Proctitis is an inflammation of the lining of the rectum causing pain, soreness, bleeding, and a discharge of mucus or pus. Proctitis can last a long or a short amount of time. When the inflammation extends beyond the rectum, the condition is often referred to as proctocolitis. At times, it is necessary to treat proctitis the same way as inflammatory bowel disease – a related disorder characterized by an inflammation of the lining of other parts of the gastrointestinal tract.

Common symptoms of proctitis include:

• Anal or rectal pain and discomfort, such as itching
• Urgent desire to defecate
• Discharge of mucus, pus, or blood
• Change in bowel habits, such as constipation or diarrhea
• Rectal bleeding
• Fever

Proctitis has both infectious and noninfectious causes. Some infections that cause proctitis include:

• Campylobacter
• Entamoeba histolytica
• Salmonella

Other infections that cause proctitis may be sexually transmitted, such as:

• Herpes simplex
• Gonorrhea
• Chlamydia
• Syphilis
• Shigellan

In addition to these infectious causes, some antibiotic medications used to treat an unrelated infection may actually cause proctitis. While antibiotics selectively inhibit the growth of particular bacteria in the bowel, other microorganisms can withstand the antibiotics, multiply, and cause infection.

Trauma and radiation therapy for cancer of the pelvis or lower abdomen are examples of noninfectious causes of proctitis.

The following are associated with a high risk of proctitis:

• Oral-anal intercourse, particularly with multiple partners
• Compromised immune system 
• Radiation therapy to the lower abdominal or pelvic region 
• Use of antibiotic medication 

Because some people with proctitis also develop inflammatory bowel disease, and related conditions such as Crohn's disease and ulcerative colitis, the risk factors in those instances of proctitis may be similar to the risk factors for inflammatory bowel disease (a family history of inflammatory bowel disease or Jewish ancestry).

Several steps can be taken to prevent the development of proctitis:

• Avoiding anal intercourse may prevent proctitis from being spread by sexual transmission.
• A reduction in caffeine, dairy foods, high-fat foods, and artificial sweeteners may lower the risk of proctitis. Studies suggest a link between ulcerative colitis and diets high in these foods.
• Stress-reduction techniques such as yoga, tai chi, and deep relaxation, may also lower the risk of proctitis. Studies have shown that stressful situations may induce an inflammation of the lining of the intestines, possibly leading to inflammatory bowel disease.

Proctitis is a condition that tends to respond very effectively to a combination of both conventional and complementary therapies. Given the potential for complications from surgery, nonsurgical therapy is preferred for the treatment of proctitis. The specific treatment, however, depends on the cause of proctitis. For example, a physician may prescribe antibiotics for proctitis caused by bacterial infection. If the inflammation is caused by Crohn's disease or ulcerative colitis, the physician may recommend corticosteroids or enemas containing non-steroidal anti-inflammatory medication. In addition to these conventional treatments, acupuncture, herbs, and nutritional supplements, such as omega-3 fatty acids and magnesium, may also provide relief from the symptoms of proctitis.

Antibiotic medication, prescribed by a physician, effectively treats proctitis caused by the following bacterial infections:

• Herpes simplex
• Gonorrhea
• Chlamydia

When the cause of proctitis is unknown, or when proctitis is caused by radiation therapy, the following drug therapies may be more effective:

• Corticosteroids, such as hydrocortisone cream, applied directly to the area
• Anti-inflammatory drugs, particularly those used to treat inflammatory bowel disease (such as sulfasalazine and mesalamine), administered orally or as a foam, enema, or suppository

Some symptoms of proctitis, including dilation of the blood vessels on the surface of the inner lining of the rectum or colon, may be treated by a procedure called endoscopic cauterization. Most researchers agree, however, that more aggressive surgery should only be considered when less invasive treatments have proved ineffective.

Nutrition and dietary supplements that may reduce the symptoms of proctitis include the following:

Omega-3 fatty acids

Studies have shown that diets high in omega-3 essential fatty acids, found in cold-water fish, reduce inflammation, abdominal pain, rectal bleeding, anorexia, general malaise, and fever associated with proctocolitis more effectively than placebo.

