Proctitis: Symptoms, Causes, and Treatment in the UK

Proctitis is a condition characterised by inflammation of the tissue that lines the rectum, the last few inches of the large intestine. While it can be a short-term issue, for many in the UK, it is a chronic symptom of an underlying condition. The inflammation causes the rectal lining to become swollen and sensitive, leading to significant discomfort and changes in bowel habits.

According to NHS guidance, proctitis is distinct from conditions like haemorrhoids (piles), although they may share some symptoms such as rectal bleeding. Because the rectum is responsible for the final storage of stool before evacuation, inflammation here often results in a constant, frustrating feeling that you need to pass stool, even when the rectum is empty (a sensation known as tenesmus).

The symptoms of proctitis can range from mild annoyance to severe, debilitating pain. The most frequently reported symptoms among British patients include:

• Rectal Bleeding: Seeing bright red blood on the toilet paper or in the stool.
• Tenesmus: A persistent and painful urge to have a bowel movement.
• Rectal Pain: A dull ache or sharp pain on the left side of the abdomen or within the rectum itself.
• Discharge: Passing mucus or pus from the rectum.
• Diarrhoea or Constipation: Significant changes in the consistency or frequency of bowel movements.

If these symptoms persist for more than a few days, it is important to seek medical advice to rule out serious causes such as Inflammatory Bowel Disease (IBD).

Inflammatory Bowel Disease (IBD)

The most common cause of chronic proctitis in the UK is Ulcerative Colitis or Crohn’s Disease. In Ulcerative Colitis, inflammation often starts in the rectum (Ulcerative Proctitis) and may stay confined there or spread further up the colon.

Infections and STIs

Infectious proctitis can be caused by bacteria typically associated with food poisoning, such as Salmonella. However, it is also frequently caused by sexually transmitted infections (STIs) including chlamydia, gonorrhoea, and syphilis. This is particularly common in individuals who engage in receptive anal intercourse.

Radiation Proctitis

Patients undergoing radiation therapy for cancers of the prostate, ovaries, or rectum may develop inflammation as a side effect. This can occur during treatment or many months—sometimes years—after therapy has concluded.

Other Causes

Less common causes include 'diversion proctitis' (occurring after certain types of bowel surgery) and injury to the rectal area.

In the UK, GPs follow NICE (National Institute for Health and Care Excellence) pathways to diagnose the cause of rectal symptoms. The process usually begins with a thorough history of your symptoms and a physical examination, which may include a digital rectal exam (DRE).

Further investigations often include:

• Blood Tests: To check for signs of anaemia or inflammation.
• Stool Samples: To look for infection or markers of IBD like faecal calprotectin.
• Proctoscopy or Sigmoidoscopy: A thin, flexible tube with a camera is used to look directly at the rectal lining.
• STI Screening: Swabs may be taken if an infectious cause is suspected.

Treatment is tailored strictly to the underlying cause identified by your doctor:

• For IBD: Doctors typically prescribe anti-inflammatory medications. These are often administered as suppositories or enemas (mesalazine) to deliver the medicine directly to the inflamed rectal tissue.
• For Infections: If the cause is bacterial or an STI, a course of antibiotics will be prescribed. If caused by a virus (like herpes), antiviral medications are used.
• For Radiation Proctitis: Treatment may involve stool softeners to reduce irritation or, in more complex cases, thermal therapy to stop bleeding vessels.

Managing your diet by increasing fibre (if constipated) or avoiding trigger foods (if experiencing diarrhoea) can also help manage symptoms alongside medical treatment.

If you are experiencing rectal discomfort, you may feel hesitant to discuss it in person. Using an online doctor service in the UK provides a discreet, professional way to begin your journey toward relief. During a video consultation, a GP can assess your symptoms, discuss your medical history, and advise on the most likely cause.

An online GP can:

• Provide a private prescription for symptomatic relief or antibiotics if an infection is suspected.
• Advise on how to collect stool samples for further testing.
• Offer a referral letter to a gastroenterologist if they suspect chronic conditions like Ulcerative Colitis.
• Discuss lifestyle changes to help soothe rectal inflammation.

Seeking help early is vital, as untreated proctitis can lead to complications such as ulcers, anaemia from blood loss, or fistulas.