Signs and Symptoms

Common symptoms of proctitis include:

• Pain in the anus or rectum
• Feeling like you need to have a bowel movement often
• Passing of mucus, pus, or blood through the rectum
• Change in bowel habits, such as constipation or diarrhea
• Bleeding from the rectum

Causes

A number of conditions can cause proctitis. Sexually transmitted diseases (STDs) are the most common:

• STDs. A person can get proctitis through anal or oral-anal intercourse. STDs that cause proctitis include herpes simplex, gonorrhea, chlamydia, and syphilis.
• Bacterial infections that are not transmitted sexually.Campylobacter, salmonella, and streptococcus can cause proctitis.
• Inflammatory bowel disease (IBD). People with Crohn disease or ulcerative colitis may be more likely to get proctitis. Both diseases involve inflammation of the digestive tract.
• Other causes. Radiation therapy (such as for rectal, uterine, cervical, or prostate cancer), injury to the rectum, or taking antibiotics for another infection.

Risk Factors

Someone is more likely to get proctitis if they:

• Have oral-anal intercourse, particularly with multiple partners
• Have a weakened immune system
• Get radiation therapy to the lower abdomen or pelvis
• Take antibiotic medication
• Have IBD

Preventive Care

You can take several steps to prevent proctitis:

• Practice safe sex. Using condoms and having only one sex partner can prevent STDs that cause proctitis.
• Eating a well-balanced diet and cutting back on caffeine, alcohol, and high-fat foods may help reduce symptoms of ulcerative colitis. Ulcerative colitis can cause proctitis.
• Stress-reduction techniques, such as yoga, tai chi, and deep relaxation, may also lower the risk of IBD, which can cause proctitis.

Treatment

You can treat proctitis with a combination of conventional and complementary (CAM) therapies. The specific treatment depends on what is causing the proctitis. For example, your doctor may prescribe antibiotics for a bacterial infection. If the inflammation is caused by Crohn disease or ulcerative colitis, your doctor may prescribe corticosteroids or other medications.

In addition to these conventional treatments, acupuncture, herbs, and nutritional supplements may help relieve the symptoms of proctitis.

Medications

The type of medication your doctor prescribes depends on the cause of your proctitis.

• Proctitis caused by a bacterial or viral infection can be treated with antibiotics or antiviral medications (such as medications for herpes).
• Proctitis caused by radiation therapy, bleeding from chronic proctitis may cause anemia. Your doctor may prescribe iron supplements.
• Proctitis caused by IBD. Your doctor will work to reduce the inflammation caused by your IBD. You may take anti-inflammatory medications (such as corticosteroids, sulfasalazine, or other drugs) or medications to stop diarrhea.
• Proctitis caused by antibiotics. Your doctor may prescribe metronidazole (Flagyl) or vancomycin (Vancocin). These drugs can kill the harmful microbes that may grow in place of "friendly" bacteria your intestine after you take antibiotics.

Surgery and Other Procedures

In more severe cases of proctitis from radiation therapy, ablation therapy may be used to destroy bleeding tissue. Laser therapy uses a laser to cauterize the tissue, while argon plasma coagulation uses argon gas.

Nutrition and Dietary Supplements

A comprehensive treatment plan for proctitis may include complementary and alternative therapies (CAM). Ask your team of health care providers about how to include CAM into your treatment plan. Always tell your provider about the herbs and supplements you are using or considering using.

These tips can keep you in good health overall:

• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
• Eat foods high in B-vitamins, calcium, and magnesium, such as almonds, beans, whole grains, and dark leafy greens (such as spinach and kale).
• Avoid refined foods such as white breads, pastas, and especially sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
• Use healthy oils, such as olive oil or coconut oil.
• Reduce or eliminate trans fats, found in commercially-baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid caffeine, alcohol, and tobacco.
• Drink 6 to 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week.

