Etiology

The relative prevalence of the many causes of proctitis in unselected populations is unknown. The differential diagnosis for proctitis depends on the clinical history in each case.

  • Infectious proctitis is most likely in patients who have had anal-receptive sex, especially in men who have sex with men or if immunocompromised.[1]

  • Anorectal symptoms, including proctitis, have been unique to the 2022 global mpox outbreak, and were not described previously.[2][3]​​

  • Radiation proctitis is the most common cause of rectal bleeding in those who have received pelvic irradiation treatment, and may occur early during treatment or months later.[4] Up to 50% of patients experience minor rectal bleeding after pelvic irradiation for prostate, gynecologic, or urologic cancers.[5]

  • Ischemic proctitis should be considered in older patients with a recent significant hypotensive episode, or surgery for abdominal aortic aneurysm.[6][7][8]

  • Celiac disease - a gluten allergy that causes weight loss, diarrhea, and malabsorption - has also been associated with proctitis.[9]

  • Nonsteroidal anti-inflammatory drug-induced proctitis may occur in patients taking either oral or suppository forms, and can cause painful rectal ulceration.[10]

  • Diversion proctitis occurs occasionally in patients who have had surgery that diverts the fecal stream to a stoma (e.g., ileostomy or colostomy) and is reversible once fecal flow is restored.[11]

  • Intentional and unintentional insertion of caustic agents into the rectum can cause acute proctitis.[12]

  • Inflammatory bowel disease (ulcerative colitis, Crohn disease) is the most likely diagnosis where none of the above factors appear to be implicated.

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