Living with proctitis can be a physically uncomfortable and emotionally taxing experience. This condition, characterized by inflammation of the lining of the rectum, often causes symptoms such as rectal pain, bleeding, and a continuous, urgent need to have a bowel movement. These symptoms can make simple tasks like sitting, walking, or using the restroom stressful and painful. Whether the inflammation is acute and short-lived or a chronic issue, finding relief is a priority for restoring comfort and daily function.

Treatment is essential to heal the inflamed tissue, stop bleeding, and prevent the condition from spreading further up the colon. Because proctitis stems from various causes ranging from inflammatory bowel disease (IBD) and infections to side effects from radiation therapy, treatment is not one-size-fits-all. A doctor will tailor the medication plan based on the specific underlying cause and the severity of the inflammation (National Institute of Diabetes and Digestive and Kidney Diseases, 2017).

Overview of treatment options for Proctitis

The primary goals of treating proctitis are to reduce inflammation, clear any infection, and alleviate pain. The approach depends entirely on the diagnosis. If the cause is an infection, curing the infection usually cures the proctitis. If the cause is chronic, such as ulcerative colitis or Crohn’s disease, the goal is long-term symptom management and remission.

For many patients, especially those with IBD-related proctitis, topical medications administered directly into the rectum (suppositories, foams, or enemas) are the preferred starting point. This allows the drug to reach the inflamed tissue directly while minimizing side effects on the rest of the body. Oral medications are typically reserved for more severe cases or when the infection requires systemic treatment.

Medications used for Proctitis

For inflammation related to Inflammatory Bowel Disease (IBD), the first-line treatment is typically a class of drugs called aminosalicylates (5-ASAs). Mesalamine is the most common medication in this group. It is frequently prescribed as a suppository or enema to be used at bedtime. Clinical experience suggests that topical mesalamine is highly effective for inducing remission in mild to moderate cases.

If aminosalicylates are not effective, or if symptoms are severe, doctors may prescribe corticosteroids. Medications like hydrocortisone or budesonide can be administered rectally as foams or enemas. These are potent anti-inflammatories used to bring active flares under control quickly.

For Infectious Proctitis, treatment involves antimicrobials targeting the specific pathogen. If the cause is a bacterial sexually transmitted infection (STI), antibiotics such as doxycycline or ceftriaxone are commonly prescribed. For viral infections like herpes simplex, antiviral medications such as acyclovir or valacyclovir are used to shorten the duration of the outbreak and reduce pain.

For Radiation Proctitis, which can occur after radiation therapy for prostate or cervical cancer, treatment focuses on symptom control. Anti-inflammatory enemas or stool softeners are often used to reduce irritation and straining (Mayo Clinic, 2022).

How these medications work

Aminosalicylates (5-ASAs) work by acting locally on the lining of the gut. They block the production of certain chemicals (prostaglandins and leukotrienes) that trigger inflammation. By reducing these chemical signals, the redness and swelling in the rectal lining decrease, allowing the tissue to heal.

Corticosteroids mimic the effects of cortisol, a natural hormone that suppresses the immune system. By dampening the immune response in the rectal area, they rapidly decrease swelling and pain. Antibiotics and antivirals work by directly attacking the invading organism either by killing bacteria or by stopping viruses from replicating thereby removing the source of the inflammation.

Side effects and safety considerations

Rectal medications (suppositories, foams, enemas) can be messy and cause local irritation or an urge to expel, but have fewer systemic side effects than oral pills due to local application.

Oral aminosalicylates may cause headache, nausea, or abdominal pain. Corticosteroids, even when rectal, should be used briefly to avoid rectal lining thinning or systemic issues. Antibiotics can cause stomach upset or sun sensitivity. For infectious proctitis, sexual partners must be treated to prevent reinfection. Seek immediate medical care for severe abdominal pain, uncontrollable heavy bleeding, or high fever (American Society of Colon and Rectal Surgeons, 2023).

Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.

References

1. Mayo Clinic. https://www.mayoclinic.org
2. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov
3. American Society of Colon and Rectal Surgeons. https://fascrs.org
4. Crohn’s & Colitis Foundation. https://www.crohnscolitisfoundation.org