Magnesium
Researchers have found that patients with severe diarrhea caused by radiation therapy improve significantly faster when treated with intravenous magnesium sulfate than when treated with anti-diarrhea medication.

Glutamine
Some animal studies suggest that glutamine, an amino acid found in various plant and animal products, may reduce inflammation of the intestinal lining caused by radiation therapy. Unfortunately, researchers have yet to determine whether glutamine is as effective in humans.

Lactobacillus acidophilus
Given that proctitis may develop after taking antiobiotic medication, researchers theorize that Lactobacillus acidophilus, or other probiotics (organisms that enhance the life processes of other organisms), may help prevent antibiotic-induced proctitis.

The use of herbs for the treatment of proctitis has yet to be thoroughly scientifically evaluated, but professional herbalists may recommend the following herbs to individuals with the condition:

• Cascara sagrada bark (Rhamnus purshiana) – used to soften stool
• Marshmallow root (Althaea officinalis) – used to reduce inflammation of the colon
• Flaxseed (Linum usitatissimum) – soothes inflamed tissue
• Slippery elm (Ulmus fulva) – soothes inflamed tissue
• Marigold (Calendula officinalis) and wild yam (Dioscorea villosa) – soothe inflamed tissue

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 herb 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

One promising study of 44 patients with proctitis caused by radiation therapy found that acupuncture "cured" 73% of the patients, "markedly" relieved symptoms in 9% of the patients, and reduced symptoms to "moderate" in 18% of the patients. There were no patients whose symptoms worsened or remained the same following acupuncture treatment.

Although research suggests that stress may be associated with an inflammation of the bowel, scientists have yet to determine whether specific personality types are linked to inflammatory bowel disease. Based on clinical experience, however, some psychiatrists report that inflammatory bowel diseases may be associated with anxiety, anger, aggression, obsession, and a tendency to keep emotions bottled up inside. For these reasons, some researchers suggest that psychotherapy combined with the following stress-reduction techniques may help relieve the symptoms of proctitis:

• Biofeedback
• Hypnotherapy

Ayurvedic practitioners describe people with inflammation of the rectum or bowel as having a pitta or "fire" illness which can be aggravated by Mars, the planet related to blood and to the liver. They recommend yoga postures, particularly "the fish," "the boat," and "the bow," to relieve symptoms of the condition. The traditional Ayurvedic herbal remedy called Boswellia serrata has also shown promise in preliminary studies as a potential alternative treatment for ulcerative colitis. For this reason, some practitioners suggest that Boswellia serrata may be effective for the treatment of proctitis, although it has not been studied for this condition specifically.

An individual with proctitis should keep the following considerations in mind:

Complications from proctitis can range from the formation of ulcers and boils to severe bleeding. Proctitis related to ulcerative colitis may even evolve to include more widespread areas of the colon and other parts of the gastrointestinal tract.

Mild forms of proctitis, which often resolve spontaneously or with the application of topical creams and foams, will not require long-term medication. People with more severe forms of proctitis, such as proctitis caused by gonorrhea, are often less responsive to treatment with the failure rate being as high as 35% in some cases. In general, however, the prognosis for individuals with most forms of proctitis is good with proper treatment and follow-up with a healthcare provider.

Almallah YZ, Ewen SW, El-Tahir A, et al. Distal proctocolitis and n-3 polyunsaturated fatty acids (n-3 PUFAs): the mucosal effect in situ. J Clin Immunol. 2000;20(1):68-76.

Anton PA. Stress and mind-body impact on the course of inflammatory bowel diseases. Semin Gastrointest Dis. 1999;10(1):14-19.

Babb RR. Radiation proctitis: a review. Am J Gastroenterol. 1996;91(7):1309-1311.

Bartelsman JF, Tytgat GN. Extra-ordinary forms of proctitis. Neth J Med. 1990;37(suppl 1):S52-S56.

Balzarini A, Felisi E, Martini A, De Conno F. Efficacy of homeopathic treatment of skin reactions during radiotherapy for breast cancer: a randomized, double-blind clinical trial. Br Homeopath J. 2000;89(1):8-12.

