Proctitis

Proctitis is an inflammation of the lining of the rectum causing pain, soreness, bleeding, and a discharge of mucus or pus. Proctitis can last a long or a short amount of time. When the inflammation extends beyond the rectum, the condition is often referred to as proctocolitis. At times, it is necessary to treat proctitis the same way as inflammatory bowel disease – a related disorder characterized by an inflammation of the lining of other parts of the gastrointestinal tract.

Signs and Symptoms

Common symptoms of proctitis include:

• Anal or rectal pain and discomfort, such as itching
• Urgent desire to defecate
• Discharge of mucus, pus, or blood
• Change in bowel habits, such as constipation or diarrhea
• Rectal bleeding
• Fever

Causes

Proctitis has both infectious and noninfectious causes. Some infections that cause proctitis include:

• Campylobacter
• Entamoeba histolytica
• Salmonella

Other infections that cause proctitis may be sexually transmitted, such as:

• Herpes simplex
• Gonorrhea
• Chlamydia
• Syphilis
• Shigellan

In addition to these infectious causes, some antibiotic medications used to treat an unrelated infection may actually cause proctitis. While antibiotics selectively inhibit the growth of particular bacteria in the bowel, other microorganisms can withstand the antibiotics, multiply, and cause infection.

Trauma and radiation therapy for cancer of the pelvis or lower abdomen are examples of noninfectious causes of proctitis.

Risk Factors

The following are associated with a high risk of proctitis:

• Oral-anal intercourse, particularly with multiple partners
• Compromised immune system
• Radiation therapy to the lower abdominal or pelvic region
• Use of antibiotic medication

Because some people with proctitis also develop inflammatory bowel disease, and related conditions such as Crohn's disease and ulcerative colitis, the risk factors in those instances of proctitis may be similar to the risk factors for inflammatory bowel disease (a family history of inflammatory bowel disease or Jewish ancestry).

Preventive Care

Several steps can be taken to prevent the development of proctitis:

• Avoiding anal intercourse may prevent proctitis from being spread by sexual transmission.
• A reduction in caffeine, dairy foods, high-fat foods, and artificial sweeteners may lower the risk of proctitis. Studies suggest a link between ulcerative colitis and diets high in these foods.
• Stress-reduction techniques such as yoga, tai chi, and deep relaxation, may also lower the risk of proctitis. Studies have shown that stressful situations may induce an inflammation of the lining of the intestines, possibly leading to inflammatory bowel disease.

Treatment Approach

Proctitis is a condition that tends to respond very effectively to a combination of both conventional and complementary therapies. Given the potential for complications from surgery, nonsurgical therapy is preferred for the treatment of proctitis. The specific treatment, however, depends on the cause of proctitis. For example, a physician may prescribe antibiotics for proctitis caused by bacterial infection. If the inflammation is caused by Crohn's disease or ulcerative colitis, the physician may recommend corticosteroids or enemas containing non-steroidal anti-inflammatory medication. In addition to these conventional treatments, acupuncture, herbs, and nutritional supplements, such as omega-3 fatty acids and magnesium, may also provide relief from the symptoms of proctitis.

Medications

Antibiotic medication, prescribed by a physician, effectively treats proctitis caused by the following bacterial infections:

• Herpes simplex
• Gonorrhea
• Chlamydia

When the cause of proctitis is unknown, or when proctitis is caused by radiation therapy, the following drug therapies may be more effective:

• Corticosteroids, such as hydrocortisone cream, applied directly to the area
• Anti-inflammatory drugs, particularly those used to treat inflammatory bowel disease (such as sulfasalazine and mesalamine), administered orally or as a foam, enema, or suppository

Surgery and Other Procedures

Some symptoms of proctitis, including dilation of the blood vessels on the surface of the inner lining of the rectum or colon, may be treated by a procedure called endoscopic cauterization. Most researchers agree, however, that more aggressive surgery should only be considered when less invasive treatments have proved ineffective.

