Proctitis
Encyclopedia
Proctitis is an inflammation
of the anus
and the lining of the rectum
, affecting only the last 6 inches of the rectum.
, rectal bleeding
and possible discharge, a feeling of not having adequately emptied the bowels, involuntary spasms and cramping during bowel movements, left-sided abdominal pain, passage of mucus through the rectum, and anorectal pain.
and prostate cancer) or as a sexually transmitted infection, as in lymphogranuloma venereum
and herpes proctitis. Proctitis is also linked to stress and recent studies suggest a celiac disease-associated "proctitis" can result from an intolerance to gluten
.
A common cause is engaging in anal sex
with multiple partners infected with sexual transmitted diseases in men who have sex with men
. Shared enema usage has been shown to facilitate the spread of Lymphogranuloma venereum
proctitis .
can also be caused, showing symptoms such as pale skin, irritability, weakness, dizziness, brittle nails, and shortness of breath.
(Gonococcal proctitis)
Chlamydia
(chlamydia proctitis)
Herpes Simplex Virus 1 and 2
(herpes proctitis)
Syphilis
(syphilitic proctitis)
is taken, in which the doctor scrapes a tiny piece of tissue from the rectum, and this tissue is then tested. The physician may also take a stool sample to test for infections or bacteria. If the physician suspects that the patient suffers from Crohn's disease or ulcerative colitis, colonoscopy or barium enema
X-rays are used to examine areas of the intestine.
(5ASA) or corticosteroid
s applied directly to the area in enema or suppository
form, or taken orally in pill form. Enema and suppository applications are usually more effective, but some patients may require a combination of oral and rectal applications.
Another treatment available is that of fiber supplements such as Metamucil
. Taken daily these may restore regularity and reduce pain associated with proctitis.
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
of the anus
Anus
The anus is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, unwanted semi-solid matter produced during digestion, which, depending on the type of animal, may be one or more of: matter which the animal cannot digest,...
and the lining of the rectum
Rectum
The rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...
, affecting only the last 6 inches of the rectum.
Overview
Symptoms are ineffectual straining to empty the bowels, diarrheaDiarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
, rectal bleeding
Hematochezia
Hematochezia is the passage of fresh blood per anus, usually in or with stools . Hematochezia is commonly associated with lower gastrointestinal bleeding, but may also occur from a brisk upper GI bleed...
and possible discharge, a feeling of not having adequately emptied the bowels, involuntary spasms and cramping during bowel movements, left-sided abdominal pain, passage of mucus through the rectum, and anorectal pain.
Causes
Proctitis has many possible causes. It may occur idiopathically (idiopathic proctitis). Other causes include damage by irradiation (for example in radiation therapy for cervical cancerCervical cancer
Cervical cancer is malignant neoplasm of the cervix uteri or cervical area. One of the most common symptoms is abnormal vaginal bleeding, but in some cases there may be no obvious symptoms until the cancer is in its advanced stages...
and prostate cancer) or as a sexually transmitted infection, as in lymphogranuloma venereum
Lymphogranuloma venereum
Lymphogranuloma venereum is a sexually transmitted disease caused by the invasive serovars L1, L2, L2a or L3 of Chlamydia trachomatis....
and herpes proctitis. Proctitis is also linked to stress and recent studies suggest a celiac disease-associated "proctitis" can result from an intolerance to gluten
Gluten
Gluten is a protein composite found in foods processed from wheat and related grain species, including barley and rye...
.
A common cause is engaging in anal sex
Anal sex
Anal sex is the sex act in which the penis is inserted into the anus of a sexual partner. The term can also include other sexual acts involving the anus, including pegging, anilingus , fingering, and object insertion.Common misconception describes anal sex as practiced almost exclusively by gay men...
with multiple partners infected with sexual transmitted diseases in men who have sex with men
Men who have sex with men
Men who have sex with men are male persons who engage in sexual activity with members of the same sex, regardless of how they identify themselves; many men choose not to accept sexual identities of homosexual or bisexual...
. Shared enema usage has been shown to facilitate the spread of Lymphogranuloma venereum
Lymphogranuloma venereum
Lymphogranuloma venereum is a sexually transmitted disease caused by the invasive serovars L1, L2, L2a or L3 of Chlamydia trachomatis....
proctitis .
Symptoms
A common symptom is a continual urge to have a bowel movement—the rectum could feel full or have constipation. Another is tenderness and mild irritation in the rectum and anal region. A serious symptom is pus and blood in the discharge, accompanied by cramps and pain during the bowel movement. If there is severe bleeding, a condition called anemiaAnemia
Anemia is a decrease in number of red blood cells or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin...
can also be caused, showing symptoms such as pale skin, irritability, weakness, dizziness, brittle nails, and shortness of breath.
Sexually transmitted proctitis
GonorrheaGonorrhea
Gonorrhea is a common sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. The usual symptoms in men are burning with urination and penile discharge. Women, on the other hand, are asymptomatic half the time or have vaginal discharge and pelvic pain...
(Gonococcal proctitis)
- This is the most common cause. Strongly associated with anal intercourse. Symptoms include soreness, itching, bloody or pus-like discharge, or diarrheaDiarrheaDiarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
. Other rectal problems that may be present are anal warts, anal tears, fistulaFistulaIn medicine, a fistula is an abnormal connection or passageway between two epithelium-lined organs or vessels that normally do not connect. It is generally a disease condition, but a fistula may be surgically created for therapeutic reasons.-Locations:Fistulas can develop in various parts of the...
s, and hemorrhoids.
