Proctitis vs. ulcerative colitis: What to know

Proctitis is very common in UC, but doctors also associate it with other conditions.

Proctitis is a condition where the tissue lining the inner part of the rectum becomes inflamed. The rectum is a part of the digestive system that connects the colon to the anus. The rectum allows the stool to pass to where the body will excrete it.

UC may also start in the rectum as proctitis, but it may develop farther in the colon. This condition can be short term or acute, but it can also be long lasting or chronic.

Causes

Proctitis is usually a symptom of another underlying condition, such as:

• one form of IBD, such as UC or Crohn’s disease
• sexually transmitted infections (STIs), such as:
  • gonorrhea
  • chlamydia
  • herpes
  • syphilis
• infections from bacteria that cause food poisoning, such as:
  • Salmonella
  • Shigella
  • Campylobacter
• infections that occur while a person is taking antibiotics
• radiation to treat a type of cancer, such as:
  • colon
  • cervical
  • prostate
  • rectal
• lack of blood flow to the rectum
• injury to the anus or rectum
• side effects of certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs)
• having had an ostomy surgery

Symptoms

Symptoms of proctitis include:

• tenesmus, which is a constant urge to have a bowel movement
• diarrhea
• constipation
• cramping and pain in the anus, rectum, or left side of the abdomen
• rectal bleeding or blood in the stool
• mucus or pus in the stool

Individuals who pass blood, mucus, or pus from the rectum or experience extreme abdominal pain should contact a physician as soon as possible.

Read more about other types of UC.

UC is a form of IBD and is a chronic condition where the lining of the colon, rectum, or both are inflamed, causing ulcers to develop.

Causes

Suspected causes of UC include genetics and environmental factors, such as bacteria and viruses that cause an immune reaction.

Risk factors for UC include:

• having a family history of UC
• smoking
• being of Jewish descent
• taking certain medications, such as:
  • oral contraceptives
  • hormone replacement therapy
  • NSAIDs

Symptoms

Symptoms of UC include:

• incontinence
• urgent bowel movements
• fatigue
• increased frequency of bowel movements
• mucus discharge
• abdominal pain
• fever
• weight loss
• diarrhea
• blood in the stool

Learn more from our IBD hub.

Doctors categorize people’s conditions and the type of UC they have by how much of the colon and rectum are inflamed and affected.

The main difference between the two conditions is the area of the affected intestines. Proctitis is an inflammation of the rectum, whereas other forms of UC affect different parts of the large intestine.

To determine if an individual has UC, a gastroenterologist may perform one or more of the following tests:

• blood tests
• stool tests
• X-rays to see the digestive tract better
• an endoscopy to examine the inside of the colon and rectum
• a chromoendoscopy to look for colon polyps

The diagnosis of proctitis is through a flexible sigmoidoscopy and colonoscopy. These tests help determine if an individual has a form of IBD.

These tests are pretty invasive, but doctors will administer sedation through a small tube in the arm to help a person relax. Doctors usually perform this procedure in an outpatient setting.

In rare cases, people may:

• have a reaction to the sedation
• experience bleeding afterward
• get a small tear in their bowels

Other tests can help identify the cause of proctitis, such as the following:

• Stool test: Doctors may perform this test to help determine if a bacterial infection is causing the proctitis.
• Rectal culture exam: This is when doctors insert a cotton swab into the rectum to identify organisms that may be causing the condition.
• Tests for STIs: These tests check whether a person has an STI, such as chlamydia and syphilis, to determine if this infection is the cause of proctitis.

Currently, there is no medical cure for UC or proctitis. In severe cases, people may have their colon or rectum surgically removed.

However, there are some lifestyle changes that a person can make to help manage both conditions better.

Diet

There is no universal diet for UC, as each person’s body reacts to food differently. However, some general dietary tips include:

• Eating a low fat diet: 2021 research showed that people with UC who consumed less fat on a low fat diet had decreased markers of inflammation. Find out which foods are low in fat.
• Avoiding alcohol: Further evidence from 2021 showed that alcohol use can alter the microbiome, resulting in intestinal inflammation.
• Eating small meals: Eating five to six meals instead of three is easier on the digestive tract and helps control symptoms.
• Being mindful of fiber: A 2015 article showed that dietary fiber had significant clinical benefits in some people with IBD. However, eating a low fiber diet can sometimes help improve symptoms during a flare-up.
• Consuming juices: Fruit and vegetable juices containing high vitamin C and vitamin K levels may help reduce symptoms. Find out what the best juices are for UC.
• Keeping a food diary: Keeping track of what food a person eats and their symptoms is a great way to determine what types of food to avoid.

Read on for diets and recipes for UC.

Exercise

Exercise may play a preventive role in the development of IBDs.

Some research associates exercise and disease activity. Moderate-intensity exercise may be safe and potentially beneficial for people with nonsevere symptoms.

Reduce stress levels

Emotional disorders, such as stress, can aggravate symptoms of both conditions, such as abdominal pain, and make disease activity more severe.

Lifestyle habits may help reduce stress, such as:

• yoga
• meditation
• breathing exercises

Medications

If symptoms are severe and modifying lifestyle factors are ineffective, a person should speak with a medical professional. A doctor will prescribe medication and strategies to help better manage a person’s condition.

First-line treatment for UC and proctitis will likely involve drugs to reduce inflammation in the rectum or colon. Doctors will also prescribe 5-aminosalicylic acid (5-ASA), also called mesalamine. A doctor, or the individual, will administer this drug via enema once or twice per day, depending on the severity of the symptoms.

Other drugs doctors use to treat proctitis may be similar to those that treat other types of UC, such as corticosteroids and biologics.

In severe cases, if the medication does not relieve symptoms, a doctor may offer surgery to remove part of the affected area of the colon.

Read about what to expect from UC surgery.

Proctitis is a type of UC that affects the rectum.

Individuals with UC or proctitis should work with a doctor to monitor their condition. Because there is no medical cure, a gastroenterologist can help develop and implement strategies to reduce the severity of symptoms.

Doctors treat most cases with medication and lifestyle changes. Diet, exercise, and stress reduction are examples of changes people can make to relieve symptoms.