Proctitis is a chronic inflammatory disease affecting the rectal mucosa (rectum) and characterized by bloody diarrhea. There are two main types of proctitis, ulcerative and gonorrheal, which differ in how they occur. Gonorrheal proctitis is transmitted through sexual contact. The most common symptoms of proctitis are pain in the rectal area and a frequent urge to defecate. Bloody diarrhea, painful defecation and bleeding in the rectal area are also commonly seen with the condition. Diarrhea may be followed by constipation with spasm and strong straining of the rectal muscles (tenesmus) usually during defecation. In some cases, the stool may be well formed but surrounded by blood and mucus. Proctitis is usually mild, intermittent for many years. Sometimes there is a neurological disorder with bladder dysfunction, weakness and burning in the lower extremities (paresthesias) and pain in the thighs. Erectile dysfunction may occur in men. When the diagnosis of gonorrheal proctitis is confirmed, testing for other (sexually transmitted) infections such as syphilis, amebiasis, chlamydia, campylobacter, shigella, and herpes simplex virus infections is also necessary. Ulcers in the rectum are observed in cases of ulcerative proctitis. Ulcers are usually accompanied by rectal bleeding, rectal muscle tension (tenesmus) and discharge of bloody mucus. However, rectal bleeding is rarely severe. Diarrhea often describes a lack of increase in stool volume, but rather frequent passage of small amounts of mucus or blood. Fever and weight loss in ulcerative proctitis are also rare. The symptoms of ulcerative proctitis are very similar to ulcerative colitis. However, ulcerative proctitis is not as serious a condition as ulcerative colitis and is limited to the rectum. Ulcerative proctitis can be caused by radiation damage (from radiotherapy to the pelvic area), trauma from a foreign body, constriction or blockage of a blood vessel (ischemia), infection, or the cause may be unknown (idiopathic). The effects of irritating enemas or laxatives can be confused with ulcerative proctitis. This disorder can also mimic the symptoms of long-term trauma. The diagnosis of proctitis is made during sigmoidoscopy when inflammation of the rectal mucosa is detected with a clearly defined upper border, above which the mucosa is normal. The rest of the colon and small intestine are found to be normal by barium smear radiography, while colonoscopy and rectal biopsy may show changes that are indistinguishable from those of chronic ulcerative colitis. Treatment for proctitis is determined by the cause of the condition. Gonococcal proctitis responds to intramuscular injection of procaine penicillin or spectinomycin, but less well to oral treatment with penicillin or tetracycline. Primary herpetic proctitis responds well to acyclovir. Chlamydial proctitis is affected by tetracycline.Treatment of idiopathic (unknown cause) ulcerative proctitis is very similar to that of ulcerative colitis and Crohn’s disease and includes diet and antidiarrheal medication. Topical corticosteroids can be used as suppositories or enemas, which should be administered at bedtime to maximize their retention. Other symptoms of the disease can be relieved by pain-relieving and antispasmodic drugs. Hospitalization may be required for a thorough physical examination. Although proctitis can persist for many years, it is not associated with an increased incidence of rectal or colon cancer. With treatment, proctitis usually occurs with intermittent mild to severe episodes of symptoms. The inflammation spreads outside the rectum in only 10 to 30% of patients affected by proctitis. In less than 15% of cases of ulcerative proctitis, chronic ulcerative colitis develops. References: 1. Regueiro MD. Diagnosis and treatment of ulcerative proctitis 2. Xu CT, Meng SY, PanBR. Drug Therapy for ulcerative colitis 3. National Digestive Diseases Information Clearinghouse (NDDIC). Proctitis 4. Medical Encyclopedia. MedlinePlus. Proctitis