Nutrition and Dietary Supplements

Nutrition and dietary supplements that may reduce the symptoms of proctitis include the following:

Omega-3 fatty acids
Studies have shown that diets high in omega-3 essential fatty acids, found in cold-water fish, reduce inflammation, abdominal pain, rectal bleeding, anorexia, general malaise, and fever associated with proctocolitis more effectively than placebo.

Magnesium
Researchers have found that patients with severe diarrhea caused by radiation therapy improve significantly faster when treated with intravenous magnesium sulfate than when treated with anti-diarrhea medication.

Glutamine
Some animal studies suggest that glutamine, an amino acid found in various plant and animal products, may reduce inflammation of the intestinal lining caused by radiation therapy. Unfortunately, researchers have yet to determine whether glutamine is as effective in humans.

Lactobacillus acidophilus
Given that proctitis may develop after taking antiobiotic medication, researchers theorize that Lactobacillus acidophilus, or other probiotics (organisms that enhance the life processes of other organisms), may help prevent antibiotic-induced proctitis.

Herbs

The use of herbs for the treatment of proctitis has yet to be thoroughly scientifically evaluated, but professional herbalists may recommend the following herbs to individuals with the condition:

• Cascara sagrada bark (Rhamnus purshiana) – used to soften stool
• Marshmallow root (Althaea officinalis) – used to reduce inflammation of the colon
• Flaxseed (Linum usitatissimum) – soothes inflamed tissue
• Slippery elm (Ulmus fulva) – soothes inflamed tissue
• Marigold (Calendula officinalis) and wild yam (Dioscorea villosa) – soothe inflamed tissue

Homeopathy

While no scientific studies have examined the use of homeopathy to prevent or treat proctitis, professional homeopaths may recommend the following remedies for people with symptoms of the disease:

• Gambogia – used to reduce inflammation of the colon and rectum as well as severe bouts of diarrhea; this herb is particularly useful for those who are extremely fatigued after loose bowel movements
• Natrum sulphuricum– used to reduce diarrhea, flatulence, and inflammation of the colon and rectum caused primarily by gonorrhea
• Sulphur – used to reduce inflammation of the colon and rectum as well as the itching, burning sensation in the rectum caused by diarrhea

Acupuncture

One promising study of 44 patients with proctitis caused by radiation therapy found that acupuncture "cured" 73% of the patients, "markedly" relieved symptoms in 9% of the patients, and reduced symptoms to "moderate" in 18% of the patients. There were no patients whose symptoms worsened or remained the same following acupuncture treatment.

Mind/Body Medicine

Although research suggests that stress may be associated with an inflammation of the bowel, scientists have yet to determine whether specific personality types are linked to inflammatory bowel disease. Based on clinical experience, however, some psychiatrists report that inflammatory bowel diseases may be associated with anxiety, anger, aggression, obsession, and a tendency to keep emotions bottled up inside. For these reasons, some researchers suggest that psychotherapy combined with the following stress-reduction techniques may help relieve the symptoms of proctitis:

• Biofeedback
• Hypnotherapy

Ayurveda

Ayurvedic practitioners describe people with inflammation of the rectum or bowel as having a pitta or "fire" illness which can be aggravated by Mars, the planet related to blood and to the liver. They recommend yoga postures, particularly "the fish," "the boat," and "the bow," to relieve symptoms of the condition. The traditional Ayurvedic herbal remedy called Boswellia serrata has also shown promise in preliminary studies as a potential alternative treatment for ulcerative colitis. For this reason, some practitioners suggest that Boswellia serrata may be effective for the treatment of proctitis, although it has not been studied for this condition specifically.

Other Considerations

An individual with proctitis should keep the following considerations in mind:

Prognosis and Complications

Complications from proctitis can range from the formation of ulcers and boils to severe bleeding. Proctitis related to ulcerative colitis may even evolve to include more widespread areas of the colon and other parts of the gastrointestinal tract.

Mild forms of proctitis, which often resolve spontaneously or with the application of topical creams and foams, will not require long-term medication. People with more severe forms of proctitis, such as proctitis caused by gonorrhea, are often less responsive to treatment with the failure rate being as high as 35% in some cases. In general, however, the prognosis for individuals with most forms of proctitis is good with proper treatment and follow-up with a healthcare provider.

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