Ulcerative Proctitis vs. Ulcerative Colitis: What Are the Differences?

Ulcerative colitis is a chronic condition. It is one type of inflammatory bowel disease (IBD), with other types including Crohn’s disease and indeterminate colitis. Ulcerative colitis causes inflammation of the colon, which includes the large intestine and the rectum.

There are different types of ulcerative colitis, including ulcerative proctitis, proctosigmoiditis, left-sided colitis, and pancolitis. The types of ulcerative colitis are categorized by how much of the colon and rectum are inflamed.

Ulcerative proctitis is inflammation in the rectum, while other forms of ulcerative colitis have inflammation in one or more sections of the large intestine. This article will discuss the similarities and differences in their symptoms, causes, diagnosis, and treatment.

Symptoms

The symptoms of ulcerative colitis can include diarrhea, blood in or on the stools, the urgent need to move your bowels, and abdominal cramps (usually on the left side and sometimes improving after going to the bathroom).

In ulcerative proctitis, diarrhea is less common, and there may instead be constipation.

Causes

It’s not known why people develop ulcerative colitis. The disease does tend to run in families, and people who have a family member who lives with IBD are more likely to develop the condition. However, most people who live with IBD don’t have a relative with the disease.

There is a genetic component, but not everyone who has the genes associated with the disease goes on to develop it.

There tends to be one or more triggers. The triggers aren’t completely defined. However, there appears to be a connection to the microbiome in the gut. The gut contains a diverse number of bacteria, called the microbiome, and people with an IBD tend to have a disruption in their gut microbiome. This is called dysbiosis.

Dysbiosis is thought to lead to damage to the inner layer of the large intestine. But it’s not clear why it happens. Some of the theories being studied include certain types of food additives, some types of medications (such as antibiotics and nonsteroidal anti-inflammatories like Advil, an ibuprofen, or Aleve, a naproxen), and infections.

Diagnosis

The various forms of ulcerative colitis are diagnosed after a number of conditions have been met. The first step that a physician will take is getting your history. A description of your symptoms, as well as how long they’ve been going on and how severe they are, is an important part of diagnosis.

Beyond symptoms are the signs of ulcerative colitis that may be occurring outside of the colon, including mouth ulcers and joint pain. Your doctor will ensure that there is not an infection causing, or contributing to, the symptoms.

The most important part of the diagnostic process is an examination of the inside of the rectum and/or the large intestine and what is happening with the tissue there.

Visually seeing the tissues and getting the results of a biopsy (a tissue sample removed for further examination in a lab) can help your doctor determine if you have ulcerative colitis and how much of the colon is affected. If only the rectum is affected, a diagnosis of ulcerative proctitis may be made. If more of the intestine is inflamed, another form of ulcerative colitis may be diagnosed.

Tests that might be done include:

• Colonoscopy: This test looks at the entire large intestine. A flexible tube with a camera and a light on the end is put up through the rectum and into the colon. The physician can see the inside lining of the intestine and take small pieces of tissue (biopsy) to be tested. This procedure is usually done under sedation.
  
• Sigmoidoscopy: A sigmoidoscopy is less extensive than a colonoscopy and is used to look at the last part of the large intestine. It’s usually done without sedation. Biopsies can be taken for testing.
  
• Stool test: In a stool test, the stool must be collected and brought to a lab for testing. A plastic “hat” that fits over a toilet (or plastic wrap over the toilet) might be used to collect the stool. It’s then transferred to a specimen container. The doctor’s office or the lab can provide tips and any tools needed.

Treatment

The treatment used for ulcerative colitis will depend on several factors. One of these is the extensiveness of the disease.

The treatments for ulcerative proctitis might be different from those for other diseases affecting more of the colon. Medications for ulcerative proctitis might be given topically (applied directly to the area being treated). That may have a more profound effect.

Treatments that may be used include:

• 5-aminosalicylic acids (5-ASA): These medications come in oral and topical forms. They are often used topically to treat ulcerative proctitis. That means that they are given through the rectum to work directly on the tissues there. Given orally, they can treat both ulcerative proctitis and other forms of ulcerative colitis.
  
• Corticosteroids: Steroids might also be given for all forms of ulcerative colitis. For ulcerative proctitis, they may be given rectally or orally. For the more extensive forms of ulcerative colitis, steroids might be given orally.
  
• Immunomodulators: Medications such as Azasan (azathioprine), Purinethol (6-mercaptopurine), and Gengraf (cyclosporine) are more often used for ulcerative colitis than ulcerative proctitis.
  
• Biologics: Remicade (infliximab), Humira (adalimumab), Stelara (ustekinumab), Entyvio (vedolizumab), or Cimzia (certolizumab pegol) may be used for more extensive types of ulcerative colitis. There is less evidence for biologics being used in ulcerative proctitis, although they may be considered if the condition doesn’t improve with other drugs.
  

Surgery

It’s not common for surgery to be needed to treat ulcerative proctitis. It’s estimated that about 12% of patients who were originally diagnosed with ulcerative proctitis go on to have surgery. The type of surgery that might be used for ulcerative colitis includes removing part or all of the colon and creating a colostomy or an ileostomy (openings in the colon to collect waste outside the body).

Surgery to create a rectum out of the end of the small intestine might also be used. The new “rectum” is connected to the anus and stool leaves the body out of the anus. This surgery is called ileal pouch–anal anastomosis (IPAA).

Prevention

It’s not known how to prevent ulcerative proctitis or ulcerative colitis. For those who are at risk of developing an IBD because of family history, talking to a doctor about reducing risk may be helpful. It may also help to be aware of possible symptoms so anything that seems related to ulcerative colitis can be checked out right away.

Summary

Ulcerative colitis includes ulcerative proctitis as well as forms of colitis affecting other areas of the large intestine. Ulcerative colitis often presents with diarrhea, while ulcerative proctitis may have symptoms of constipation.

The underlying cause for either condition is unclear. Diagnosis for both is made through a history, physical examination, and imaging. Medications used in treatment are similar, although topical forms may be used for ulcerative proctitis.

A Word From Verywell

Ulcerative proctitis is one form of ulcerative colitis. It can be distressing to be diagnosed with ulcerative proctitis because it can be lifelong. It’s also confusing because much of the information about the disease is aimed at the more extensive forms of IBD.

Ulcerative proctitis does need to be treated and watched because the inflammation caused by the disease may spread up the colon. There are many treatments available but the ones that seem to have the best chance of working are topical. Topical treatments present challenges because they’re not as easy to take as a pill would be, but they may have fewer side effects. 

Seeing a gastroenterologist is important to getting your ulcerative proctitis treated effectively. A gastroenterologist can also answer questions about how the disease may change over time.