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Proctitis

Also listed as: Rectal inflammation

Signs and Symptoms
Causes
Risk Factors
Preventive Care
 
Treatment
Other Considerations
Supporting Research

Proctitis is an inflammation of the lining of the rectum. It causes pain, soreness, bleeding, and a discharge of mucus or pus. Proctitis can last a long (chronic) or a short (acute) amount of time. When the inflammation goes beyond the rectum, the condition is often called proctocolitis. Proctitis can usually be treated successfully. Treatment depends on what's causing the inflammation. Sometimes proctitis can be treated the same way as inflammatory bowel disease, a condition where the lining of other parts of the digestive tract get inflamed.

Signs and Symptoms

Common symptoms of proctitis include:

  • Anal or rectal pain
  • Frequent urge to defecate
  • Passing of mucus, pus, or blood through the rectum
  • Change in bowel habits, such as constipation or diarrhea
  • Rectal bleeding

Causes

A number of conditions can cause proctitis. Sexually transmitted infections are the most common:

  • Sexually transmitted diseases (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 aren’t transmitted sexually -- Campylobacter, salmonella, and streptococcus can cause proctitis.
  • Inflammatory bowel disease (IBD) -- People with Crohn's disease or ulcerative colitis may be more likely to get proctitis. Both diseases involve inflammation of the gastrointestinal tract.
  • Other causes -- include radiation therapy (such as for rectal, uterine, cervical, or prostate cancer), injury to the rectum, or use of antibiotics for another infection.

Risk Factors

These factors can raise someone’s risk of proctitis:

  • Having oral-anal intercourse, particularly with multiple partners
  • Weakened immune system
  • Radiation therapy to the lower abdomen or pelvis
  • Taking antibiotic medication
  • Having inflammatory bowel disease

Preventive Care

You can take several steps to prevent proctitis:

  • Practicing safe sex -- using condoms, having only one sex partner -- can prevent STDs that cause proctitis.
  • Eating a well-balanced diet and limiting caffeine, alcohol, and high-fat foods may help reduce symptoms of ulcerative colitis, which can cause proctitis.
  • Stress-reduction techniques such as yoga, tai chi, and deep relaxation, may also lower the risk of inflammatory bowel disease, which can cause proctitis.

Treatment

Proctitis can usually be treated with a combination of both conventional and complementary therapies. The specific treatment depends on what’s causing the proctitis. For example, your doctor may prescribe antibiotics for proctitis caused by a bacterial infection. If the inflammation is caused by Crohn's disease or ulcerative colitis, your doctor may recommend corticosteroids or other medications. In addition to these conventional treatments, acupuncture, herbs, and nutritional supplements may also help relieve the symptoms of proctitis.

Medications

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

  • Proctitis caused by infection -- can be treated with antibiotics, for a bacterial infection, or antivirals for a viral infection, such as one related to 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. Your doctor may prescribe anti-inflammatory medications (such as corticosteroids, sulfasalazine, or other drugs) or medications to stop diarrhea.
  • Proctitis caused by antibiotic use -- Your doctor may prescribe metronidazole (Flagyl) or vancomycin (Vancocin). These drugs can kill the harmful bacteria 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 to get rid of abnormal tissue.

Nutrition and Dietary Supplements

A comprehensive treatment plan for proctitis may include a range of complementary and alternative therapies. Ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan. Always tell your health care 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 (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
  • 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 in foods, such as olive oil or vegetable oil.
  • Reduce or eliminate trans-fatty acids, 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 - 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:

  • When proctitis is caused by inflammatory bowel disease, getting more soluble fiber in your diet may help you have easier, more solid bowel movements. 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 foods such as apples, steel cut oats, and flax seeds. For some people, insoluble fiber (such as Metamucil or psyllium husks) can be irritating.
  • Probiotic supplement (containing Lactobacillus acidophilus), 5 - 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 proper balance of bacteria in your intestines. You should refrigerate your probiotic supplements for best results.
  • Vitamin C, 500 mg; and vitamin E, 400 IU; three 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) 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 lessened symptoms of proctocolitis. Fish oil may increase your risk of bleeding, so ask your doctor before taking it.
  • Glutamine, 400 mg four times per day) -- is an amino acid found in the body that that helps the intestine function properly. While there is no evidence that glutamine specifically helps reduce symptoms of proctitis, it may be good for overall intestinal health. Glutamine is best taken on an empty stomach. Do not take glutamine if you have diabetes, seizures, or a history of manic episodes.

