Proctitis: symptoms, causes, treatment and when to see a GP

Crohn's & Colitis UK lists the common symptoms of proctitis as blood or mucus in your poo or passing blood or mucus without any poo, diarrhoea or constipation, an urgent need to use the toilet, and tenesmus. It notes that constipation is common with proctitis, unlike more extensive colitis where diarrhoea dominates.

Infectious proctitis may add anal pain or discharge. The NHS lists pain, itching and discharge from the bottom as a possible effect of gonorrhoea in the anus, and pain, bleeding and discharge from the bottom as a possible effect of chlamydia. Symptoms may be mild or absent in some people.

• Bleeding from the bottom, either on the paper or mixed with stool.

• Mucus or pus passed from the back passage.

• Feeling that you must go urgently, or repeatedly with little result.

• Cramping or aching low in the tummy or around the back passage.

• Pain or a feeling of fullness in the rectum.

• Fever or feeling generally unwell, which suggests more than simple inflammation.

For ulcerative proctitis, Crohn's & Colitis UK says 5-ASAs (aminosalicylates, such as mesalazine) are often the first option for mild to moderate colitis. Because the inflammation is low down, treatment is often topical: a liquid or foam applied with an applicator, or a small bullet-shaped suppository inserted into the bottom. Steroids can calm a flare but are not for long-term use, and stronger immune-modifying medicines are reserved for disease that does not settle.

For constipation linked to proctitis, the charity says laxatives such as macrogol may help, and advises avoiding NSAIDs such as ibuprofen unless the IBD team agrees, because they may trigger a flare. Bulking agents should not be used in someone with a stricture.

For infection, treatment is antibiotics chosen by the clinic. The NHS Borders guideline describes a three-week doxycycline course for confirmed LGV and says symptoms should settle within one to two weeks of starting. The NHS advises no vaginal, anal or oral sex until you and any partner have finished treatment and tests show the infection has gone, and says partners also need testing.

For radiation proctitis, Cancer Research UK says anti-diarrhoea drugs, anti-spasm medicines, plenty of fluids and dietary changes can help, and that bleeding should be reported to the radiotherapy team. Side effects usually get better within a few weeks of finishing radiotherapy, though diarrhoea can sometimes continue as a long-term effect.

The rectum holds stool before it leaves the body. When its inner lining becomes inflamed, swollen and sore, the result is proctitis. It is a description rather than a single disease, a bit like saying "a sore throat". The underlying reason can be an immune condition, an infection, a treatment side effect or something else.

Because the rectum sits right at the end of the bowel, the problems are typically felt low down: urgency, discomfort, a sense of incomplete emptying, and visible blood or mucus. Many people find the symptoms embarrassing and put off mentioning them, but they are common and treatable, and a GP will have heard them before.

Three groups account for most cases. The first is ulcerative colitis limited to the rectum, sometimes called ulcerative proctitis. Crohn's & Colitis UK describes colitis as happening when the immune system goes wrong, and says doctors do not yet know what causes flare-ups.

The second group is infection. An NHS Borders clinical guideline lists the sexually acquired causes of proctitis as gonorrhoea, chlamydia, syphilis, herpes simplex virus, and possibly Mycoplasma genitalium. It singles out lymphogranuloma venereum (LGV), caused by particular strains of chlamydia, as important among men who have sex with men in the UK. The NHS says gonorrhoea and chlamydia pass through vaginal, anal or oral sex without a condom.

The third group is radiotherapy. Cancer Research UK says diarrhoea, tenesmus, mucus and, more rarely, blood in the stool are among the bowel effects of abdominal or pelvic radiotherapy. The NHS Borders guideline also lists non-sexual infections, inflammatory bowel disease, coeliac disease, medicine side effects and trauma among alternative explanations a clinician considers.

It depends on the cause. Proctitis from ulcerative colitis is an immune condition. Crohn's & Colitis UK describes colitis as happening when the immune system goes wrong, and it is not something you can pass on to a partner.

Proctitis caused by infection can be passed on. The NHS says gonorrhoea and chlamydia pass through vaginal, anal or oral sex without a condom, and an NHS Borders clinical guideline lists gonorrhoea, chlamydia, syphilis, herpes simplex virus and lymphogranuloma venereum (LGV) among the sexually acquired causes. The NHS advises no vaginal, anal or oral sex until you and any partner have finished treatment and tests show the infection has gone, and says partners also need testing. Radiation proctitis is a side effect of treatment and is not infectious.

The approach depends on the story. A clinician will ask about sexual history, recent antibiotics, travel, medicines and any past radiotherapy. Crohn's & Colitis UK says tests for colitis include blood tests for inflammation and anaemia, poo tests for infection and a faecal calprotectin test to show bowel inflammation, and endoscopy to look at the lining. A sigmoidoscopy examines the rectum and lower colon, and biopsies are taken for the laboratory.

If infection is possible, a sexual health clinic can take swabs. The NHS says you may have a swab of the bottom, and that you can be tested even without symptoms. The NHS Borders guideline recommends proctoscopy if tolerated, swabs for gonorrhoea and chlamydia, LGV-specific testing when chlamydia is positive, syphilis serology, and HIV and hepatitis C testing for men who have sex with men.

Stool samples may be sent to look for other gut infections when diarrhoea is present. For anyone with bleeding that does not have a clear cause, the doctor will also consider bowel conditions such as polyps or cancer, so do not assume it is only proctitis.

Outlook depends on the cause. Infectious proctitis is usually cured with the right antibiotics, although follow-up testing may be needed. Radiation-related symptoms generally ease in the weeks after treatment finishes, but can persist, so mention ongoing symptoms to the cancer team.

Ulcerative proctitis is a lifelong condition with periods of remission and flare-ups, as the NHS explains for ulcerative colitis in general. Crohn's & Colitis UK says there is currently no cure, but medicines can keep symptoms under control, and many people stay well with regular treatment. Because 1 in 10 people with proctitis later develop more widespread colitis, new symptoms such as more frequent diarrhoea should prompt a review.

See a GP if you have rectal bleeding, mucus or a new change in bowel habit that lasts, and a sexual health clinic if you think an infection is possible. Treatment is quick and confidential.

The NHS ulcerative colitis guidance says to ask for an urgent GP appointment or contact NHS 111 if you have bloody or very bad diarrhoea, a high temperature, a fast heartbeat, or cannot pass wind or stool. It advises calling 999 or going to A&E for severe tummy pain, non-stop bleeding from the bottom, a lot of blood or large clots, or vomiting blood.