Proctitis

Proctitis - an inflammation of the rectal mucosa­has a good prognosis unless massive bleeding occurs.

Causes

Many diseases spread by sex may cause proctitis, such as gonorrhea, syphilis, or herpes. A rectal injury or putting objects in the rectum may cause proctitis. Other causes may be radiation therapy or anal sex. Proctitis is caused most often by sexually transmitted diseases, including gonorrhea, syphilis, herpes simplex (genital herpes), candidiasis, and chlamydia. It can also be caused by inflammatory bowel diseases, such as Crohn's disease, or ulcerative colitis - with which it is a very common component. Occasionally it is caused by an amoeba that causes dysentery.

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.

Signs and Symptoms

The patient typically complains of these key symptoms: constipation, a feeling of rectal fullness, and cramps in the left abdomen. The history may also reveal tenesmus producing a few bloody or mucoid stools.

Diagnostic tests

Sigmoidoscopy in acute proctitis shows edematous, bright red or pink rectal mucosa that is shiny, thick, friable, and possibly ulcerated. In chronic proctitis, sigmoidoscopy shows thickened mucosa, loss of vascular pattern, and stricture of the rectal lumen.

Biopsy is performed to rule out cancer.

Bacteriologic and viral analyses are used to detect the cause.

Treatment

The goal of therapy is to remove the underlying cause of proctitis, such as fecal impaction or laxative abuse. Anti-infective medications are given for infection. Corticosteroids (in enema or suppository form) may reduce inflammation as may sulfasalazine, mesalamine, or similar agents. Tranquilizers may relieve emotion- al stress.

Prevention

Safer sexual practices, such as monogamous sex and condom use, help protect against STDs that can cause proctitis.