Chlamydia
Chlamydia (bacterium)
Chlamydia is a genus of bacteria that are obligate intracellular parasites. Chlamydia infections are the most common bacterial sexually transmitted infections in humans and are the leading cause of infectious blindness worldwide....
(chlamydia proctitis)
- Accounts for twenty percent of cases. People may show no symptoms, mild symptoms, or severe symptoms. Mild symptoms include rectal pain with bowel movements, anal discharge, and cramping. With severe cases, people may have discharge containing blood or pus, severe rectal pain, and diarrheaDiarrheaDiarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
. Some people suffer from rectal strictures, a narrowing of the rectal passageway. The narrowing of the passageway may cause constipation, straining, and thin stools.
Herpes Simplex Virus 1 and 2
Herpes simplex virus
Herpes simplex virus 1 and 2 , also known as Human herpes virus 1 and 2 , are two members of the herpes virus family, Herpesviridae, that infect humans. Both HSV-1 and HSV-2 are ubiquitous and contagious...
(herpes proctitis)
- Symptoms may include multiple vesicles that rupture to form ulcers, tenesmusTenesmusRectal tenesmus is a feeling of incomplete defecation. It is experienced as an inability or difficulty to empty the bowel at defecation...
, rectal pain, discharge, hematocheziaHematocheziaHematochezia is the passage of fresh blood per anus, usually in or with stools . Hematochezia is commonly associated with lower gastrointestinal bleeding, but may also occur from a brisk upper GI bleed...
. The disease may run its natural course of exacerbations and remissionRemissionRemission may refer to:*Remission , the state of absence of disease activity in patients with a chronic illness, with the possibility of return of disease activity*Remission , the reflection or scattering of light by a material...
s but is usually more prolonged and severe in patients with immunodeficiency disorders. Presentations may resemble dermatitisDermatitis-Etymology:Dermatitis derives from Greek derma "skin" + -itis "inflammation" and genetic disorder.-Terminology:There are several different types of dermatitis. The different kinds usually have in common an allergic reaction to specific allergens. The term may describe eczema, which is also called...
or decubitusDecubitusCommonly used in medicine, the word decubitus is used to mean "lying down". It is derived from the Latin verb “decumbere” meaning "to lie down"....
ulcers in debilitated, bedridden patients. A secondary bacterial infection may be present.
Syphilis
Syphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
(syphilitic proctitis)
- The symptoms are similar to other causes of infectious proctitis; rectal pain, discharge, and spasms during bowel movements, but some people may have no symptoms. Syphilis occurs in three stages.
- The primary stage: One painless sore, less than an inch across, with raised borders found at the site of sexual contact, and during acute stages of infection, the lymph nodes in the groin become diseased, firm, and rubbery.
- The secondary stage: Sores are produced around the anus and rectum, these are wart-like growths resembling cauliflowerCauliflowerCauliflower is one of several vegetables in the species Brassica oleracea, in the family Brassicaceae. It is an annual plant that reproduces by seed...
. - The third stage: Occurs late in the course of syphilis and affects mostly the heart and nervous system.
Diagnosis
Doctors can diagnose proctitis by looking inside the rectum with a proctoscope or a sigmoidoscope. A biopsyBiopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
is taken, in which the doctor scrapes a tiny piece of tissue from the rectum, and this tissue is then tested. The physician may also take a stool sample to test for infections or bacteria. If the physician suspects that the patient suffers from Crohn's disease or ulcerative colitis, colonoscopy or barium enema
Enema
An enema is the procedure of introducing liquids into the rectum and colon via the anus. The increasing volume of the liquid causes rapid expansion of the lower intestinal tract, often resulting in very uncomfortable bloating, cramping, powerful peristalsis, a feeling of extreme urgency and...
X-rays are used to examine areas of the intestine.
Treatment
Treatment for proctitis varies depending on severity and the cause. For example, the physician may prescribe antibiotics for proctitis caused by bacterial infection. If the proctitis is caused by Crohn's disease or ulcerative colitis, the physician may prescribe the drug 5-aminosalicyclic acidMesalazine
Mesalazine , also known as Mesalamine or 5-aminosalicylic acid , is an anti-inflammatory drug used to treat inflammation of the digestive tract ulcerative colitis and mild-to-moderate Crohn's disease...
(5ASA) or corticosteroid
Corticosteroid
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte...
s applied directly to the area in enema or suppository
Suppository
A suppository is a drug delivery system that is inserted into the rectum , vagina or urethra , where it dissolves.They are used to deliver both systemically-acting and locally-acting medications....
form, or taken orally in pill form. Enema and suppository applications are usually more effective, but some patients may require a combination of oral and rectal applications.
Another treatment available is that of fiber supplements such as Metamucil
Metamucil
Metamucil is a bulk-producing laxative and fiber supplement. The Metamucil brand has existed since 1934, and was owned by G.D. Searle & Company until 1985 when Procter & Gamble acquired the brand. The active ingredient is psyllium seed husks. It may also reduce cholesterol when taken daily....
. Taken daily these may restore regularity and reduce pain associated with proctitis.