Do you also have difficulty going to the toilet? Let's learn about proctitis?

Do you sometimes experience stomach pain when you go to the toilet, or do you notice a little blood or mucus in your stool? Or do you feel like you have to go to the toilet all the time? Don't ignore these things. Because these can be symptoms of a condition called `(Proctitis)`. Today, let's talk about what `(Proctitis)` is, why it occurs, and what we should do.

What is this `(Proctitis)`? To put it very simply...

Proctitis is an inflammation of the lining of the rectum, the last part of the large intestine, just before the anus. To be precise, Procto means rectum and itis means inflammation. This condition occurs when the lining of the rectum becomes irritated (swollen, reddened) for a variety of reasons, such as bacteria, chemicals, or conditions such as inflammatory bowel disease. This can cause uncomfortable symptoms, such as pain, rectal bleeding, and changes in bowel habits.

Are there different types of `(Proctitis)`?

Yes, depending on the cause of `(Proctitis)`, it can be short-term (acute) or long-term (chronic) . `(Acute)` means that it occurs suddenly and disappears after a short time. `(Chronic)` means that it lasts for a long time. Types of `(Proctitis)` that occur due to different causes are sometimes called by different names. For example, the one caused by sexually transmitted infections `(Sexually-Transmitted Infections - STIs)` is called `(infectious proctitis)`. The one caused by radiation therapy for cancer is called `(radiation proctitis)`. Similarly, the one caused by a condition called `(Ulcerative colitis)` is also called `(ulcerative proctitis)`.

What are the symptoms of `(Proctitis)`?

These are the symptoms that are commonly seen:

• Anorectal pain. It may even be difficult to sit still.
• Pain in your abdominal left quadrant.
• Passing a liquid like blood or mucus with the stool. This is the first thing most people notice.
• Feeling as if the rectum is swollen and full.
• A constant feeling of needing to defecate (tenesmus), but sometimes only a small amount comes out when you go to the toilet.
• Difficulty or pain during bowel movements (dyschezia).
• Constipation.
• Diarrhea.

What are the first symptoms of `(Proctitis)`?

Often the first symptoms are when you go to the bathroom. You may feel discomfort, burning, or a feeling of pressure when you have a bowel movement. You may feel the urge to go to the bathroom suddenly, but you may not be able to completely empty your bowels. Diarrhea and blood or mucus in your stool are common early symptoms.

Why does this `(Proctitis)` occur? What are the causes?

There are several causes of proctitis, some more common than others.

Common causes of `(Proctitis)`:

• Inflammatory Bowel Disease (IBD): Diseases like Crohn's disease and Ulcerative colitis cause long-term inflammation in various parts of the intestines. In about 30% of people with these diseases, the inflammation mainly affects the rectum. This is the main cause of proctitis in general.
• Sexually-Transmitted Infections (STIs): Sexually transmitted viral infections and bacterial infections can enter the anus through the anus. Examples include:
• `(Gonorrhea)` (Gonorrhea)
• `(Chlamydia)` (Chlamydia)
• `(Herpes simplex 2)` (Herpes simplex 2)
• `(Syphilis)` (Syphilis)
• `(Human Papillomavirus - HPV)` (Human Papillomavirus)

This infection can affect both women and men who have anal-receptive sexual contact.

• Gastrointestinal infections: Bacterial infections in the intestines caused by food poisoning can sometimes affect the rectum. Examples:
• `(Salmonella)` (Salmonella)
• `(Shigella)` (Shigella)
• `(Campylobacter)` (Campylobacter)

If you have recently finished a course of antibiotics, you may also be at risk of developing an infection in your intestines and rectum caused by a bacteria called Clostridium difficile (C. diff). C. diff is a bacteria that is already in your intestines. But when the good bacteria in your intestines are killed by antibiotics, the bacteria that keep C. diff in check are gone, and C. diff can overgrow.