Herbs

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

Slippery elm (Ulmus fulva) is a demulcent, a substance that protects irritated tissues and helps them heal. It may help soothe the digestive tract. Take 60 - 320 mg per day. One tsp. powder may be mixed with water and drunk three to four times a day.

Marshmallow (Althaea officinalis) is a demulcent and emollient, a substance that soothes mucous membranes like those found in the digestive tract. Drink one cup of tea three times per day. To make tea, steep 2 - 5 g of dried leaf or 5 g dried root in one cup boiling water. Strain and cool. Avoid marshmallow if you have diabetes. Marshmallow can interact with some medications, including lithium.

Garlic (Allium sativum), standardized extract, 400 mg two to three times daily, for antibacterial or antifungal and immune activity. Garlic can have blood-thinning properties and may increase the risk of bleeding. Talk to your doctor before taking garlic if you also take blood thinners such as warfarin (Coumadin) or aspirin, or if you have a clotting disorder.

Boswellia (Boswellia serrata, 1,200 mg three times per day for up to 8 weeks) has anti-inflammatory properties. A few small studies suggest that it may help in treating inflammatory bowel disease. It hasn't 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.
  • Natrumsulphuricum -- 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 symptoms associated with proctitis. 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%. There were no participants whose symptoms got worse or stayed the same following acupuncture treatment. Better studies are needed to know if acupuncture can really help proctitis.

Mind-Body Medicine

Although research suggests that stress may be associated inflammatory bowel disease, scientists aren't sure exactly what the connection is. Some researchers believe that psychotherapy combined with the following stress-reduction techniques may help relieve symptoms of proctitis:

  • Biofeedback
  • Hypnotherapy

Other Considerations

If you have proctitis, keep the following considerations in mind:

Prognosis and Complications

Complications from proctitis can range from ulcers and boils to severe bleeding. Proctitis related to ulcerative colitis may spread to include 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 topical creams and foams, don’t need long-term medication. People with more severe forms of proctitis, such as proctitis caused by gonorrhea, often don't respond as well to treatment. In general, however, the prognosis for people with most forms of proctitis is good with proper treatment and follow-up with a doctor.

Supporting Research

Ammon HP. Boswellic acids in chronic inflammatory diseases. Planta Med. 2006 Sep;72(12):1100-16.

Bast A, Haenen GR. Lipoic acid: a multifunctional antioxidant. Biofactors. 2003;17(1-4):207-13.

Beers MH, Porter RS, et al. The Merck Manual of Diagnosis and Therapy. 18th ed. Whitehouse Station, NJ: Merck Research Laboratories; 2006:1651-1655.

Bruzzese E, Raia V, Gaudiello G, et al. Intestinal inflammation is a frequent feature of cystic fibrosis and is reduced by probiotic administration. Aliment Pharmacol Ther. 2004;20(7):813-9.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.

Cvetnic Z, Vladimir-Knezevic S. Antimicrobial activity of grapefruit seed and pulp ethanolic extract. Acta Pharm. 2004;54(3):243-50.

Doron S, Gorbach SL. Probiotics: their role in the treatment and prevention of disease. Expert Rev Anti Infect Ther. 2006;4(2):261-75.

Gonclaves C, Dinis T, Batista MT. Antioxidant properties of proanthocyanidins of Uncaria tomentosa bark decoction: a mechanism for anti-inflammatory activity. Phytochemistry. 2005;66(1):89-98.

Holt PR, Katz S, Kirshoff R. Curcumin therapy in inflammatory bowel disease: a pilot study. Dig Dis Sci. 2005 Nov;50(11):2191-3.

Kennedy M, Bruninga K, Mutlu EA, et al. Successful and sustained treatment of chronic radiation proctitis with antioxidant vitamins E and C. Am J Gastroenterol. 2001;96:1080-4.

Ng SC, Kamm MA. Therapeutic strategies for the management of ulcerative colitis. Inflamm Bowel Dis. 2009 Jun;15(6):935-50. Review.

Regueiro M, Loftus EV Jr, Steinhart AH, Cohen RD. Medical management of left-sided ulcerative colitis and ulcerative proctitis: critical evaluation of therapeutic trials. Inflamm Bowel Dis. 2006 Oct;12(10):979-94.

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-96.


Review Date: 10/11/2010
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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