Proctitis is an extremely painful inflammation of the rectum and anus. It is often caused by venereal disease or systemic diseases such as ulcerative colitis or Crohn’s disease.
What is proctitis?
Proctitis is inflammation of the rectum. While other inflammatory bowel diseases usually affect the entire bowel or large sections of the bowel, the inflammation in proctitis affects only the last 16 centimeters of the bowel. The causes of the disease are varied. For example, bacterial infections, chronic inflammatory bowel diseases or allergic reactions are possible causes. Patients suffer from bloody discharge, pain and urge to defecate. Proctitis can promote the development of anal polyps. These are enlargements of the anal papillae. They can grow up to two centimeters in size. During defecation, they slip out of the anus and then have to be pushed back with a finger. They also often cause a foreign body sensation in the bowel.
Causes
Infectious inflammation of the rectum occurs primarily in association with sexually transmitted diseases. For example, gonorrhea (gonorrhea) results in purulent proctitis. Proctitis can also occur during the three stages of syphilis. Other venereal diseases that may be accompanied by the inflammation include ulcus molle, lymphogranuloma inguinale, AIDS, donovanosis, infections with Chlamydia trachomatis, and herpes simplex virus infections. The most common cause of infectious proctitis is unprotected receptive anal sex. However, chronic inflammatory bowel disease can also affect the rectum. The best known chronic inflammatory bowel diseases are ulcerative colitis and Crohn’s disease. Ulcerative colitis spreads continuously from the anus to the mouth. Ulceration of the upper mucosal layers of the intestine occurs. In Crohn’s disease, the inflammation penetrates all layers of the intestine. However, here the spread is not continuous, but segmental. The disease preferentially affects the small intestine and the colon. Allergic or toxic reactions can also lead to proctitis. For example, allergic exanthema of the intestinal mucosa is caused by suppositories, condoms, or lubricants. A special form of toxic reaction is ergotism gangraenosus cutaneus. Here, ulceration occurs after the insertion of ergotamine suppositories. These suppositories are used by migraine patients, for example. Other causes of proctitis are trauma or radiation therapy, for example in cancer.
Symptoms, complaints and signs
In proctitis, patients report watery, bloody, or purulent discharge from the anus. The stool may also contain bloody and purulent admixtures. There is severe itching in the anal region. Those affected have rather irregular bowel movements, but constantly feel the need to go to the toilet. Often they cannot hold the stool, fecal incontinence occurs. Air can also not be held in the intestine and escapes uncontrollably. This is also called flatulence. The anus appears reddened and is bulging. In the further course of the disease, anal fissures or fistulas may also occur at the anus. Anal fissures are tears in the skin or mucosa of the anus. A fistula is a connection between an internal hollow organ and the surface of the body. In the case of proctitis, a tube-like connection forms from the rectum to the skin surface around the anus. Both anal fissure and fistula are very painful. Depending on the type of infection, genital warts may also form. What symptoms actually occur depends on the cause. For example, proctitis caused by gonorrhea causes little discomfort other than a purulent discharge.
Diagnosis and course of the disease
Symptoms provide the first clues to proctitis. If inflammation of the rectum is suspected, the doctor first inspects the anus. Protrusions, redness, fistulas, or fissures may be seen here. This is followed by a digital rectal examination (DRU). The rectum is palpated with a finger. In the case of severe inflammation, this can be very painful under certain circumstances. A rectoscopy provides definitive certainty. Before the examination, the patient must take a laxative to ensure that the rectum is free of stool residue.The doctor then inserts an endoscope into the anus. This allows him to detect inflammation and bleeding and, in case of doubt, to treat them directly. Rectoscopy reveals inflammatory redness and infiltrated intestinal walls. Erosions or ulcers may also be visible. For further clarification, the physician may take smears or biopsies during rectoscopy. Again, depending on the position of the endoscope, pain may be experienced during the examination.
Complications
Although proctitis is a very unpleasant condition, complications are rare. The specific cause plays a role. For example, proctitis or rectal inflammation can extend to the entire intestine if it persists for a long time. Under certain circumstances, ulcerative and chronic intestinal inflammations develop, which considerably restrict the patient’s quality of life. In particularly severe forms of proctitis, blood loss may occur due to bleeding in the rectal area. These bleedings occur especially in connection with hemorrhoids. However, inflammation of the bowel does not affect the formation and development of hemorrhoids. This happens especially in chronic inflammatory processes. The blood loss sometimes leads to anemia (anemia) in severe cases. Typical symptoms of this are general pallor, weakness, shortness of breath or dizziness. If proctitis is left untreated, it can also lead to adhesions in the rectal area. Furthermore, the development of chronic fecal incontinence is also possible. If proctitis is caused by the so-called human papillovirus, genital warts sometimes form. These usually heal completely, but can also rupture and thus lead to bleeding. Some forms of proctitis are caused by sexually transmitted pathogens and are therefore highly contagious if left untreated.
