Proctitis

Proctitis is inflammation of the lining of the rectum. It can be limited to the rectal mucosa or extend into the sigmoid colon, a condition known as proctosigmoiditis. The condition can be acute or chronic and varies in severity.

Causes of proctitis include infectious, inflammatory, traumatic, and ischemic factors. Infectious proctitis is commonly caused by sexually transmitted pathogens such as Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, and herpes simplex virus, as well as non–sexually transmitted organisms like amebae, Shigella, and Campylobacter. Inflammatory bowel diseases, particularly ulcerative colitis, can involve the rectum. Radiation therapy to the pelvis, chemical irritants (for example certain enema solutions or irritants), ischemia of the rectal area, and less commonly malignancy can also lead to proctitis.

Common symptoms include rectal pain or burning, a persistent urge to have a bowel movement (tenesmus), frequent or urgent bowel movements, rectal discharge or mucus, and sometimes blood in the stool. Some people may have no symptoms.

Diagnosis relies on clinical history and examination, including a digital rectal exam. Endoscopic evaluation such as proctoscopy or sigmoidoscopy with biopsy is often performed, along with stool tests for infectious agents and targeted testing for sexually transmitted infections. Additional imaging may be used to assess complications or extent when needed.

Treatment depends on the underlying cause. Infectious proctitis is treated with appropriate antimicrobial or antiviral therapy. Inflammatory proctitis from ulcerative colitis is managed with standard IBD therapies, including topical or systemic anti-inflammatory medications. Radiation and ischemic proctitis are managed with supportive care and targeted treatments to address symptoms and underlying factors. Prevention focuses on reducing exposure to infectious agents (for example, safe sex practices and STI testing) and managing risk factors when possible.