During a flexible sigmoidoscopy exam, the doctor inserts a sigmoidoscope into your rectum to check for abnormalities in your sigmoid colon and most of your descending colon.
During a colonoscopy, the doctor inserts a colonoscope into your rectum to check for abnormalities in your entire colon.
Tests and procedures used to diagnose proctitis include:
- Blood tests. These can detect blood loss or infections.
- Stool test. You may be asked to collect a stool sample for testing. A stool test may help determine if your proctitis is caused by a bacterial infection.
- Scope exam of the last portion of your colon. During this test (flexible sigmoidoscopy), your doctor uses a slender, flexible, lighted tube to examine the last part of your colon (sigmoid), as well as the rectum. During the procedure, your doctor can also take small samples of tissue (biopsy) for laboratory analysis.
- Scope exam of your entire colon. This test (colonoscopy) allows your doctor to view your entire colon using a thin, flexible, lighted tube with an attached camera. Your doctor can also take a biopsy during this test.
- Tests for sexually transmitted infections. These tests involve obtaining a sample of discharge from your rectum or from the tube that drains urine from your bladder (urethra).
Treatment for proctitis depends on the underlying cause of the inflammation.
Treatment for proctitis caused by an infection
Your doctor may recommend medications to treat your infection. Options may include:
- Antibiotics. For proctitis caused by bacterial infections, your doctor may recommend an antibiotic, such as doxycycline (Oracea, Vibramycin, others).
- Antivirals. For proctitis caused by viral infections, such as the sexually transmitted virus herpes, your doctor may prescribe an antiviral medication, such as acyclovir (Sitavig, Zovirax, others).
Treatment for proctitis caused by radiation therapy
Mild cases of radiation proctitis may not require treatment. In other cases, radiation proctitis can cause severe pain and bleeding that requires treatment. Your doctor may recommend treatments such as:
- Medications. Medications are given in pill, suppository or enema form. They include sucralfate (Carafate), mesalamine (Asacol HD, Canasa, others), sulfasalazine (Azulfidine) and metronidazole (Flagyl). These medications can help control inflammation and reduce bleeding.
- Stool softeners and dilation. These can help open up obstructions in the bowel.
- Treatment to destroy damaged tissue. These techniques improve proctitis symptoms by destroying abnormal tissue (ablation) that is bleeding. Ablation procedures used to treat proctitis include argon plasma coagulation (APC), cryoablation, electrocoagulation and other therapies.
Proctitis caused by inflammatory bowel disease
Treatment of proctitis related to Crohn's disease or ulcerative colitis is aimed at reducing the inflammation in your rectum. Treatment may include:
- Medications to control rectal inflammation. Your doctor may prescribe anti-inflammatory medications, either by mouth or as a suppository or enema, such as mesalamine (Asacol HD, Canasa, others) — or corticosteroids — such as prednisone (Rayos) or budesonide (Entocort EC, Uceris). Inflammation in people with Crohn's disease often requires treatment with a medication that suppresses the immune system, such as azathioprine (Azasan, Imuran) or infliximab (Remicade).
- Surgery. If drug therapy doesn't relieve your signs and symptoms, your doctor may recommend surgery to remove a damaged portion of your digestive tract.
Preparing for your appointment
Start by seeing your family doctor or a general practitioner if you have rectal pain or bleeding, or if you continuously feel the need to have a bowel movement. If your doctor suspects you may have proctitis, you may be referred to a doctor who specializes in diseases of the digestive system (gastroenterologist).
Here's some information to help you get ready and to know what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, as well as any vitamins or supplements, that you're taking.
- Take a family member or friend along to help you remember everything you and your doctor talked about.
- Write down questions to ask your doctor.
Questions to ask your doctor
- Is proctitis causing my symptoms or condition?
- What are possible causes for my proctitis?
- What kinds of tests do I need?
- What are my treatment options?
- What are the benefits and risks of each treatment option?
- I have other medical conditions. How can I best manage them while also managing proctitis?
- Are there any restrictions that I need to follow?
- Is there a generic alternative to the medicine you're prescribing?
- Are there any brochures or other printed material that I can take with me?
- What websites do you recommend?
- Should I plan for a follow-up visit?
Don't hesitate to ask other questions.
June 16, 2020
- Proctitis. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/proctitis/all-content. Accessed April 27, 2020.
- Proctitis. Merck Manual Professional Version. https://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/proctitis#. Accessed April 27, 2020.
- Walls RM, et al., eds. Disorders of the anorectum. In: Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Elsevier; 2018. https://www.clinicalkey.com. Accessed April 27, 2020.
- Gajendran M, et al. A comprehensive review and update on ulcerative colitis. Disease-a-Month. 2019; doi:10.1016/j.disamonth.2019.02.004.
- McCarty TR, et al. Efficacy and safety of radiofrequency ablation for treatment of chronic radiation proctitis: A systematic review and meta-analysis. Journal of Gastroenterology and Hepatology. 2019; doi:10.1111/jgh.14729.
- What is anemia? National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/anemia. Accessed April 27, 2020.
- Friedman LS. Clinical manifestations, diagnosis, and treatment of radiation proctitis. https://www.uptodate.com/contents/search. Accessed April 27, 2020.
- Tominaga K, et al. Diversion colitis and pouchitis: A mini-review. World Journal of Gastroenterology. 2018; doi:10.3748/wjg.v24.i16.1734.