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
Proctitis has both infectious and noninfectious causes. Some infections that
cause proctitis include:
Other infections that cause proctitis may be sexually transmitted, such as:
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.
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
Use of antibiotic medication
Because some people with proctitis also develop inflammatory bowel disease,
and related conditions such as
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).
Several steps can be taken to prevent the development of proctitis:
Avoiding anal intercourse may prevent proctitis from being spread by
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 asyoga, 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.
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
enemas containing non-steroidal
anti-inflammatory medication. In addition to these conventional treatments,
herbs, and nutritional supplements, such as
omega-3 fatty acids and
magnesium, may also provide relief
from the symptoms of proctitis.
Antibiotic medication, prescribed by a physician, effectively treats
proctitis caused by the following bacterial infections:
When the cause of proctitis is unknown, or when proctitis is caused by
radiation therapy, the following drug therapies may be more
Corticosteroids, such as hydrocortisone cream, applied directly to the
Anti-inflammatory drugs, particularly those used to treat inflammatory
bowel disease (such as
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
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
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
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
Marshmallow root (Althaea
officinalis) - used to reduce inflammation of
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
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
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.
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:
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
An individual with proctitis should keep the following considerations in
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
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
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Review Date: March 2001
Reviewed By: Participants in the review process include: Ruth DeBusk, RD, PhD, Editor,
Nutrition in Complementary Care, Tallahassee, FL; Richard Glickman-Simon, MD,
Department of Family Medicine, New England Medical Center, Tufts University,
Boston, MA; Jacqueline A. Hart, MD, Department of Internal Medicine,
Newton-Wellesley Hospital, Harvard University and Senior Medical Editor
Integrative Medicine, Boston, MA; Dana Ullman, MPH, Homeopathic Educational
Services, Berkeley, CA.
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