threatening infections if left untreated.

Treatment for proctitis depends on the cause.

Infectious proctitis
Your doctor is likely to prescribe medications to alleviate the cause of the infection. The specific medication depends on the cause of the infection.

  • Antibiotics. For bacterial STDs, the antibiotic depends on the STD. For non-sexually transmitted infections, your doctor will likely prescribe an oral antibiotic, such as ciprofloxacin (Cipro), levofloxacin (Levaquin), penicillin, amoxicillin (Amoxil, Trimox), azithromycin (Zithromax), clarithromycin (Biaxin), clindamycin (Cleocin) or an antibiotic from the cephalosporin class (Keflex, Ceclor).
  • Antivirals. For viral STDs, such as herpes-related proctitis, your doctor may prescribe an antiviral medication, such as acyclovir (Zovirax). If taken within 48 hours, antiviral medication may lessen pain and shorten the duration of signs and symptoms.

Noninfectious proctitis
The most common cause of noninfectious proctitis is a side effect from radiation treatment to the pelvis. Mild signs and symptoms may require no treatment. However, more severe cases, particularly those involving bleeding, may need Treatment:

  • Corticosteroids. These medications, which suppress inflammation, may be given as enemas. In some cases, your doctor may prescribe oral corticosteroids.
  • Laser therapy. A relatively new procedure uses a laser on the rectal lining to destroy newly formed blood vessels, thereby reducing inflammation and bleeding.

For proctitis caused by antibiotic use, your doctor may prescribe metronidazole (Flagyl, Protostat) or vancomycin (Vancocin) to destroy harmful bacteria that have developed in place of normal intestinal bacteria.

Proctitis caused by inflammatory bowel disease
Proctitis related to Crohn's disease or ulcerative colitis may require ongoing treatment directed at the underlying condition. The goal of treatment is to reduce the inflammation that causes the signs and symptoms.

  • Anti-inflammatory medications. Your doctor may prescribe corticosteroids or other anti-inflammatory agents, such as sulfasalazine (Azulfidine) or mesalamine (Asacol, Rowasa, others), in pill, suppository or enema form. Steroid suppositories or enemas may ease inflammation in your rectum.
  • Anti-diarrheals. If you have diarrhea, your doctor may prescribe a fiber supplement, such as psyllium powder (Metamucil) or methylcellulose (Citrucel), to add bulk to your stool. For more severe diarrhea, loperamide (Imodium) or a combination of diphenoxylate and atropine (Lomotil) may be effective. However, these drugs may cause serious side effects, such as colon dilation and rupture, especially if taken over time or in high doses. If your IBD symptoms tend to flare, these treatments can cause your disease to spread farther up your colon. Talk to your doctor before using them.
  • Surgery. If drug therapy doesn't relieve your signs and symptoms, your doctor may recommend surgery to remove a damaged portion of your digestive tract.

Safer sexual practices, such as monogamous sex and condom use, help protect against STDs that can cause proctitis.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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