Acute Proctitis Clinical Presentation

Updated: Nov 09, 2018
  • Author: Lisandro Irizarry, MD, MBA, MPH, FACEP; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
  • Print


General symptoms of acute proctitis include the following:

  • Feeling of rectal fullness

  • Anal and rectal pain

  • Diarrhea, usually frequent, small amounts

  • Frequent or continuous urge to have a bowel movement

  • Pain in the lower left abdomen

  • Passing mucus through the rectum

  • Rectal bleeding

Idiopathic proctitis

Symptoms of idiopathic proctitis include the following:

  • Passage of blood and mucus per rectum

  • Tenesmus

  • Occasionally, passage of loose stool, with or without lower abdominal pain or rectal cramping

Infectious proctitis

Infectious proctitis may have the following features:

  • Pruritus

  • Rectal and anal pain (may become severe)

  • Avoidance of defecation due to pain

  • Most common causes - Neisseria gonorrhoeae, Chlamydia trachomatis, herpes simplex virus (HSV) types 1 and 2

  • Indolent and extensive HSV types 1 and 2 infections: Symptoms may include the following: tenesmus, rectal pain, discharge, and hematochezia. The disease may run its natural course of exacerbations and remissions but is usually more prolonged and severe in patients with immunodeficiency disorders. Presentations may resemble dermatitis or decubitus ulcers in debilitated, bedridden patients. A secondary bacterial infection may be present.

Radiation-induced proctitis

Radiation-induced proctitis includes the following symptoms:

  • Early symptoms include tenesmus and diarrhea that resolve shortly after the radiation treatment period.

  • Later symptoms of proctitis (occurring months to years after the completion of radiation therapy) include tenesmus, bleeding, low-volume diarrhea, and rectal pain.

  • Symptoms of radiation-induced proctitis are associated with low-grade obstruction or fistulous tracts into adjacent organs.


Physical Examination

Physical examination findings may include the following:

  • Mucosal erythema

  • Mucosal friability

  • Groups of vesicles eroding into circular superficial ulcers enlarged

  • Tender inguinal lymph nodes (HSV)

  • Painless chancres

  • Hemoccult positive stools

  • Telangiectasias

  • Elevated fecal calprotectin and fecal lactoferrin [4]