What is proctitis?

Proctitis is the inflammation of the inner lining of your rectum. Your rectum is the lower part of your large intestines, just before your anus.

There are different types of proctitis that have different causes and treatments.

Examples include:

• infectious proctitis, caused by STIs
• radiation proctitis, caused by radiation therapy
• ulcerative proctitis, caused by ulcerative colitis

You can get proctitis at any age. Proctitis can be acute and go away quickly. It can also be chronic and affect your quality of life.

What symptoms are related to proctitis?

If you have proctitis, you may have:

• diarrhoea or constipation
• a feeling that you need to urgently poo, even when your bowels are empty
• mucus discharge or bleeding from your rectum
• lower abdominal (tummy) cramps.
• anal pain

You may also have general symptoms of fever, weight loss and vomiting.

What causes proctitis?

Proctitis can be caused by:

• sexually transmitted infections (STIs) — gonorrhoea, chlamydia, herpes, Mpox, syphilis or mycoplasma genitalium
• gastrointestinal infections in your gut — shigella, campylobacter or clostridioides difficile (also known as clostridium difficile)
• inflammatory bowel diseases — ulcerative colitis or Crohn's disease
• coeliac disease
• radiation therapy to your pelvic area

You can get infectious proctitis if you have unprotected anal sex with somebody who has an STI.

Radiation proctitis can be acute or chronic. Acute proctitis develops when you are going through radiation therapy. It goes away when you finish treatment. Chronic radiation proctitis develops after you have finished radiation therapy. Your symptoms can be severe and difficult to treat, affecting your quality of life.

How is the cause of proctitis diagnosed?

If you have proctitis, your doctor will find out what is causing it by:

• asking you questions about your symptoms and medical history
• examining your body, including your anal area
• requesting tests — CT (computed tomography) scan, colonoscopy, biopsy of your rectum, taking a sample of your stool to test and examine under microscope, or sigmoidoscopy

If you have infectious proctitis, you will be tested for all STIs, including HIV (human immunodeficiency virus). You will need a blood test and a swab of your rectum.

Knowing what has caused your proctitis is important for you to get the right treatment.

When should I see my doctor?

You should see your doctor if you:

• have symptoms of proctitis
• notice a change in the consistency and how often you poo
• notice blood or mucous in your poo or bleeding from your rectum
• had unprotected sex or worry your partner has an STI

When to seek urgent care

How is proctitis treated?

Your treatment will include medicines to relieve your symptoms and help you recover.

If you have ulcerative proctitis, your symptoms will improve within a week of starting treatment. It takes 4 to 6 weeks to recover.

Self-care

Be sure to stay hydrated.

If you have infectious proctitis, you should:

• avoid all sexual contact for 7 days after you have started your treatment or until you have finished your antibiotics and your symptoms have gone away, whichever is later
• avoid sexual contact with any of your sexual partners from the last 6 months unless they have been tested for STIs and treated if necessary

Ask your doctor about pain-relief medicines.

Medicines for proctitis

Your doctor may prescribe:

• antibiotics — if you have infectious proctitis
• anti-diarrhoea medicines
• mesalazine — a medicine used to treat ulcerative colitis that comes as an enema, suppository or pill
• steroid creams, suppositories or pills
• biological medicines — if you have ulcerative proctitis that did not get better with other medicines

Other treatment options

If your condition does not improve with medicines, you might need surgery or a procedure.

Once you have recovered from ulcerative proctitis your doctor will monitor you every 6 to 12 months to check that you have healed.

What are the complications of proctitis?

If you have ulcerative proctitis or chronic radiation proctitis, you can develop complications, including:

• severe rectal bleeding
• bowel perforation — a hole in your bowels
• fistula

You may need urgent surgery and be admitted into intensive care.

You can also develop faecal incontinence.

Can proctitis be prevented?

You can prevent infective proctitis caused by STIs by having safe sex. Speak with your doctor or a sexual health counsellor to learn how.

If you are sexually active and do not always have safe sex, there are ways to reduce your risk of some STIs, such as:

• pre-exposure prophylaxis (PrEP) or postexposure prophylaxis (PEP) — prevent syphilis, chlamydia or HIV
• vaccinations for monkey pox (Mpox) and meningococcal disease

Read more about safe sex.

Resources and support

• Learn more about healthy sex at Stop the Rise of STIs.
• Visit Cancer Council NSW to learn more about radiation proctitis.
• Read about ulcerative colitis on the Crohn's & Colitis Australia website.
• If you have infectious proctitis from an STI, inform past sexual partners, so they can get tested and treated. Visit Let Them Know to notify them anonymously.
• You can call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.

Looking for information for Aboriginal and/or Torres Strait Islander people?

Visit Better to Know, a sexual health resource for Aboriginal and/or Torres Strait Islander people.

Do you prefer to read in languages other than English?

Crohn's & Colitis Australia website is available in many community languages.

Talk. Test. Treat. has a collection of sexual health resources translated into many community languages.

Looking for information for sexually and gender-diverse families?

ACON is a community organisation that helps sexuality and gender diverse people take control of their sexual health.