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Proctitis

Synonyms of Proctitis

  • Antibiotic-Induced Proctitis
  • Gonorrheal Proctitis
  • Herpetic Proctitis
  • Ischemic Proctitis
  • Radiation Proctitis
  • Syphilitic Proctitis

Disorder Subdivisions

  • No subdivisions found.

General Discussion

Proctitis is a chronic inflammatory disease arising in the rectum and characterized by bloody diarrhea. There are two types of proctitis, ulcerative and gonorrheal, which are differentiated by the means in which they are contracted. Gonorrheal proctitis is transmitted through sexual contact.

Symptoms

Symptoms of proctitis are most frequently pain in the rectal area and a frequent desire to pass feces. Bloody diarrhea, painful defecation and bleeding in the rectal area are also common. Diarrhea may be followed by constipation with spasm and severe straining of the rectal muscles (tenesmus). In some cases, stools may be well formed but surrounded by blood and mucus.

Proctitis usually runs a mild, intermittent course over many years. Occasionally there is neurological involvement with urinary bladder dysfunction, weakness and burning of the lower limbs (paresthesias) and pain in the thighs. Men may have difficulty maintaining penile erections. When a diagnosis of gonorrheal proctitis is confirmed, individuals also should be tested for other sexually transmitted organisms such as syphilis, amebiasis, chlamydia, campylobacter, shigella, and herpes simplex virus infections.

Upon examination, individuals with ulcerative proctitis show ulcers in the rectum. Ulcerations are usually accompanied by rectal bleeding, straining of rectal muscles (tenesmus) and an anal discharge of bloody mucus. However, anal bleeding is seldom severe. Individuals with diarrhea often describe no increase in stool volume but rather frequent passage of small amounts of mucous or blood. Fever and weight loss are rare. Symptoms of ulcerative proctitis are very similar to ulcerative colitis. However, ulcerative proctitis is not as serious as colitis and is limited to the rectum. (See related disorder section for more information on Ulcerative Colitis.)

Causes

Proctitis can be caused by the pus-producing bacteria gonococci and by the herpes simplex virus, primary and secondary syphilis, chlamydia trachomatis and the human papilloma viruses. Gonococcal Proctitis usually results from passive anal intercourse with men who have infection in the canal that empties urine from the bladder (urethra).

Ulcerative Proctitis may be caused by radiation injury, trauma from a foreign body, constriction or obstruction of a blood vessel (ischemia), infection or the cause may be unknown (idiopathic).

The effects of irritating enemas or laxatives may be confused with Ulcerative Proctitis. This disorder may also mimic the symptoms of long-term trauma.

Affected Populations

Proctitis is increasing in incidence. Gonococcal Proctitis is most frequently found in women and homosexual men who practice anal-receptive intercourse.

Related Disorders

Symptoms of the following disorders can be similar to those of Proctitis. Comparisons may be useful for a differential diagnosis:

Ulcerative Colitis is an acute inflammation of the large intestine (colon) characterized by multiple, irregular, superficial ulcerations. The inflammation results in thickening of the wall of the colon with scar tissue and polyp-like growths. The primary symptom of Ulcerative Colitis is bloody diarrhea. The disease may involve only one side of the colon or it may eventually spread throughout the entire large intestine. (For more information on this disorder, choose "Ulcerative Colitis" as your search term in the Rare Disease Database.)

Crohn's Disease is a form of inflammatory bowel disease and is characterized by chronic diarrhea, abdominal pain, fever, weight loss and a solid mass in the abdomen. The intestine gradually becomes thickened and leathery. Complications may appear in the joints, skin and eyes. (For more information on this disorder, choose "Crohn's Disease" as your search term in the Rare Disease Database.)

Standard Therapies

Diagnosis
Diagnosis of proctitis is made when sigmoidoscopy reveals inflammation of the mucus lining of the rectum with a clearly demarcated upper border above which the lining is normal. The remainder of the colon and small intestine is found to be normal by barium x-rays, while colonoscopy and rectal biopsy may show changes which are indistinguishable from those of chronic ulcerative colitis. (For more information on chronic ulcerative colitis, see the related disorder section of this report.)

