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. Sometimes 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 -- is treated.

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
• Shigella

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 doctor may prescribe antibiotics for proctitis caused by bacterial infection. If the inflammation is caused by Crohn's disease or ulcerative colitis, the doctor may recommend corticosteroids or enemas containing non-steroidal anti-inflammatory medication. In addition to these conventional treatments, acupuncture, herbs, and nutritional supplements may also relieve the symptoms of proctitis.

Medications

Antibiotic medication, prescribed by a doctor, 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

Surgery and Other Procedures

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

A comprehensive treatment plan for proctitis may include a range of complementary and alternative therapies. Ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan. Always tell your health care provider about the herbs and supplements you are using or considering using.

Following these nutritional tips may help reduce symptoms:

• Try to eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
• Talk to your doctor about the possibility of increasing the level of soluble fiber in your diet through foods such as apples, steel cut oats, and flax seeds. This may help to stimulate easier more solid bowel movements. You should use caution with insoluble fiber (such as Metamucil or psyllium husks), as it can potentially be irritating. Proctitis patients should not use fiber medicinally, even dietary fiber, without first consulting a physician.
• Eat foods high in B-vitamins, calcium, and magnesium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
• Avoid refined foods such as white breads, pastas, and especially sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
• Use healthy oils in foods, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week.

Nutritional deficiencies may be addressed with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-vitamins and trace minerals, such as magnesium, calcium, folic acid, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil one to two times daily, to help decrease inflammation and improve immunity. Cold-water fish, such as salmon or halibut, are good sources.
• Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results.
• Grapefruit seed extract (Citrus paradisi), 100 mg capsule or 5 - 10 drops (in favorite beverage) three times daily, for antibacterial or antifungal activity and immunity.
• Vitamin C, 500 - 1,000 mg one to three times daily, as an antioxidant, and for immune support.
• L-glutamine, 500 - 1,000 mg three times daily, for support of gastrointestinal health and immunity.
• Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
• Garlic (Allium sativum), standardized extract, 400 mg two to three times daily, for antibacterial or antifungal and immune activity.
• Cat's claw (Uncaria tomentosa) standardized extract, 20 mg three times a day, for inflammation and antibacterial or antifungal activity.
• Olive leaf (Olea europaea) standardized extract, 250 - 500 mg one to three times daily, for anticancer and immune effects.
• Boswellia (Boswellia serrata) standardized extract, 200 - 400 mg three times daily, for inflammation and gastrointestinal health.

Homeopathy

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 remedy is particularly useful for those who are extremely fatigued after loose bowel movements.
• Natrumsulphuricum -- 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

Homeopathic creams for problems in the anal area, such as itching and dryness, may be helpful in relieving symptoms associated with proctitis. Ask your health care provider for more information.

Acupuncture

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.

Mind-Body Medicine

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

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

Prognosis and Complications

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 health care provider.

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