When a patient presents with symptoms of proctitis, key differential diagnoses to consider include infectious proctitis (caused by sexually transmitted infections such as gonorrhoea, chlamydia, herpes simplex virus, and syphilis), inflammatory bowel disease (notably ulcerative proctitis as a form of ulcerative colitis), radiation proctitis following pelvic radiotherapy, and diversion proctitis occurring after surgical diversion of the fecal stream. Other causes include ischemic proctitis, drug-induced proctitis, and less commonly, malignancy or trauma-related inflammation. Infectious causes are particularly important to consider in sexually active patients and may require targeted microbiological testing. Inflammatory bowel disease should be suspected if there is a history of chronic gastrointestinal symptoms or extraintestinal manifestations. Radiation and diversion proctitis are linked to prior treatments or surgeries. Clinical assessment combined with endoscopic evaluation and appropriate imaging or biopsy helps differentiate these conditions effectively NICE CG99 Wu et al. 2015McNeil et al. 2024Al Mulhim et al. 2021.
Key References
- CG99 - Constipation in children and young people: diagnosis and management
- NG147 - Diverticular disease: diagnosis and management
- (Wu et al., 2015): Pathogenesis, diagnosis, and management of ulcerative proctitis, chronic radiation proctopathy, and diversion proctitis.
- (Al Mulhim et al., 2021): Transperineal Ultrasound in the Diagnosis of Proctitis in the Emergency Department.
- (McNeil et al., 2024): Proctitis: An Approach to the Symptomatic Patient.