Proctitis is inflammation of the lining of the rectum (rectal mucosa).

• The inflammation has many causes ranging from infection to radiation therapy.
• Depending on its cause, proctitis can be painless or very painful.
• A doctor makes the diagnosis after examining the inside of the rectum.
• Antibiotics can treat proctitis caused by an infection.

Proctitis, which is becoming increasingly common, has several causes. It may result from Crohn's disease or ulcerative colitis. It can also result from a sexually transmitted disease (such as gonorrhea, syphilis, Chlamydia trachomatis infection, herpes simplex virus infection, or cytomegalovirus infection), especially among homosexual men.

A person whose immune system is impaired is also at increased risk of developing proctitis, particularly from infections by the herpes simplex virus or cytomegalovirus. Proctitis may also be caused by some bacteria not transmitted sexually, such as Salmonella, or by the use of an antibiotic that destroys normal intestinal bacteria, thus allowing other bacteria to grow in their place (see Clostridium difficile–Induced Colitis). Another cause of proctitis is radiation therapy directed at or near the rectum, which is commonly used to treat prostate and rectal cancer.

Symptoms and Diagnosis

Proctitis typically causes painless bleeding or the passage of mucus from the rectum. When the cause is gonorrhea, herpes simplex virus, or cytomegalovirus, the anus and rectum may be intensely painful.

To make the diagnosis, a doctor looks inside the rectum with an anoscope or sigmoidoscope (a tube used to view the rectum or anus) and takes swabs and a tissue sample of the rectal lining for examination. The laboratory then can identify the bacterium, fungus, or virus that may be causing the proctitis. A doctor may also examine other areas of the intestine using colonoscopy.

Treatment

Antibiotics are the best treatment for proctitis caused by a specific bacterial infection. When proctitis is caused by use of an antibiotic that destroys normal intestinal bacteria, a doctor may prescribe metronidazole or vancomycin, which should destroy the harmful bacteria that have displaced the normal ones.

When the cause is radiation therapy or is unknown, anti-inflammatory drugs such as hydrocortisone (a corticosteroid) or mesalamine may provide relief. Both hydrocortisone and mesalamine can be given as either an enema or a suppository. Some corticosteroids are available in a foam preparation that can be inserted with a cartridge and plunger. Mesalamine and other anti-inflammatory drugs, such as sulfasalazine and olsalazine, may be taken by mouth at the same time that drugs are given rectally, for added benefit. If these forms of treatment do not relieve the inflammation, formalin can be applied directly to the area or corticosteroids taken by mouth may be used. Laser or Argon plasma coagulation has also been used.

Last full review/revision October 2007 by Parswa Ansari, MD; Norman Sohn, MD