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Proctitis
Last reviewed: 05.07.2025
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Proctitis is an inflammatory process that primarily affects the mucous membrane of the rectum. The disease can occur in both acute and chronic forms.
Proctitis is an inflammation of the lining of the rectum that may be caused by infection, inflammatory bowel disease, or radiation. Symptoms of proctitis include discomfort in the rectum and bleeding. Diagnosis is by sigmoidoscopy, usually with biopsy and bacterial culture. Treatment of proctitis depends on the etiology.
Proctitis may be caused by sexually transmitted diseases, certain intestinal infections (eg, Campylobacter, Shigella, Salmonella ), inflammatory bowel disease, or radiation therapy; the disease may be associated with previous antibiotic use. Proctitis caused by sexually transmitted infections is more common in homosexuals. Immunocompromised patients have a certain risk of developing herpes simplex and cytomegalovirus infections.
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Causes of proctitis
Proctitis can be caused by various types of trauma (foreign bodies, frequent cleansing enemas, chemical and thermal burns), long-term use of antibiotics and other medications. Secondary proctitis develops with some diseases of the digestive organs (calculous cholecystitis, gastritis, pancreatitis, intestinal tumors) and pathological processes in adjacent organs.
Symptoms of proctitis
Typically, patients complain of mucus or blood discharge from the rectum. Proctitis as a consequence of gonorrhea, herpes simplex or cytomegalovirus is accompanied by intense anorectal pain.
Proctoscopy or sigmoidoscopy are necessary for diagnosis, which allow visualization of the inflamed rectal mucosa. Small isolated ulcers and vesicles suggest herpes infection. A smear from the mucosa should be examined for the culture of Neisseria gonorrhoeae, Chlamydia, pathogenic intestinal microflora and pathogenic viral infection. Serological tests for syphilis and stool testing for Clostridium difficile toxin should be performed. Sometimes a biopsy of the mucosa is necessary. In some patients, colonoscopy may be informative.
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Acute proctitis
Acute proctitis is characterized by a sudden onset. The main clinical manifestations are: tenesmus against the background of constipation, fever, chills, a feeling of heaviness and burning in the rectum.
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Diagnosis of acute proctitis
Examination in the acute period is difficult due to severe pain and sphincter spasm. However, sphincter spasm is less pronounced than in anal fissures, and with abundant lubrication of the finger with Vaseline, as a rule, it is possible to conduct a digital examination. It reveals swelling of the mucous membrane. Bloody mucus is sometimes found on the finger of the glove after the examination.
Considering that proctitis can be secondary and develop, for example, with colon tumors as a result of irritation of the rectal mucosa by necrotic masses of a malignant tumor, colonoscopy is mandatory, but most often after 5-7 days from the onset of the disease, i.e. during the period of attenuation of acute manifestations. The mucous membrane in acute proctitis is sharply hyperemic and has a color from bright red to crimson. It often bulges into the lumen of the intestine or even completely closes it. The vascular pattern can be sharply enhanced or completely absent. Mucus with blood streaks is observed in the lumen of the intestine.
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Treatment of acute proctitis
Treatment of acute proctitis is conservative. First of all, a diet is necessary with the exclusion of all irritating products (spicy dishes, seasonings, spices) and alcohol. J. M. Yukhvidova recommends (1984) the following diet:
- for breakfast - protein omelet, liquid semolina porridge in water with a small piece of butter, cottage cheese;
- for lunch - meat broth or pureed vegetable soup, boiled meat minced through a meat grinder (you can also use steamed chicken cutlets and boiled fish), liquid cranberry jelly; for dinner - rice porridge with water and butter, steamed cutlet, cottage cheese.
Antibiotics are prescribed in cases of acute proctitis when the disease is accompanied by fever.
Since the severe pain syndrome does not completely cleanse the intestines, and repeated bowel movements aggravate the disease, the intestines should be cleaned daily in the morning with chamomile decoction enemas. Laxatives are not recommended, as they increase the urge and pain. Before giving a cleansing enema, the tip is thickly lubricated with Vaseline.
After complete bowel cleansing, 100.0 ml of warm chamomile infusion (temperature 37-38 °C) is introduced into the intestine for therapeutic purposes. An oil enema is given at night (50-75 ml of warm - 37-38 °C - vegetable oil). Starting from the second week of the disease, morning medicinal chamomile enemas are replaced by enemas of 0.3-0.5% collargol solution. The concentration of the solution is determined by the intensity of the inflammatory process in the intestine. Evening oil microclysters are continued for 14 days. The general course of treatment is 2 weeks. After a 10-day break, the course of treatment should be repeated to avoid relapse.
Chronic proctitis
Chronic proctitis, or proctosigmoiditis, can be a consequence of untreated acute proctitis, or the disease can be sluggish from the very beginning, manifesting itself over a long period of time with one or two mild symptoms.
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Symptoms of chronic proctitis
General symptoms of chronic proctitis are practically not observed. Periodically, a feeling of discomfort in the rectum and a feeling of incomplete bowel movement may occur. When the process worsens, the urge to defecate becomes more frequent. The stool is in the form of formed lumps with an admixture of mucus and sometimes blood. Often the disease is complicated by hemorrhoids, anal fissure. Weeping in the anus, anal itching are observed.
Diagnosis of chronic proctitis
First of all, infectious and parasitic diseases should be excluded. Digital examination allows to detect changes in sphincter tone and pain in the area of the crypts.
Endoscopic examination reveals granularity and hyperemia of the mucous membrane, mucus on the walls and in the lumen of the intestine, and contact bleeding.
Treatment of chronic proctitis
The same remedies are recommended as for acute proctitis, but the course of conservative therapy is longer. The best effect is achieved by therapeutic microclysters with collargol.
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Treatment of proctitis
Infectious proctitis requires antibiotic therapy. Homosexual men with nonspecific proctitis should be treated empirically with ceftriaxone 125 mg intramuscularly once (or ciprofloxacin 500 mg orally twice daily for 7 days) plus doxycycline 100 mg orally twice daily for 7 days. For antibiotic-associated proctitis, metronidazole (250 mg orally four times daily) or vancomycin (125 mg orally four times daily) should be given for 7 to 10 days.
In radiation proctitis, topical formalin applied to the affected mucosa is usually effective. Alternative treatments include topical glucocorticoids as a spray (hydrocortisone 90 mg) or enema (hydrocortisone 100 mg or methylprednisolone 40 mg) twice daily for 3 weeks or mesalamine (4 g) as an enema at bedtime for 3-6 weeks. Also effective are mesalamine suppositories 500 mg once or twice daily, mesalamine 800 mg orally 3 times daily, or sulfasalazine 500-1000 mg orally 4 times daily for more than 3 weeks, either alone or in combination with topical treatment. If this form of treatment fails, systemic glucocorticoids may be effective.