Ulcerative proctitis/idiopathic ulcerative proctitis

Ulcerative proctitis is a poorly-understood inflammatory disease of the rectum (proctum).  It is most commonly seen in young people and presents with rectal bleeding, often associated with bloody slime and an urge to have frequent small bowel movements.  Often the bowel movements consist only of bloody slime, and the patient has the urge to go back to the toilet every 20 minutes to pass some more.  This symptom is called ‘tenesmus’.  It is the rectal equivalent to a runny nose when a patient has a head cold.  There may or may not be associated lower abdominal cramps and a sense of abdominal bloating.  No one knows what causes ulcerative proctitis.  It can start suddenly, last for a week or two and then just disappear, or it can persist for years.  Rarely, it can extend upwards with worsening of symptoms, including fever and diarrhea.  It tends to recur.  Patients with idiopathic ulcerative proctitis will often relate a similar episode in the past that disappeared before they were able to see a doctor.  Ulcerative proctitis is called ‘idiopathic’ because no one knows the cause.  It must be differentiated from an infectious inflammation of the rectum (infectious proctitis) which, although rare, must be treated with antibiotics.  Stool cultures should be taken in all patients with proctitis in order to determine if it is the infectious form or the idiopathic type.  The treatment of idiopathic ulcerative proctitis is an intestinal anti-inflammatory.  These are administered in the form of anti-inflammatory suppositories (if the inflammation is only involves an inch or two of the rectum), anti-inflammatory enemas (if the inflammation is up to ten inches or so), or anti-inflammatory oral tablets (if the inflammation is higher than the rectum).  Sometimes a combination of these is required.