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

Blumenthal M, ed. Herbal Medicine: Expanded Commission E Monographs. Newton, Mass: Integrative Medicine Communications; 2000:47-51:246-247; 134-137.

Carl UM, Peusch-Dreyer D, Frieling T, Schmitt G, Hartmann KA. Treatment of radiation proctitis with hyperbaric oxygen: what is the optimal number of HBO treatments? Strahlenther Onkol. 1998;174(9):482-483.

Cohen L, Kitzes R. Early radiation-induced proctosigmoiditis responds to magnesium therapy. Magnesium. 1985;4(1):16-19.

Collins SM, Barbara G, Vallance B. Stress, inflammation and the irritable bowel syndrome. Can J Gastroenterol. 1999;13(suppl. A):47A-49A.

Gupta I, Parihar A, Malhotra P, et al. Effects of Boswellia serrata gum resin in patients with ulcerative colitis. Eur J Med Res. 1997;2(1):37-43.

Irizarry L. Proctitis. In: Jonathan Adler et al, eds. Emergency Medicine: an On-line Medical Reference. http://www.emedicine.com/. Chapter version April 24, 2000.

Lad V. Ayurveda: The Science of Self-Healing. Sante Fe, NM: Lotus Press; 1984.

Maunder R, Esplen MJ. Facilitating adjustment to inflammatory bowel disease: a model of psychosocial intervention in non-psychiatric patients. Psychother Psychosom. 1999;68(5):230-240.

Melko GP, Turco TF, Phelan TF, Sauers NM. Treatment of radiation-induced proctitis with sucralfate enemas. Ann Pharmacother. 1999;33(12):1274-1276.

Miller AL. Therapeutic considerations of L-glutamine: A review of the literature. Alternative Medicine Review. 1999;4(4):239-248.

Nagata Y, Lee C, Anderson P, et al. Reduction of radiation damage in small intestine of rats by glutamine. Presented at: the 43rd Annual Meeting of the Radiation Research Society and the 15th Annual Meeting of the North American Hyperthermia Society. San Jose, Calif: 1995:178.

Pinto A, Fidalgo P, Cravo M, et al. Short chain fatty acids are effective in short-term treatment of chronic radiation proctitis: randomized, double-blind, controlled trial. Dis Colon Rectum. 1999;42(6):788-796.

Reif S, Klein I, Lubin F, Farbstein M, Hallak A, Gilat T. Pre-illness dietary factors in inflammatory bowel disease. Gut. 1997;40(6):754-760.

Russel MG, Engels LG, Muris JW, et al. Modern life in the epidemiology of inflammatory bowel disease: a case-control study with special emphasis on nutritional factors [see comments]. Eur J Gastroenterol Hepatol. 1998;10(3):243-249.

Rompalo AM. Diagnosis and treatment of sexually acquired proctitis and proctocolitis: an update. Clin Infect Dis. 1999;28(suppl 1):S84-S90.

Schafer DW. Hypnosis and the treatment of ulcerative colitis and Crohn's disease. Am J Clin Hypn. 1997;40(2):111-117.

Scheppach W, Christl SU, Bartram HP, Richter F, Kasper H. Effects of short-chain fatty acids on the inflamed colonic mucosa. Scand J Gastroenterol Suppl. 1997;222:53-57.

Silk DB. Medical management of severe inflammatory disease of the rectum: nutritional aspects. Baillieres Clin Gastroenterol. 1992;6(1):27-41.

Tocchi A, Lepre L, Liotti G, et al. Familial and psychological risk factors of ulcerative colitis. Ital J Gastroenterol Hepatol. 1997;29(5):395-398.

Tytgat GN, Fockens P, Schotborgh RH, Hofer SO. Proctitis. Neth J Med. 1990;37(suppl 1):S37-S42.

Zhang ZH. Effect of acupuncture on 44 cases of radiation rectitis following radiation therapy for carcinoma of the cervix uteri. J Tradit Chin Med. 1987;7(2):139-140.

Zimmermann FB, Feldmann HJ. Radiation proctitis: Clinical and pathological manifestations, therapy and prophylaxis of acute and late injurious effects of radiation on the rectal mucosa. Strahlenther Onkol. 1998;174(suppl 3):85-89.