What to know about ulcerative proctosigmoiditis

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Proctosigmoiditis is a form of ulcerative colitis, an inflammatory bowel disease. Symptoms are a result of inflammation in the large intestines. It is not clear what causes this inflammation, but several factors could play a role.

For example, an overactive immune system can lead to ulcerative colitis. In some people, certain strains of bacteria may cause the immune system to attack the large intestine mistakenly. This triggers inflammation and may lead to symptoms of proctosigmoiditis.

Ulcerative colitis also tends to run in families, so a person’s genes are another possible reason why proctosigmoiditis may develop.

Environmental factors can also increase the risk of proctosigmoiditis, including:

• oral contraceptives
• antibiotic medications
• high fat diet.

While there is no cure for the condition, it is possible to manage the symptoms. Treatments for proctosigmoiditis typically include medication, surgery, or a combination of both.

To control symptoms and prevent serious complications, most people who have proctosigmoiditis will need to take medication for their lifetime.

While there is no cure for the disease currently, medications help reduce the symptoms of proctosigmoiditis, preventing serious complications, and improving quality of life.

There are five types of medications that doctors may prescribe:

• Aminosalicylates: These are anti-inflammatory drugs, such as mesalamine. They come in both topical and oral forms. Unless symptoms are extensive when a doctor first diagnoses the condition, people usually try topical forms first. Typically, these are the first type of medication prescribed for proctosigmoiditis.
• Corticosteroids: Doctors may also prescribe these drugs in either topical or oral forms to treat or prevent inflammation if necessary.
• Immunomodulators: This is a class of drugs that reduces the activity of the immune system, such as methotrexate. Immunomodulators are only necessary if other medications are not working.
• Biologics: These are a newer class of drugs that target tumor necrosis factor, a protein involved in inflammation. Examples of biologics include golimumab and infliximab.
• Other medications: Other medications may occasionally be necessary to deal with specific symptoms or complications, such as antibiotics for treating infections.

There are different ways to take these medications, which may depend on the location and severity of symptoms.

For example, some drugs come in the form of an enema, which injects the medication in a liquid or foam form through an applicator that an individual inserts into the rectum. In other cases, it could be through the mouth or a suppository.

In more severe cases of proctosigmoiditis, bowel surgery is an option. This may involve removing the last portion of the colon (large intestine) and the rectum or the large intestine entirely.

Lifestyle changes can also help people with proctosigmoiditis. This can include regular exercise, keeping a healthful diet, avoiding tobacco smoking, and reducing stress.

You can read more about which foods to avoid with IBS here.

People with proctosigmoiditis could experience complications that include:

• Rectal bleeding: This occurs when ulcers in the rectum open up, causing bleeding.
• Anemia: Blood loss from rectal bleeding can lead to anemia. This is a condition in which the body lacks enough red blood cells to function normally.
• Dehydration: The large intestines may become unable to absorb fluids properly, which can cause dehydration.
• Malabsorption and nutrient deficiencies: The large intestines can also stop fully absorbing nutrients. Over time, this can lead to nutrient deficiencies.
• Megacolon: This is where inflammation reaches deeper layers of the large intestines. It can be life threatening and require immediate treatment.
• Cancer: People with ulcerative colitis may be more likely to develop colon cancer. Several studies show that the risk increases over time. For example, someone with the condition for 10 years has around a 2% greater risk, but after 30 years, it increases to around 18%.

Possible risk factors for proctosigmoiditis include:

• having a family history of inflammatory bowel disease
• smoking
• being between 15–30 years old or over 60 years
• being of Ashkenazi Jewish descent

It is worth seeing a doctor if a person is experiencing diarrhea that lasts longer than a couple of days. This is particularly important if diarrhea occurs with bleeding, fever, or severe stomach pain.

A medical evaluation will involve a thorough discussion of a person’s medical history, family history, symptoms, and physical exam.

Further testing will likely involve a colonoscopy. This involves feeding a long, flexible camera through the rectum into the large intestines. Doctors may also suggest other tests, such as blood or stool tests.

Proctosigmoiditis is a type of ulcerative colitis that affects the rectum and large intestines.

It may be the result of an overactive immune system, genetics, or environmental factors. People with a family history of the condition face a higher risk of developing it themselves.

While it is a lifelong condition, several types of medication are available for treating symptoms. In the most severe cases, surgery may be necessary.

Complications can range from rectal bleeding to a higher risk of colon cancer, so if a person suspects they may have the condition, they should speak to a doctor.