Proctitis Cause

How do you get proctitis? What risk factors exist?

Most cases of proctitis are due to unprotected receptive anal intercourse and thus sexually transmitted pathogens such as chlamydia and gonococci. Basically, people who frequently have anal intercourse or sexual intercourse with multiple partners have a significantly increased risk of developing proctitis. People after immunosuppressive therapy or with immune disorders also have an increased risk of developing proctitis.

By inserting objects into the anus or through sexual intercourse, it is possible for the intestinal wall to tear. These lesions on the mucosa, called anal fissures, i.e., injuries to the mucous membrane of the anus, can also under certain circumstances cause proctitis.

The increasing numbers of infectious proctitis as part of a sexually transmitted disease in the general population is considered alarming, with groups of people practicing receptive anal intercourse being particularly at risk. Furthermore, young age, frequent partner changes, a history of sexually transmitted diseases, travel to countries with a high incidence of sexually transmitted diseases, or alcohol and drug abuse appear as risk factors for developing proctitis.

What are the causes of proctitis?

There are many possible causes of proctitis. Here you will find a detailed overview of the most common causes of proctitis.

Infections as a cause of proctitis

Basically, infections causing proctitis can be divided into viral and bacterial pathogens. Infectious proctitis is often triggered by unprotected anal intercourse and thus transmissible pathogens, or by injuries to the mucous membrane of the anus. Proctitis can also result from a sexually transmitted infection (such as gonorrhea, syphilis, infection with Chlamydia trachomatis, herpes simplex virus infection, or monkeypox infection), especially in people who practice receptive anal intercourse. Patients after transplantation, with HIV infection, rheumatic disease, chronic inflammatory bowel disease (IBD), or tumors can also be affected. Infectious proctitis is increasingly common in German-speaking countries and should be recognized and treated quickly. The treatment of proctitis should – especially in sexually transmitted diseases – also include the partner.

Proctitis can also be caused by some bacteria that are not sexually transmitted, e.g., salmonella, or by the use of an antibiotic that destroys the normal gut bacteria, allowing other bacteria to grow in their place. People after immunosuppressive therapy or with immune disorders also have an increased risk of developing proctitis, especially with infections caused by the herpes simplex virus.

Mechanically induced proctitis

Insertion of objects and foreign bodies (vibrators) into the anus or during sexual intercourse can cause the intestinal wall to tear, leading to lesions on the mucosa in the rectal canal. Such anal fissures are injuries to the mucous membrane of the anus and can also under certain circumstances cause proctitis. Read more here about the treatment of proctitis or the treatment of proctitis with suppositories.

Chronic inflammatory bowel diseases as a cause of proctitis

Proctitis can be a consequence of Crohn's disease or ulcerative colitis. Thus, inflammation of the rectum in the context of chronic inflammatory bowel diseases, such as Crohn's disease or ulcerative colitis, can be a cause of proctitis.

Radiation therapy as a cause of proctitis

Radiation therapy, for example for cancer, or other radiation exposure can also be a cause of proctitis, as the mucous membrane of the anus is strongly irritated by radiation therapy. This is often a consequence of radiation treatment of prostate and rectal carcinomas. Radiation proctitis, also called radiogenic proctopathy, is considered a chronic disease that significantly affects the quality of life and medical care of patients. Radiogenic proctitis or proctopathy is thus a change in the rectal mucosa as a complication after radiation therapy for malignant tumors in the pelvic area. Depending on the time of onset of proctitis after radiation exposure, changes in healthy tissue can be classified as acute (up to 3 months) and late changes (after months or years with possible long-term courses), with overlap also described in medical literature. Rectal changes in radiation proctitis include initial inflammation, edema, mucosal atrophy, or worsening anal fistulas to name a few. Symptoms of radiation proctitis range from fecal incontinence, evacuation problems, diarrhea to cramping pain, anal itching or anal burning, mucus discharge, and bleeding. Read more here about the symptoms of proctitis or about the treatment of proctitis with suppositories.

Toxic, drug-induced, or allergic proctitis

Toxic or allergic reactions can be caused by medications (such as antibiotics), rectal treatments (ointments or foams), laxatives (for example castor oil), condoms, lubricants, or wet wipes. The therapy for such proctitis consists of symptomatic treatment of proctitis and especially the identification and avoidance of the triggering allergen. Diagnosis of this type of proctitis is much faster through medical history than through histological examination or stool culture. Read more here about the symptoms and diagnosis of proctitis.

Stress as a cause of proctitis

Stress can also have a huge impact on gut health. Thus, traumatic events and psychological stress are also considered possible causes of proctitis. Stress as a cause of proctitis should be considered in the psychosomatic interplay during the diagnosis of proctitis. Read more here about stress as a cause of proctitis.

Ischemic proctitis

Ischemic proctitis can result from reduced blood flow of any cause. This ischemia, i.e., the reduction of blood flow, can lead to inflammation in the anorectal area. Causes of reduced blood flow include myocardial infarctions, thromboses, vascular diseases, or postoperative changes in blood flow. If the symptoms of ischemic proctitis appear late and chronically as a consequence, the temporal connection can make diagnosis difficult. Symptoms of ischemic proctitis range from pain, diarrhea, and mucus discharge to more severe bleeding. Read more here about the symptoms and diagnosis of proctitis. 

Hemorrhoids as a cause of proctitis

Proctitis can also be triggered by hemorrhoids. Although hemorrhoids and proctitis are different, they can sometimes cause similar symptoms or be related. Proctitis, especially in inflammatory bowel diseases, can worsen existing hemorrhoids. Conversely, inflamed hemorrhoids can promote further inflammatory foci in the rectum. Not every person with hemorrhoids also has proctitis, but it is possible for both diseases to occur at the same time or influence each other.