• Infant food protein allergies: Babies who are allergic to certain types of milk, especially dairy milk or soy, can develop inflammation anywhere in their intestines, including the rectum. Babies can get these proteins from formula or through breast milk if their mother eats foods containing these proteins.
• Radiation therapy for cancer: Radiation therapy for cancer can cause a condition called ``radiation mucositis`` anywhere in your digestive system. This is inflammation of the mucous lining of your digestive system. Radiation enteritis (inflammation of the small intestine) and radiation colitis (inflammation of the large intestine) are common when radiation therapy is given to the upper or lower abdomen. Radiation therapy to the pelvic area can cause ``radiation proctitis`` (radiation inflammation of the rectum).

Less common causes of `(Proctitis)`:

• Diversion proctitis: This is a side effect that can occur in people who have had a colostomy (a procedure where part of the large intestine is removed from the body to create a passage for stool) or an ileostomy (a procedure where part of the small intestine is removed from the body to create a passage for stool) and pass stool through a different route than through the anus. It is thought that because the stool does not pass through the anus, the anus is deprived of the nutrients and short-chain fatty acids that normally enter the anus (which help keep the anus moist and healthy), causing inflammation of the anus that is not used. However, only a small number of people experience symptoms.
• Intestinal ischemic syndromes: Like ischemic colitis, ischemic proctitis can occur when blood flow to the rectum is cut off, depriving the tissue of oxygen. Ischemia is usually caused by a blockage in a blood vessel, such as a blood clot, aneurysm, or plaque.
• Anorectal trauma: If an external object or chemical is inserted through the anus, it can cause inflammation of the anus and rectum. The chemicals in some types of enemas can also have this effect.
• Eosinophilic gastrointestinal disorders (EGID): Eosinophilia is an abnormally high production of a type of white blood cell called eosinophils. White blood cells help our immune system mount an inflammatory response. In EGID, our immune system sends an abnormally high number of eosinophils to a part of the digestive tract, causing long-term inflammation. Researchers think this may be an overreaction to a food allergy. Eosinophilic proctitis most often affects children under the age of 2.
• Idiopathic proctitis: A small number of people have proctitis for which no specific cause can be found . However, in these cases, the condition responds well to dietary changes. Idiopathic proctitis is a long-term, recurring condition. About 10% of these cases eventually develop into ulcerative colitis.

Is Proctitis a serious condition?

Under normal circumstances, proctitis is not life-threatening and responds well to treatment. However , if it is severe, lasts a long time, is left untreated, or does not respond to treatment, it can lead to more serious complications.

For example, an ulcer that does not heal can cause excessive bleeding, or the rectal wall can be destroyed. Rarely, proctitis can affect the surrounding nerves, causing neuropathy.

Complications that may occur due to long-term inflammation:

• Excessive bleeding, resulting in anemia.
• Fistulas (tunnels through the rectal wall).
• Stricture or stenosis (narrowing of the rectum due to scarring of the tissues).

Complications involving the nervous system are rare, but they can include:

• Neurogenic bladder dysfunction.
• Numbness and tingling sensations in the soles of the feet (paresthesia).
• Erectile dysfunction.

How is Proctitis diagnosed?

A doctor will first ask you about your symptoms and then examine your rectum to see if you have signs of proctitis. This may include a digital rectal exam and an anoscopy . If it looks like you have proctitis, your doctor will ask more questions to find out what is causing it and what type it is. For example:

• What medications have you taken recently?
• Does anyone in the family have autoimmune diseases?
• Do you have unprotected sex or have sex with untested partners?
• Have you traveled abroad recently?

Based on these answers and what the tests show, your doctor will decide what further tests you need.

