Proctitis is a condition that many people find difficult to talk about, even though its symptoms can significantly affect their daily life and emotional well-being. Pain, bleeding, or a burning sensation in the rectal area are issues that often cause embarrassment, leading many patients to delay visiting a specialist. However, such a delay can worsen the inflammation and make treatment more challenging.
Beyond the physical discomfort, proctitis often impacts mental health as well. The insecurity caused by bleeding or pain, fears of more serious diseases, and the strain on social activities or work make this condition important not only medically but also psychologically. That’s why being informed about its causes, symptoms, and treatment is essential for anyone who notices changes in their bowel habits.
Understanding the condition and seeking timely medical advice from a proctologist are therefore the first and most crucial steps toward proper management. Before discussing treatment, though, let’s look at what exactly proctitis is, what causes it, and how it manifests.
What is proctitis and how does it manifest?
Proctitis is an inflammatory condition that affects the inner lining of the rectum — the part of the digestive tract located just before the anus. It involves inflammation of the mucosa, which under normal circumstances is a smooth and resilient surface essential for the proper passage of stool. When this lining becomes inflamed, it swells and turns sensitive, causing symptoms that range from mild discomfort to severe pain and bleeding. In more advanced stages, the tissue becomes fragile and may bleed even without a bowel movement, while in chronic cases, small ulcers may develop, further aggravating the inflammation.
The initial signs of proctitis are often subtle and easily overlooked, as patients tend to attribute them to simple hemorrhoids or temporary intestinal irritation. However, the presence of blood or mucus in the stool, pain during bowel movements, a burning or pressing sensation in the rectum, and persistent itching in the area are clear warning signs. A characteristic symptom is tenesmus, the persistent and uncomfortable urge to defecate even when the bowel is empty. Many patients also report a feeling of incomplete evacuation — as if they haven’t completely emptied their bowels — which leads to ongoing discomfort and significantly affects their daily life.
Proctitis can manifest with varying intensity from person to person. In some cases, there may be only mild discomfort and minimal bleeding, while in others the inflammation causes constant pain, pronounced tenderness, and difficulty in normal bowel function. Some patients report that the pain worsens after defecation or when sitting for long periods, and in more severe cases it may be accompanied by low fever, fatigue, or general weakness.
It is important to note that proctitis is not always caused by a single factor; it often arises as a symptom of another condition, such as inflammatory bowel disease, infection, or rectal injury. The inflammation can be acute, appearing suddenly with intense symptoms, or chronic, with persistent or recurring discomfort over time. In any form, proctitis signals that the rectal mucosa has been damaged and requires medical evaluation.
Causes of Proctitis
Proctitis can arise from a variety of factors. Some forms are temporary and caused by infections or irritation, while others are chronic and linked to systemic diseases.
1. Inflammatory bowel diseases (IBD)
Ulcerative colitis and Crohn’s disease are two of the most common causes of chronic proctitis. In ulcerative colitis, inflammation often begins in the rectum and extends upward, leading to bloody stools and irritation. Crohn’s disease, although it usually affects sections of the small intestine, can also involve the anal and rectal regions, causing ulcers and abscesses.
2. Infections
Many microorganisms can cause infectious proctitis. The most common are bacteria such as Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum (syphilis), as well as viruses like herpes simplex virus (HSV) and human papillomavirus (HPV). These infections are usually transmitted through anal sexual contact, but may also result from contamination from other infected areas.
3. Radiation therapy
Radiation-induced proctitis is a complication that can occur after radiation therapy in the pelvic area, typically in patients treated for prostate, uterine, or rectal cancer. The inflammation may appear shortly after treatment—within a few weeks—or much later, even months or years afterward.
4. Ischemic proctitis
In rare cases, reduced blood flow to the rectum can cause ischemic proctitis, particularly in elderly individuals or those with vascular diseases.
5. Mechanical or chemical irritation
Excessive use of laxatives, suppositories, enemas, or chemical substances can lead to irritative proctitis. Similarly, frequent anal intercourse or trauma to the rectal mucosa may also result in inflammation.
Diagnosis & Treatment
The diagnosis of proctitis is based on a combination of medical history, clinical examination, and specialized endoscopic and laboratory tests. The physician—usually a proctologist—begins by taking a detailed medical history, investigating factors such as sexual habits, medication use, prior treatments, or chronic conditions that could contribute to the inflammation. This is followed by a clinical examination to assess the severity of the inflammation and identify possible complications.
In most cases, a digital rectal examination is performed, allowing the doctor to evaluate the condition of the mucosa and detect pain or bleeding. This is often followed by a proctoscopy or sigmoidoscopy, procedures that enable direct visual inspection of the rectal lining and the collection of tissue samples for further analysis. A rectal biopsy is a key diagnostic tool, as it allows histological confirmation of inflammation and helps rule out malignancy or other pathological changes.
At the same time, microbiological tests may be conducted to detect bacteria, viruses, or parasites, while blood tests can assess inflammatory markers such as CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate). The combination of these examinations provides an accurate diagnosis and helps determine the underlying cause responsible for the development of proctitis.
The treatment of proctitis aims both to relieve symptoms and to address the underlying cause of the inflammation. The therapeutic approach is individualized according to the type and severity of the condition and may include medical, local, or—in rare cases—surgical treatment.
Medication
Drug therapy involves the use of antibiotics in cases of infectious proctitis, selected based on the responsible microorganism (for example, doxycycline or ceftriaxone). When the inflammation is associated with inflammatory bowel diseases, anti-inflammatory agents such as 5-ASA compounds or corticosteroids are commonly prescribed to control the inflammatory response and improve symptoms. If proctitis is due to a viral infection, antiviral drugs such as acyclovir (for herpes virus) are recommended. In many cases, topical treatments are also used—such as suppositories or enemas containing mesalamine or corticosteroids—which act directly on the inflamed area, reducing pain and irritation.
Dietary management
Diet plays a supportive yet significant role in managing proctitis. It is advisable to avoid spicy, fatty, and acidic foods that may aggravate symptoms, as well as to limit caffeine, alcohol, and carbonated beverages. Proper hydration is essential, while foods rich in dietary fiber—as long as they are well tolerated—can help promote regular bowel movements. During flare-ups, patients are encouraged to consume mild and soft foods, such as rice, potatoes, or bananas, which are gentle on the intestinal lining.
Advanced and chronic cases
In more advanced or chronic cases of proctitis, complications such as bleeding, rectal narrowing (stricture), or abscess formation may occur. When conservative treatment is insufficient, surgical intervention or specialized endoscopic procedures (such as cauterization or laser therapy) may be required to restore the mucosa and relieve symptoms.
Proctitis is a condition with multiple causes and varying manifestations, which is why proper medical evaluation and a personalized approach are essential. With appropriate medication, dietary regulation, and lifestyle adjustments, most patients can achieve relief from discomfort and restore normal bowel function. Early diagnosis and regular follow-up by a specialized proctologist are key to effective and lasting treatment.
