Proctitis: Symptoms, Causes, and Treatment in the UK

Proctitis is a medical condition characterised by inflammation of the tissue that lines the inner surface of the rectum (the rectal mucosa). While the rectum is only the final few inches of the large intestine, inflammation here can cause significant discomfort and disruption to daily life. It is often a localised issue, but it can also be a sign of a more systemic condition affecting the digestive tract.

In the United Kingdom, proctitis is most commonly associated with Inflammatory Bowel Disease (IBD), specifically ulcerative colitis or Crohn’s disease. However, it can also occur independently due to infections or as a side effect of medical treatments. Understanding the cause is vital because treatment for infection-based proctitis differs significantly from treatment for autoimmune-related inflammation.

The symptoms of proctitis can vary from mild irritation to severe, debilitating pain. According to the NHS, the most common symptom is tenesmus—a frequent or continuous feeling that you need to have a bowel movement, even if you have just been to the toilet.

• Rectal bleeding: Passing small amounts of bright red blood, often noticed on the toilet paper or in the stool.
• Pain and pressure: A dull ache or sharp pain in the rectum or the left side of your abdomen.
• Discharge: Passing mucus or pus-like fluid from the rectum.
• Diarrhoea: Frequent loose stools, sometimes accompanied by urgency.
• Pain during bowel movements: Straining or discomfort when passing stool.

There are several distinct reasons why the rectal lining may become inflamed. A UK GP will typically categorise the cause into one of the following groups:

1. Inflammatory Bowel Disease (IBD)

Up to 30% of people with ulcerative colitis have inflammation that is limited solely to the rectum; this is often called ulcerative proctitis. Crohn’s disease can also affect this area.

2. Infections

Infections can be divided into food-borne illnesses (like Salmonella) and Sexually Transmitted Infections (STIs). Proctitis is a known complication of infections such as chlamydia, gonorrhoea, syphilis, and herpes simplex virus, particularly among individuals who engage in receptive anal intercourse.

3. Radiation Proctitis

Patients undergoing radiation therapy for cancers in the pelvic region—such as prostate, cervical, or uterine cancer—may develop rectal inflammation as a side effect. This can occur shortly after treatment or even years later.

4. Diversion Proctitis

This occurs in individuals who have had a stoma (ostomy) where the rectum is no longer used for passing stool. The lack of short-chain fatty acids normally provided by stool can cause the lining to become inflamed.

If you present with rectal symptoms, a doctor will follow NICE (National Institute for Health and Care Excellence) pathways to ensure a safe diagnosis. This usually begins with a thorough history and a physical examination, which may include a digital rectal examination (DRE).

Further investigations often include:

• Blood tests: To check for inflammation markers (CRP) and signs of anaemia.
• Stool samples: To rule out bacterial infections and check for calprotectin (a marker of bowel inflammation).
• STI screening: If an infectious cause is suspected, swabs of the rectal area may be taken.
• Endoscopy: A proctoscopy or sigmoidoscopy allows a specialist to look directly at the rectal lining and take biopsies if necessary.

Treatment for proctitis is tailored to the specific cause identified by your healthcare provider. For ulcerative proctitis, the first line of treatment usually involves mesalazine, often administered as a suppository or enema to target the inflammation directly. Steroid foam or suppositories may also be used for short-term flare-ups.

For infectious proctitis, a course of antibiotics or antivirals will be prescribed. If an STI is the cause, it is essential that sexual partners are informed and treated to stop the cycle of reinfection. For radiation proctitis, treatments can range from stool softeners to more specialised therapies like argon plasma coagulation to seal bleeding vessels.

Discussing rectal symptoms can feel embarrassing, but it is important to seek professional medical advice early. Many patients choose to speak to a GP online as an initial step because it offers a discreet environment to discuss sensitive concerns.

An online doctor can:

• Review your symptoms and medical history.
• Advise on whether your symptoms suggest an infection or a chronic condition like IBD.
• Direct you to the correct testing, such as arranging for stool kits or advising on local STI clinic services.
• Provide a private referral to a gastroenterologist if your symptoms are persistent.
• Issue prescriptions for symptomatic relief, such as haemorrhoid creams or stool softeners, while a definitive diagnosis is sought.