What Is Ulcerative Proctitis?

This form of ulcerative colitis is limited to the rectum

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Ulcerative proctitis is a condition that affects the rectum. It is when the rectum, which is the last part of the large intestine, is inflamed and has ulcers (sores). Ulcerative proctitis is one form of a disease called ulcerative colitis, which is a type of inflammatory bowel disease (IBD). Symptoms can include blood in the stool, pain in the rectal area, diarrhea, or constipation.

A doctor explains an endoscopy exam to a patient with ulcerative proctitis

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Ulcerative Proctitis Symptoms

Ulcerative proctitis, as a form of ulcerative colitis, affects only the last part of the digestive system, the rectum. The rectum is where stool is held before moving out of the body through the anus in a bowel movement. Ulcerative proctitis is sometimes also called distal proctitis.

With the area being inflamed, there can be pain when stool moves through it. The ulcers in the lining of the rectum can bleed, which leads to blood in or on the stool. Some people will have diarrhea (loose stools), which can happen several times a day. Needing to go to the bathroom urgently may also be a symptom.

Ulcerative colitis and ulcerative proctitis are often associated with having diarrhea. However, some people may find their proctitis causes constipation (having hard stools that are difficult to pass).

The symptoms of ulcerative proctitis can be mild, or they can be severe and significantly affect the quality of life. How much or how little one person is affected will be different from others with the same diagnosis.

Causes

The cause of ulcerative proctitis (like ulcerative colitis or IBD in general) is not known. There are several theories. 

The various forms of IBD, including ulcerative proctitis, are thought to be immune-mediated conditions. There is a problem with the immune system that causes it to attack the healthy tissue in the digestive system.

Over 100 genes have been found that are thought to contribute to the development of IBD. But it is not only the genetics that leads to ulcerative proctitis.

It’s thought that there must also be something else that occurs, one or more environmental triggers. This is something that causes a disruption in the balance of the bacteria that naturally live in the colon. This may lead to the lining of the intestine becoming ulcerated.

Diagnosis

Ulcerative proctitis is usually diagnosed through either sigmoidoscopy or colonoscopy, which are both types of endoscopy, in which a flexible tube is inserted into the body to look for signs of disease. These two tests are used to look inside the rectum and/or the colon and see what the lining looks like and if ulcers are present.

Biopsies (small pieces of tissue) are also taken during an endoscopy. The biopsies can be studied to see what changes are taking place in the cells. 

Treatment

The short-term goal of treatment for ulcerative proctitis is to stop the inflammation (which is called remission). The long-term goal is to keep the inflammation from coming back.

Medications that act topically (applied to a localized area) on the rectum may be tried first. This can be in the form of an enema or suppository of a 5-aminosalicylate (5-ASA) medication, such as Asacol (mesalamine), or a corticosteroid

If a topical medication doesn’t work, a 5-ASA or a corticosteroid medication may also be given orally. However, these may not be as effective for some patients and may also be associated with side effects.

A 5-ASA medication might not be an option for some people, such as those who are sensitive to the ingredients (which include a sulfa component). It’s also possible that a steroid may not be effective in calming the inflammation.

Other drugs might be tried in these cases, including thiopurines such as Imuran (azathioprine) or biologics such as Remicade (infliximab). Rarely, an immunomodulator, such as cyclosporine, might be tried.

Sometimes, both a topical form of medication and another drug in an oral form are used at the same time. 

There is not much evidence for using other types of medications or complementary or alternative treatments. However, other medications or supplements might be tried if none of the treatments that have been studied for use in ulcerative proctitis are working to get it into remission.

Surgery is not usually used to treat ulcerative proctitis. If surgery is considered, a colectomy, which is the removal of the colon, would be done.

Without a colon, an alternative way of stool leaving the body must be created. This could be with an ileostomy, where a small piece of intestine is brought outside the abdomen (called a stoma), and a pouch is worn over it to collect stool.

Another surgery is when the last part of the small intestine is used to create a reservoir for stool, like a rectum, and is attached to the anus. This is an ileal pouch anal anastomosis (IPAA), or a j-pouch. After this surgery, stool is moved out through the anus.

Prognosis

IBD is a chronic illness. The disease goes through periods of being active and causing symptoms and periods of remission, where there are few or no symptoms. There are also different types of remission, but what’s key is that the inflammation is kept under control so that it doesn’t cause symptoms or get worse.

Ulcerative colitis can be a progressive disease. That is, it may begin as ulcerative proctitis, where inflammation is limited to the rectum. However, other parts of the colon may be involved and become inflamed over time. Of people with ulcerative colitis, about 30 percent to 60 percent of them are diagnosed with ulcerative proctitis.

Some people with ulcerative colitis are at increased risk of developing colorectal cancer. This increased risk is not shown in people with ulcerative proctitis. It’s recommended that screening for colon cancer be done with the same frequency as in those who are of average risk.

However, many people are able to get the disease into remission. Remission can not only help in lowering the effects of symptoms and their effect on the quality of life, but also in preventing the disease from progressing. 

Coping

Being diagnosed with a form of ulcerative colitis like ulcerative proctitis is a challenging and confusing time. Learning more about the condition and how to manage it is important. A gastroenterologist (a specialist in digestive system diseases) will be the most important source of information. 

Connecting with other patients through support groups or patient advocacy groups is also helpful. Learning from people who have been living with ulcerative proctitis for some time will be helpful. 

Stress can affect people in various ways and sometimes lead to feeling symptoms feeling heightened. For that reason, working to keep stress as low as possible may help in staying on top of the effects of ulcerative colitis.

It will take time to learn how to manage symptoms, work with physicians, and adjust lifestyle factors such as diet. Being patient and working with a mental health professional, if needed, may be helpful. There are psychologists who specialize in working with patients with chronic conditions or digestive diseases.

Summary

Ulcerative proctitis is a form of ulcerative colitis that causes inflammation to occur in the rectum. It is a chronic disorder that can cause symptoms to come and go. Medications may be used to treat the inflammation, which can include those that are delivered topically through the rectum or orally. Regular medical care from a gastroenterologist will be part of managing the disease.

A Word From Verywell

While the diagnosis is unsettling, it’s possible to live a full life while coping with ulcerative proctitis. Many treatments can help get the inflammation into remission and prevent it from getting worse.

There will be a need to work with healthcare professionals to monitor the condition. Learning more about ulcerative proctitis and what to expect will be important, so asking questions of a gastroenterologist and meeting other patients will be helpful. 

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4 Sources
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