When should you see a doctor?
Irregularities in the area of the anus should be presented to a doctor. If symptoms persist unabated for several days or increase in intensity, the affected person needs medical attention. Itching, pain, difficulty going to the toilet, or a feeling of pressure in the bowel should be investigated and treated. Affected persons often report a foreign body sensation. This should be examined more closely by a physician. In many cases, proctitis occurs as a concomitant of a sexually transmitted disease. If this has not yet been diagnosed, a visit to the doctor for clarification should be contacted as soon as possible. Swelling, problems moving around or in a sitting position are signs of an irregularity. A visit to the doctor is necessary so that the cause of the discomfort can be found. If warts, growths or fistulas develop in the anal region, they should be looked at by a doctor. Treatment is necessary to avoid complications. In case of bleeding, impaired sphincter activity or loss of control over sphincter activity, it is advisable to see a doctor. Sufferers of proctitis are often unable to regulate the timing of excretions on their own. Therefore, they should seek medical help. If there are disturbances within the sexual act or a decrease in libido, these are also indications of a health impairment.
Treatment and therapy
Therapy is given depending on the cause. Bacterial infections are treated with antibiotics. Therapy for inflammatory bowel disease is somewhat more difficult. Immunosuppressants, TNF-alpha blockers, and other drugs are used here. In severe cases, pieces of the intestine must be surgically removed. If the proctitis is due to an allergic reaction, the trigger should be avoided urgently in the future. Anti-inflammatory enemas or suppositories are used for symptomatic treatment.
Prevention
Infectious proctitis can be prevented with condoms. In particular, people who have frequent anal intercourse with changing persons should always use condoms. Inserting objects into the anus can also lead to inflammation due to small tears in the intestinal mucosa. Sex toys should therefore only be used with extreme caution in this area. If allergies to certain medications or substances (for example latex) are known, these should of course be avoided as much as possible.
Aftercare
Whether follow-up care is necessary also depends on the severity and cause of the condition. For example, if it is an infection-related proctitis, some follow-up examinations may be necessary. These are still performed regularly depending on the severity of the proctitis. If the disease has only taken a mild course, no further check-ups with the doctor are necessary. However, if the course is moderate or severe, the doctor should check whether the treatment was successful. Usually, the first of these examinations takes place one to two weeks after the start of therapy. For this purpose, further swabs are taken from the intestinal wall and checked. If no further infection can be detected, the therapy was successful. Until success is confirmed, no further sexual intercourse should take place that could irritate the anus or rectum. Otherwise, after successful treatment of infectious proctitis, no further follow-up treatment is necessary. However, if the proctitis is based on a chronic inflammatory bowel disease, such as ulcerative colitis, patients may be affected by it for a longer period of time. This means that they need to be treated with medication over the long term. Meanwhile, sufferers should also see their doctor regularly for checkups.
What you can do yourself
Proctitis is an acute or chronic inflammation of the rectum. The mucous membrane of the rectum is considered very sensitive, which should be taken into account in any type of self-treatment or self-help. In many cases, proctitis is caused by bacteria, so it is then usually necessary to use antibiotics. In many cases, those affected make the mistake of not taking the antibiotic therapy long enough or in too low a dosage. Since irregular use of antibiotics can cause pathogen resistance, this often leads to chronic courses of the disease. In addition to antibiotics, other medically prescribed medications such as immunosuppressants or anti-allergic drugs should always be taken strictly as prescribed by a physician in cases of chronic proctitis. In rare cases, proctitis is due to an allergic event, in which case the allergic trigger should be avoided as much as possible in the future. Suppositories or so-called enemas can also be used for symptomatic treatment. Infectious proctitis often occurs in people who regularly engage in anal intercourse. Therefore, condoms should always be used for prevention, especially if sexual partners change frequently. Inserting sex toys into the anal canal can also cause microtears to the sensitive mucosa, leading to proctitis. If there is a latex allergy, only sex toys that are guaranteed to be latex-free should be used.
