Proctitis and Anusitis Clinical Presentation

Updated: Mar 27, 2020
  • Author: David E Stein, MD, MHCM; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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History and Physical Examination

A patient with proctitis may present with some of the following symptoms and/or signs:

  • Rectal bleeding tends to be bright red in color and persistent but is rarely severe; it may last for several weeks or longer
  • Changes in bowel habits tend to occur, usually with a decrease in volume and an increase in mucoid contents; patients will complain of a mild diarrhea with a lot of mucus; the mild diarrhea is the most common complaint
  • Patients may report tenesmus or fecal urgency
  • Severe diarrhea generally is uncommon
  • Constipation may occur if the inflammation is severe
  • Patients may also complain of abdominal cramping; this is caused by the inflammation in the pelvis

In taking the patient's history, pertinent questions should include a personal history of inflammatory bowel disease (IBD), pelvic irradiation, travel history, and sexual history (including questions regarding anal intercourse). [3] The patient's HIV status is important to note as well. Obtaining a list of medications used (eg, nonsteroidal anti-inflammatory drugs [NSAIDs] or antibiotics) is clearly important. A family history of IBD or other gastrointestinal (GI) diseases is extremely important.

A review of systems is needed to review any systemic symptoms that can be related to the proctitis, such as IBD and collagen vascular disorders. In addition, identifying patients who are immunocompromised is important, because some infections that may cause proctitis (eg, cytomegalovirus, cryptosporidiosis) affect only this subset of patients.

The physical examination findings may be unremarkable. Abdominal tenderness may be seen in IBD, infectious colitides, and ischemic proctitis. As a consequence of tenderness, it may not be possible to perform a digital rectal examination. If this is the case, an evaluation under anesthesia is required.