Proctitis

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Overview
Proctitis is defined as an inflammation of the anus and the lining of the rectum, affecting only the last 6 inches of the rectum.

Symptoms are ineffectual straining to empty the bowels, diarrhea, rectal bleeding and possible discharge, a feeling that you didn't adequately empty the bowels, involuntary spasms and cramping during bowel movements, left-sided abdominal pain, passage of mucus through the rectum and anorectal pain.

Causes
Proctitis is commonly caused by STDs, but are also caused by non-sexually transmitted infections, auto-immune disease of the colon (such as Crohn's disease and ulcerative colitis, harmful physical agents, chemicals, foreign objects placed in rectum, and trauma to the anorectal area. It may also occur independently (idiopathic proctitis). Rarer causes include damage by irradiation (for example in radiation therapy for cervical cancer) or as a sexually transmitted infection, as in lymphogranuloma venereum and herpes proctitis. Proctitis is also linked to stress and recent studies suggest it results from an intolerance to gluten.

Symptoms
A common symptom people have is a continuing urge to have a bowel movement, the rectum could feel full or have constipation. Tenderness and mild irritation in the rectum and anal region. A serious symptom is pus and blood in the discharge, accompanied by cramps and pain during the bowel movement. If there is severe bleeding, a condition called anemia can also be caused, showing symptoms of pale skin, irritability, weakness, dizziness, brittle nails, and shortness of breath.

Sexually transmitted proctitis
Gonorrhea (Gonococcal proctitis)
 * The most common cause. Strongly associated with anal intercourse. Symptoms include soreness, itching, bloody or pus-like discharge, or diarrhea. Other rectal problems that may be present are anal warts, anal tears, fistulas, and hemorrhoids.

Chlamydia (chlamydia proctitis)
 * Accounts for twenty percent of cases. People may show no symptoms, mild symptoms, or severe symptoms. Mild symptoms include rectal pain with bowel movements, anal discharge, and cramping. With severe cases, people may have discharge containing blood or pus, severe rectal pain, and diarrhea. Some people suffer from rectal strictures, a narrowing of the rectal passageway. The narrowing of the passageway may cause constipation, straining, and thin stools.

Herpes Simplex Virus 1 and 2 (herpes proctitis)
 * Symptoms may include multiple vesicles that rupture to form ulcers, tenesmus, rectal pain, discharge, hematochezia. The disease may run its natural course of exacerbations and remissions but is usually more prolonged and severe in patients with immunodeficiency disorders. Presentations may resemble dermatitis or decubitus ulcers in debilitated, bedridden patients. A secondary bacterial infection may be present.

Syphilis (syphilitic proctitis)
 * The symptoms are similar to other causes of infectious proctitis; rectal pain, discharge, and spasms during bowel movements, but some people may have no symptoms. Syphilis occurs in three stages. The primary stage: One painless sore, less than an inch across, with raised borders found at the site of sexual contact, and during acute stages of infection, the lymph nodes in the groin become diseased, firm, and rubbery. The secondary stage: Sores are produced around the anus and rectum, these are wart-like growths resembling couliflower. The third stage: Occurs late in the course of Syphilis and affects mostly the heart and nervous system.

Treatment
By looking inside the rectum with a proctoscope or a sigmoidoscope doctors can diagnose proctitis. A biopsy is taken, in which the doctor scrapes a tiny piece of tissue from the rectum, and this tissue is then tested. The physician may also take a stool sample to test for infections or bacteria. If the physician suspects that the patient suffers from Crohn's disease or ulcerative colitis, colonoscopy or barium enema x-rays are used to examine areas of the intestine.

Treatment for proctitis varies depending on severity and the cause. For example, the physician may prescribe antibiotics for proctitis caused by bacterial infection. If the proctitis is caused by Crohn's disease or ulcerative colitis, the physician may prescribe the drug 5-aminosalicyclic acid (5ASA) or corticosteroids applied directly to the area in enema or suppository form, or taken orally in pill form. Enema and suppository applications are usually more effective, but some patients may require a combination of oral and rectal applications.