These nutritional supplements may help with some symptoms of proctitis:

• Getting more soluble fiber in your diet may help you have easier, more solid bowel movements. That may help if your proctitis is caused by IBD. But you should talk to your doctor first, because some people with IBD find that fiber makes their symptoms worse. Soluble fiber is found in apples, steel cut oats, and flax seeds. Insoluble fiber (such as Metamucil or psyllium husks) can irritate some people's intestines.
• Probiotic supplement (containing Lactobacillus acidophilus), 5 to 10 billion CFUs (colony forming units) a day. Taking antibiotics can kill both friendly and unfriendly bacteria, upsetting the balance your body needs for healthy digestion. Probiotics, or "friendly" bacteria, can help restore the right balance of bacteria in your intestines. People who have IBD should ask their doctors about probiotics. Some studies have found that probiotics help reduce symptoms, but other studies have not found any effect. Some people with weakened immune systems might need to avoid probiotics. Your doctor can help you figure out if probiotics are right for you.
• Vitamin C, 500 mg; and vitamin E, 400 IU; 3 times daily. One study found that taking vitamin C and E helped reduce symptoms of proctitis caused by radiation therapy. Taking large doses of vitamin E can increase your risk of bleeding, especially if you take blood thinners like warfarin (Coumadin), clopidogrel (Plavix), or aspirin. Talk to your doctor before taking vitamin E for proctitis.
• Omega-3 fatty acids, such as those found in fish oil (2.7 g per day), may help fight inflammation. One study found that people who took fish oil reduced their symptoms of proctocolitis. Fish oil may increase your risk of bleeding, so ask your doctor before taking it.

Herbs

Herbs may strengthen and tone the body's systems. As with any therapy, you should work with your health care provider before starting treatment. You may use herbs as dried extracts (capsules, powders, and teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.

Slippery elm (Ulmus fulva): protects irritated tissues and helps them heal. It may help soothe the digestive tract. It is available as a pill or a powder. Slippery elm may interact with other medications, so ask your doctor before taking it.

Marshmallow (Althaea officinalis): soothes mucous membranes like those found in the digestive tract. You can drink it as a tea. Avoid marshmallow if you have diabetes. Marshmallow can interact with some medications, including lithium.

Garlic (Allium sativum), standardized extract, 400 mg, 2 to 3 times daily, for antibacterial or antifungal and immune activity. Garlic may interact with many medications, including some taken to treat HIV. It also can increase the risk of bleeding. Talk to your doctor before taking garlic if you also take blood thinners such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, or if you have a clotting disorder.

Boswellia (Boswellia serrate), 3 times per day for up to 8 weeks has anti-inflammatory properties. A few small studies suggest that it may help in treating IBD. It has not been studied specifically for proctitis. Boswellia may interact with several other drugs and supplements, so talk to your doctor before taking it.

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 remedy 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.

Homeopathic creams for problems in the anal area, such as itching and dryness, may help relieve proctitis symptoms. Ask your health care provider for more information.

Acupuncture

One study of 44 people with proctitis caused by radiation therapy found that acupuncture "cured" 73% of the participants, "markedly" relieved symptoms in 9%, and reduced symptoms to "moderate" in 18%. None of the people in the study said their symptoms got worse or stayed the same following acupuncture treatment. More research is needed to know if acupuncture can really help proctitis.

Mind-Body Medicine

Although research suggests that stress may be linked with IBD, scientists are not sure exactly how. Some researchers believe that psychotherapy along with these stress-reduction techniques may help relieve symptoms of proctitis:

• Biofeedback
• Hypnotherapy

Other Considerations

Prognosis and Complications

Complications can range from ulcers and boils to severe bleeding. Proctitis related to ulcerative colitis may spread to more areas of the colon and other parts of the digestive tract.

Mild forms of proctitis, which often go away on their own or by using creams and foams, do not need long-term medication. People with more severe forms of proctitis, such as proctitis caused by gonorrhea, often do not respond as well to treatment. In general, the prognosis for people with most forms of proctitis is good with proper treatment and follow-up with a doctor.

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