What symptoms occur with proctitis?
The symptoms of proctitis include a wide range of complaints. From rare asymptomatic courses (without noticeable symptoms) to severely painful inflammatory reactions or even tumor-like changes, there is a broad spectrum of proctitis symptoms. Symptoms of proctitis can vary greatly from case to case, depending on the underlying Cause of proctitis and also the severity of the inflammation. Therefore, you should definitely see a doctor if symptoms are present to get an accurate diagnosis and subsequently initiate an appropriate treatment of proctitis. If the inflammation spreads in the rectum, the following symptoms are possible:
- Rectal bleeding: Bleeding from the rectum is a common sign of proctitis. The blood may be visible directly in the stool or on toilet paper.
- Pain or discomfort: Patients may experience discomfort in the area of the rectum or anus. This can occur with bowel movements or independently. Direct pressure, such as when sitting, may also cause pain at the anus.
- Urgency to defecate: A frequent need to empty the bowels is also considered a sign of proctitis. Those affected then visit the toilet more often.
- Changes in bowel movements: Proctitis can lead to changes in stool, such as diarrhea or constipation. Bloody diarrhea is also possible. Read more here about Blood in stool.
- Mucous discharge: A thick, bloody-mucous discharge from the anus can be a symptom accompanying proctitis.
- Fever: A significantly elevated body temperature (from 38 degrees Celsius), as a systemic effect of proctitis.5
- Fatigue: General malaise, tiredness, and exhaustion may occur.
- Weight loss: Unintentional weight loss can be another symptom. Inflammation of the intestines often disrupts nutrient absorption.
- Anal itching, or severe Itching at the anus
- Afterburning, or burning at the anus
- Reddened, swollen protruding anus
How does proctitis progress?
At the beginning of proctitis, symptoms rarely occur. Affected individuals at most notice that the anus is very sensitive or that pain occurs during bowel movements.
In the advanced course, proctitis can cause pain and mucus discharge, which can often also be bloody. In addition, a purulent, bloody, or watery discharge as well as Anal itching occur. Read more here about Blood in stool.
Which symptoms occur in individual cases depends heavily on which Cause of proctitis underlies it. Proctitis caused by gonorrhea (gonorrhea) shows hardly any symptoms, for example. In addition, in the further course, fecal incontinence, but also Anal fissures and Anal fistulas occur, which also cause severe pain in the anus.
Can proctitis spread?
If proctitis lasts longer or is not treated or insufficiently treated, it is possible that it spreads to the entire intestine. This can promote the development of ulcers and chronic inflammatory bowel disease (Crohn's disease, ulcerative colitis). In about one fifth of patients, however, the disease eventually spreads to the colon and thus becomes ulcerative colitis. Ulcerative colitis is a chronic inflammatory bowel disease characterized by continuous and systematic involvement of the colon mucosa.
What is nonspecific proctitis?
The symptoms complained of in proctitis are often quite nonspecific. Patients report pain, burning sensation in the anus, pressure, urge to defecate, also a Anal itching (Pruritus ani) may occur. Mucous or purulent discharge and bleeding from the anus can also be observed.
Which doctor for proctitis?
If you suffer from the typical symptoms of proctitis, you should make an appointment with a proctology specialist. Early diagnosis and Treatment of proctitis significantly improves the chances of healing. If proctitis is diagnosed through a medical history interview and a subsequent endoscopic examination of the rectum, a specific therapy can be initiated. Depending on the cause of proctitis, for example, a bacterial infection is treated with antibiotics. If a chronic disease is the cause, long-term medication treatment of proctitis, sometimes also with anti-inflammatory agents such as corticosteroids, may be necessary. Read more here about the general treatment of proctitis and also about the treatment of proctitis with suppositories.
How is proctitis diagnosed?
With the medical history, the doctor can often make a suspected diagnosis of proctitis based on the symptoms and medical history. For diagnosis, the anus and rectum are then examined by finger. This allows the treating doctor to determine whether there is bleeding, mucus, edema, or other mucosal changes. This also indicates inflammation.
During a rectal examination (rectoscopy or proctoscopy), the inside of the rectum is examined more closely using an endoscope. This allows determination of whether the mucosa is inflamed or if there are other changes, such as ulcers or Anal fistulas. During a rectal examination (proctoscopy), a few-centimeter-long endoscope is carefully inserted through the anus into the rectum after gentle palpation to closely inspect the mucosal sections of the rectum and the transition to the external skin as well as the region of the hemorrhoidal cushions and thus to assess them. This examination is not painful when performed by an experienced and careful hand and only takes 1–2 minutes. A prerequisite for good assessment is also the preparation for this examination. This is done by you at home by emptying and cleaning the rectum. For this purpose, enemas available at the pharmacy are used, which should be applied about an hour before the scheduled examination appointment to flush the rectum.
A doctor can also examine other parts of the intestine using a colonoscopy (examination of the entire large intestine with an endoscope) for Crohn's disease or ulcerative colitis.
As part of the diagnosis, blood tests for syphilis and stool tests for Clostridioides difficile performed. In addition, the doctor can take swabs and tissue samples from the rectum. In the laboratory, it can then be checked whether there is an infection with bacteria, fungi, viruses, or another Cause of proctitis is present. Read more here about the various causes of proctitis, as well as the general treatment of proctitis and also about the treatment of proctitis with suppositories.