Treatment
The treatment of proctitis is determined by cause. Gonococcal proctitis responds to standard intramuscular injection with procaine penicillin or spectinomycin, but less consistently to oral treatment with penicillin or tetracycline. Primary herpetic proctitis responds well to acyclovir. Chlamydial proctitis responds to tetracycline. Treatment of idiopathic (unknown cause) ulcerative proctitis is very similar to that of ulcerative colitis and Crohn's disease, and includes a nonlaxative diet, the administration of antidiarrheal drugs such as diphenoxylate hydrochloride with atropine sulfate (Lomotil) or loperamide. Topical corticosteroids may be applied in the form of suppositories, steroid enemas or steroid foam. Enemas or suppositories should be administered at bedtime to maximize their retention. Other symptoms may be treated by pain-killing and antispasmodic drugs. Hospitalization may be necessary for a thorough physical examination.

Although proctitis may persist for many years, it is not associated with an increased incidence of cancer of the rectum or colon. With treatment, proctitis usually runs a course with periodic mild to severe episodes of symptoms. The inflammation spreads beyond the rectum in only 10 to 30% of individuals affected with proctitis. Less than 15% of individuals with ulcerative proctitis will develop chronic ulcerative colitis.

Approximately 40% of homosexual males with proctitis also have anorectal gonorrhea. It is not unusual to discover multiple disease producing organisms in patients with proctitis. Men who have had passive rectal intercourse with sex partners who have gonococcal infection of the ureter should have cultures performed for gonorrhea, regardless of an apparent lack of symptoms.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com

Organizations related to Proctitis

References

TEXTBOOKS
Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:339.

Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:742-43, 762.

Larson DE., ed. Mayo Clinic Family Health Book. New York, NY: William Morrow and Company, Inc; 1996:797, 798-99.

Bennett JC, Plum F., eds. Cecil Textbook of Medicine. 20th ed. W.B. Saunders Co., Philadelphia, PA; 1996:713, 742, 1649-59, 1913-15.

JOURNAL ARTICLES
Regueiro MD. Diagnosis and treatment of ulcerative proctitis. J Clin Gastronterol. 2004;38:733-40.

Xu CT, Meng SY, PanBR. Drug Therapy for ulcerative colitis. World J Gastroenterol. 2004;5:2311-17.

Schwartz DA, Herdman CR. Review article: The medical treatment of Crohn’s perianal fistula. Aliment Pharmacol Ther. 2004;19:953-67.

Denton A, Forbes A, Andreyev J, et al. Non surgical interventions for late radiation proctitis in patients who have received radical radiotherapy to the pelvis. Cochrane Database Syst Rev. 2002;CD03455.

Jiang XL, Cui HF. An analysis of 10218 ulcerative colitis cases in China. World J Gastroenterol. 2002;8:158-61.

FROM THE INTERNET
Proctitis. National Digestive Diseases Information Clearinghouse (NDDIC). February 2002. 3pp.
http://digestive.niddk.nih.gov/ddiseases/proctitis/index.htm

Proctitis. Medical Encyclopedia. MedlinePlus. Update Date: 10/9/2003. 2pp.
www.nlm.nih.gov/medlineplus/ency/article/001139.htm

Irizarry L. Proctitis. emedicine. Last Updated: June 11, 2004. 10pp.

Soni HC, Wilder C, Hardin E. Proctitis. emedicine Consumer Health. ©2003. 6pp.
www.emedicinehealth.com/fulltext/18743.htm

The information in NORD’s Rare Disease Database is for educational purposes only. It should never be used for diagnostic or treatment purposes. If you have questions regarding a medical condition, always seek the advice of your physician or other qualified health professional. NORD’s reports provide a brief overview of rare diseases. For more specific information, we encourage you to contact your personal physician or the agencies listed as “Resources” on this report.

Report last updated: 2008/04/25 00:00:00 GMT+0

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