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Proctitis is inflammation of the lining of the rectum, called the rectal mucosa.

Proctitis can be short term


(acute) or long term (chronic). Proctitis involves an inflammatory change of the rectum (within 15 cm of
the dentate line). Proctitis is similar to proctosigmoiditis but is not necessarily associated with proximal
extension of disease into the colon and usually does not evolve into ulcerative colitis. If proximal
extension does occur, it usually does so within the first 2 years of initial diagnosis.
Proctitis has many causes. It may be a side effect of medical treatments like radiation therapy or
antibiotics. Proctitis caused by sexually transmitted diseases (STDs) is transmitted through receptive anal
intercourse and is most commonly due to gonorrhea and chlamydia, or less commonly lymphogranuloma
venereum or herpes virus. Nonsexually transmitted causes include autoimmune disease of the colon,
such as Crohn disease and ulcerative colitis, celiac disease, chemicals, rectal instrumentation, and
trauma to the anorectal area. It may also occur as idiopathic proctitis.
For more information on Crohn disease and ulcerative colitis, see Medscape'sInflammatory Bowel
Disease Resource Center.

Proctitis involves mucosal cell loss, acute inflammation of the lamina propria, eosinophilic crypt abscess,
and endothelial edema of the arterioles. These may improve or in turn progress with subsequent fibrosis
of connective tissue and endarteritis of the arterioles, resulting in rectal tissue ischemia and leading to
mucosal friability, bleeding, ulcers, strictures, and fistula formation.

Frequency
United States
Frequencies of proctitis are associated with their individual etiologies.
Radiation therapy accounts for 5-20% of patients with acute proctitis, usually within 6 months of treatment
with a total dose of greater than 50 Gy. Chronic radiation proctitis has a more delayed onset from 9-14
months after initial radiation exposure but can occur any time up to 30 years post irradiation.
[1]

Race
Incidence is higher in Jewish persons.
Sex
Males are affected more often than females.
Age
Proctitis occurs predominantly in adults.

History
General symptoms
Feeling of rectal fullness
Anal and rectal pain
Diarrhea, usually frequent, small amounts
Frequent or continuous urge to have a bowel movement
Pain in the lower left abdomen
Passing mucus through the rectum
Rectal bleeding
Idiopathic proctitis
Passage of blood and mucus per rectum
Tenesmus
Occasionally, passage of loose stool, with or without lower abdominal pain or rectal cramping
Infectious proctitis
Pruritus
Rectal and anal pain (may become severe)
Avoidance of defecation due to pain
Most common causes - Neisseria gonorrhoeae, Chlamydia trachomatis,herpes simplex virus (HSV)
types 1 and 2
Indolent and extensive HSV types 1 and 2 infections: Symptoms may include the following: tenesmus,
rectal pain, discharge, and hematochezia. The disease may run its natural course of exacerbations and
remissions but is usually more prolonged and severe in patients with immunodeficiency disorders.
Presentations may resemble dermatitis or decubitus ulcers in debilitated, bedridden patients. A
secondary bacterial infection may be present.
Radiation-induced proctitis
Early symptoms include tenesmus and diarrhea that resolve shortly after the radiation treatment period.
Later symptoms of proctitis (occurring months to years after the completion of radiation therapy) include
tenesmus, bleeding, low-volume diarrhea, and rectal pain.
Symptoms of radiation-induced proctitis are associated with low-grade obstruction or fistulous tracts into
adjacent organs.

Physical examination findings may include the following:
Mucosal erythema
Mucosal friability
Groups of vesicles eroding into circular superficial ulcers enlarged
Tender inguinal lymph nodes (HSV)
Painless chancres
Hemoccult positive stools
Telangiectasias
Elevated fecal calprotectin and fecal lactoferrin
[2]


Causes of proctitis may include the following:
N gonorrhoeae
C trachomatis
HSV 1 (10%) and HSV 2 (90%)
Radiation therapy
Immunodeficiency disorders
Crohn disease
Syphilis (usually secondary)
Papillomavirus
Amebiasis
Lymphogranuloma venereum
Ischemia
Toxins (eg, hydrogen peroxide enemas)
Vasculitis
Cytomegalovirus (CMV)
Clostridium difficile
Campylobacter species

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