Brief overview
- Symptoms: Varies depending on the cause; including itching, pain in the anal area, redness and/or swelling of the anus, possibly fecal incontinence, bloody-mucous stool or discharge; flatulence
- Treatment: Depending on the cause, suppositories for pain and itching, antibiotics, anti-inflammatory agents as suppositories, ointment or foam; rarely surgery
- Causes and risk factors: Frequently infections through unprotected sexual intercourse; allergies possible; chronic inflammation such as Crohn’s disease or ulcerative colitis; psychological-traumatic causes
- Diagnosis: Inspection of the anus; palpation of the anus and rectum; endoscopic examination of the rectum
- Prognosis: Chronic progression possible if left untreated; rapid healing in many cases with treatment; proctitis favors the development of anal polyps
- Prevention: Protected sexual intercourse; avoid anal injuries
What is proctitis?
Proctitis (inflammation of the rectum) is an inflammation of the last section of the rectum and usually also the anus. It is accompanied by symptoms such as bloody and loose stools, difficulty passing stools and pain in the hip and groin region.
In contrast to other inflammatory bowel diseases, the symptoms of proctitis are limited to the last 15 centimetres of the bowel up to the anus.
Proctitis: What are the symptoms?
At the beginning of proctitis, symptoms rarely occur. At most, those affected notice that the anus is very sensitive or that pain occurs during bowel movements.
After some time, during which the inflammation spreads in the rectum, the following symptoms are possible:
- Bloody and purulent discharge
- Bloody-purulent bowel movements
- Constant feeling of having to go to the toilet
- Irregular bowel movements
- Fecal incontinence
- Pain and cramps
- Air escapes from the bowel (flatulence)
- Itching in the anus
- Reddened, bulging anus
In the further course of proctitis, anal fissures, genital warts or fistulas often occur in the anus, which also often cause severe pain.
The symptoms that occur in individual cases depend heavily on the factors that caused the proctitis. Proctitis caused by gonorrhea, for example, hardly causes any symptoms.
Proctitis: treatment
The treatment of proctitis depends on the causative factors:
Treatment of the infection
Treatment of inflammatory bowel disease
In the case of chronic inflammatory bowel disease (ulcerative colitis, Crohn’s disease), the anti-inflammatory agent mesalazine is initially administered as suppositories three times a week. If this does not bring about an improvement, the medication is given in tablet form. Doctors also frequently use mesalazine foam or mesalazine enemas for ulcerative proctitis. In very severe cases of ulcerative proctitis, the inflamed area of mucous membrane may be removed.
Drug treatment for chronic inflammatory bowel disease may be necessary for the rest of the patient’s life.
In the case of ulcerative proctitis and inflammatory bowel diseases in general, it often helps to change the diet and avoid certain foods that frequently trigger problems. These vary from person to person. In general, however, foods that are particularly high in fat, particularly spicy, smoked or generally difficult to digest are often triggers for problems associated with intestinal inflammation. Individual advice can be obtained from a doctor or nutritionist.
Treatment of allergic proctitis
Treatment of radiation damage
Treatment of proctitis caused by radiation is not usually necessary, as this disease is very mild and in most cases heals itself.
Symptomatic treatment of proctitis
In many cases, suppositories or a bowel enema (enema) help to treat the symptoms of rectal inflammation. A bowel enema involves passing water into the bowel via the anus. However, this measure must not be used in the case of certain pre-existing conditions.
In some cases, the doctor may use heat or a laser to stop bleeding.
What home remedies can help with proctitis?
Some home remedies from naturopathy, which help against hemorrhoids in many cases, can also be helpful in treating the symptoms of proctitis.
These include sitz baths with oak bark, camomile or yarrow, which are said to have anti-inflammatory, antipruritic and skin-soothing effects. These herbal remedies can also be used as a wash.
Another natural remedy is witch hazel. Suppositories and ointments containing the active ingredient, which are available for haemorrhoids, are also said to help symptomatically in many cases of proctitis.
Home remedies have their limits. If the symptoms persist over a longer period of time, do not improve or even get worse, you should always consult a doctor.
Monitoring the course of treatment
In moderate and severe cases of proctitis, regular control swabs of the intestinal mucosa are taken to assess the success of the treatment. This is not necessary for mild cases.
Proctitis: causes and risk factors
Proctitis can be caused by a variety of factors. Most cases of proctitis are due to unprotected sexual intercourse during which the patient contracts a sexually transmitted disease. In particular, infections with (lues), gonorrhea, HIV (AIDS), donovanosis (a tropical sexually transmitted disease), genital herpes (genital herpes), chlamydia or the human papillomavirus (HPV) are often associated with proctitis.
The risk of developing proctitis is greatly increased in people who have frequent anal intercourse or sexual intercourse with different people. When inserting objects into the anus during sexual intercourse, it is also possible for the bowel wall to tear. These injuries may also contribute to proctitis.
Proctitis is also a possible consequence of allergic reactions to the ingredients of suppositories, condoms or lubricants
Furthermore, traumatic events and psychological stress are potential triggers of proctitis in the sense of a psychosomatic interplay.
Radiotherapy for cancer or other radiation exposure are also possible causes of proctitis.
Proctitis: examinations and diagnosis
To diagnose proctitis, the doctor will first ask the patient’s medical history (anamnesis). The symptoms described by the patient and any existing illnesses usually provide the first indications of proctitis. The doctor uses three examination methods to make a reliable diagnosis:
Inspection of the anus
The doctor checks whether there are any inflammatory changes at the anus, such as reddening of the mucous membrane.
Digital rectal examination
During a digital rectal examination (DRU), the doctor uses a finger to feel the anus and surrounding organs. “Digital” is derived from the Latin term “digitus”, which means “finger”. In this case, it has nothing to do with a digital evaluation in the sense of modern information technology. The term is therefore somewhat misleading.
Rectoscopy
If an infection is the cause of proctitis, a reliable diagnosis can only be made in the laboratory. Among other things, the DNA of the bacteria is detected in the swabs taken from the mucous membrane during rectoscopy.
Proctitis: course of the disease and prognosis
People with proctitis often wait a long time to see a doctor about their symptoms out of a sense of shame. However, the longer treatment for proctitis is postponed, the higher the risk that the inflammation will develop into a chronic condition and can then only be treated with surgery.
If you consult a doctor immediately at the first sign of symptoms in the gastrointestinal tract, treatment can begin straight away. In almost all treated cases of proctitis, sufferers have a good prognosis and the disease can be completely cured.
In contrast to other inflammatory bowel diseases, the risk of bowel cancer is not significantly increased with proctitis. However, proctitis does increase the risk of anal polyps forming.
