Proctitis and Rectal pain: Causes, treatment and surgery in Bangladesh

What is proctitis?

The rectum is the final part of the large intestine. It stores stool before a bowel movement. When its inner lining becomes swollen or irritated, the condition is called proctitis.

Proctitis can be short-term or chronic. It may remain limited to the rectum or develop with ulcerative colitis, Crohn’s disease, infection, pelvic radiation therapy or previous bowel surgery.

Common symptoms of proctitis

Proctitis can cause discomfort and inflammation in the rectum, with symptoms ranging from mild irritation to persistent pain. Recognizing these signs early can help ensure timely diagnosis and proper treatment. Symptoms differ between patients. Common signs include:

• Rectal pain or burning
• Pain during bowel movements
• Fresh blood, mucus or pus
• Diarrhoea or constipation
• Lower abdominal cramps
• An urgent need to pass stool
• A feeling that the bowel is not empty

What causes proctitis and rectal pain?

There is more than one possible cause. Finding the actual reason is the first step towards choosing the right proctitis treatment in Bangladesh.

Inflammatory bowel disease

Ulcerative colitis and Crohn’s disease can inflam the rectum. Ulcerative proctitis is a form of ulcerative colitis that mainly affects this area. Symptoms may settle for some time and return later.

People with inflammatory bowel disease may therefore need long-term follow-up instead of treatment only when pain or bleeding becomes severe.

Infection

Bacterial, viral or parasitic infections may cause rectal inflammation. Some come from contaminated food or water. Others may be sexually transmitted.

Recent antibiotic use can also be relevant. In some patients, it may be followed by a Clostridioides difficile infection, which can cause inflammation and changes in bowel movement.

Radiation therapy

Radiotherapy for cancers in the pelvic area may damage rectal tissue and small blood vessels. This is known as radiation proctitis or radiation proctopathy.

It may cause rectal bleeding, mucus discharge, bowel urgency and pain. The symptoms can begin during radiation treatment or appear later. Some patients develop long-term bleeding because the damaged blood vessels become fragile.

Diversion proctitis

After certain bowel operations, stool is diverted through a stoma and no longer passes through the rectum. The unused rectal lining may then become inflamed.

Treatment depends on whether the bowel can be reconnected and whether the patient is medically suitable for another operation.

Other causes of rectal pain

Not every case of rectal pain is proctitis. Anal fissure, thrombosed piles, anal fistula, perianal abscess, rectal prolapse, hard stool and colorectal tumours may cause similar symptoms.

Taking piles medicine repeatedly without an examination may delay the actual diagnosis. New or persistent rectal bleeding should not simply be assumed to be hemorrhoids.

How is proctitis diagnosed in Bangladesh?

A colorectal surgeon usually begins by discussing the symptoms and medical history. The doctor may ask about:

• Rectal bleeding or mucus
• Recent changes in bowel habits
• Previous infection or antibiotic use
• Inflammatory bowel disease
• Pelvic radiation therapy
• Earlier bowel or stoma surgery

The examination may include checking the anal area and performing a digital rectal examination. Tests may include blood and stool tests, a rectal swab, proctoscopy, flexible sigmoidoscopy, colonoscopy or a biopsy.

Blood tests can help identify anaemia, infection or inflammation. Stool tests may find an infectious cause. During endoscopy, the doctor can directly examine the rectal lining and collect a small tissue sample when required.

Endoscopy is particularly useful because symptoms alone cannot confirm proctitis. It also helps distinguish the condition from inflammatory bowel disease, polyps, tumours and other colorectal problems.

Proctitis treatment in Bangladesh

There is no single treatment for every patient. Care is selected after identifying the cause and severity of the inflammation.

Medicines for inflammation

Proctitis related to ulcerative colitis or Crohn’s disease may be treated with anti-inflammatory medicines called aminosalicylates. These can be taken by mouth or placed directly into the rectum as a suppository or enema.

Steroids may be used when the inflammation is more active. Immunosuppressants or biologic medicines may be considered when standard treatment does not control the disease. These medicines need medical supervision and follow-up.

Treatment for infectious proctitis

Bacterial proctitis may require antibiotics. Some viral infections need antiviral medicine.

The treatment should match the diagnosed infection. Random antibiotic use may temporarily change the symptoms, cause side effects and make later test results less useful.

Treatment for radiation proctitis

Mild radiation proctitis may improve with medicine and supportive care. However, persistent or repeated bleeding may need endoscopic treatment.

Argon plasma coagulation, commonly called APC, is an endoscopic procedure. It uses controlled energy to seal fragile bleeding vessels in the rectum. Formalin therapy may also be considered in selected patients with chronic radiation-related bleeding.

Managing pain and bowel movements

A doctor may suggest stool-softening measures when hard stool increases rectal pain. Drinking enough water and maintaining a balanced diet can support more comfortable bowel movements.

Patients may track foods that appear to worsen their symptoms. Still, cutting out many foods without medical or nutritional advice can create other problems. Repeated use of laxatives, suppositories, herbal products or rectal home remedies should also be avoided until the cause of the pain is known.

When is surgery needed for proctitis?

Most patients do not need surgery at the beginning. Medicine, infection treatment or endoscopic procedures are usually considered first. Surgery may become necessary when other treatments fail or a serious complication develops. Possible reasons include:

• Perianal or rectal abscess
• Anal or rectal fistula
• Severe narrowing of the rectum
• Uncontrolled rectal bleeding
• Severely damaged bowel tissue
• Diversion proctitis requiring bowel reconnection
• Inflammatory bowel disease resistant to medicine
• Suspected or confirmed colorectal cancer

When should rectal pain be treated urgently?

Arrange a medical assessment without delay when rectal pain is accompanied by:

• Heavy or repeated bleeding
• Fever or chills
• Pus discharge
• Severe abdominal pain
• A painful swelling near the anus
• Difficulty passing stool or gas
• Unexplained weight loss
• Dizziness, weakness or signs of anaemia

Note: These symptoms may indicate severe inflammation, infection, an abscess or another colorectal condition requiring prompt care.

Consult a colorectal surgeon for proctitis and rectal pain

Ongoing rectal pain, bleeding or mucus needs proper assessment. Prof. Dr. Tariq Akhtar Khan is a colorectal and laparoscopic surgeon in Dhaka with MBBS, FCPS, MS and FRCS qualifications. He has more than 16 years of experience in colorectal care and provides treatment for different anal and rectal diseases.

Prof. Dr. Tariq Akhtar Khan and his medical team can assess the cause of rectal pain and discuss medicine, colonoscopy, endoscopic therapy or surgery where required. Book a consultation instead of continuing uncertain home treatment.

Book an Appointment