Additional tests may include:

• Blood test: A blood test can detect infections and other conditions that can cause proctitis. It can also show a decrease in blood or an increase in white blood cell count.
• Stool test: The doctor will take a sample of your stool and check for infection, bleeding, or an increase in white blood cells.
• Rectal culture: For this test, the doctor swabs the inside of the rectum with a swab and then cultures the sample to identify the bacteria or viruses present.
• Proctoscopy: This is an examination of the inside of the rectum using a short, rigid tube-like instrument. A proctoscope is a hollow tube with a camera and light at the end. If necessary, the doctor can pass a tool through the tube to take a tissue sample (biopsy).
• Flexible sigmoidoscopy: If the doctor wants to look further into the sigmoid colon, the last part of the large intestine that connects to the anus, a longer, more flexible tube called a flexible sigmoidoscopy may be used. If there is a problem with the large intestine, it can show signs of inflammatory bowel disease or an infection in the digestive tract. A bowel prep may be done before this test.

Does Proctitis heal on its own?

It may be, but there's no reason to suffer. If you have an infection, antibiotics or antivirals can help you get better quickly. If it's not caused by an infection, your doctor may prescribe medications like steroids to reduce the inflammation. If you have radiation proctitis, it usually goes away within a few weeks after radiation treatment. But in the meantime, topical pain medications can help. If you have long-term IBD, proctitis may come and go. But you can use specific medications when it flares up.

How long does proctitis last?

This varies depending on the cause and the person. With treatment, it usually resolves quickly. In general, it takes about four to six weeks to heal after the cause of the inflammation has been resolved. While the proctitis is healing, you can take over-the-counter (OTC) medications for pain or diarrhea.

What are the treatments for `(Proctitis)`?

Treatment depends on the cause and how severe the condition is. It may include:

• Stopping the cause of the inflammation.
• Antibiotics or antivirals for infections.
• Immunosuppressants for proctitis caused by autoimmune conditions.
• Medicines such as Sulfasalazine or Mesalamine for Ulcerative colitis/proctitis.
• Medicines such as Infliximab for Proctitis caused by Crohn's disease.
• Topical corticosteroids are used as ointments to reduce pain and inflammation.
• Sucralfate enemas are used to treat rectal ulcers.
• Endoscopic procedures to stop bleeding in the digestive tract.

What is the future if I have `(Proctitis)`?

Most cases of proctitis respond well to treatment. If it is a short-term (acute) condition, it should resolve within four to eight weeks in adults or a few months in infants. If you have long-term proctitis associated with IBD, you may find that the inflammation comes and goes. You can treat flare-ups with anti-inflammatory drugs when needed. A small number of people develop chronic radiation proctitis. Long-term cases are more likely to develop complications and can be more difficult to treat.

Can Proctitis be prevented?

Testing partners before having sex can reduce the risk of STIs. Protective measures such as condoms can help in some cases, but some infections can also be spread through oral sex. Using dental dams can reduce the spread or infection of STIs through oral sex. Practicing safe food preparation practices and being careful about what you eat and drink, especially when traveling abroad, can reduce the risk of gastrointestinal infections caused by food poisoning. Unfortunately, there is no way to prevent IBD or radiation proctitis.

When should you see a doctor about `(Proctitis)`?

Always see a doctor if you have symptoms of proctitis. It is important to identify the cause and treat it to prevent the condition from getting worse. If you are receiving treatment, but it still does not seem to be working, continue to contact your doctor. Some types of proctitis require some effort to effectively manage. Rarely, some cases may not respond to any standard treatment. In such cases, surgery may be necessary.

The symptoms of proctitis, whether they are temporary or ongoing, can be very uncomfortable. Treatment for proctitis focuses on the cause of the inflammation and the symptoms. In some cases, such as radiation proctitis, only the symptoms can be treated. In other cases, such as an infection, it is important to get tested to identify the specific bacteria or virus that is causing your symptoms.

The most important things to remember (Take-Home Message)

Okay, so now you have a better understanding of what we've been talking about, `(Proctitis)`. The most important thing is, if you have unusual discomfort, pain, blood or mucus when you go to the toilet, don't ignore it. See a doctor right away to find out the cause. Most of the time, these conditions can be treated very well.

Don't be afraid, but don't be late either! Your health is in your hands.

Also, practicing safe sex and eating clean foods will help protect against such situations.

` Proctitis, inflammation of the rectum, bleeding with stool, anal pain, STIs, IBD, digestive system