All About Ulcerative Proctitis

Medically Reviewed By Saurabh Sethi, M.D., MPH
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Ulcerative proctitis is a chronic inflammatory disease that affects the large intestine. It is a mild form of ulcerative colitis and is related to Crohn’s disease and other colon conditions. Ulcerative proctitis can cause symptoms such as bleeding in the stool and diarrhea. Treatment options include medications and lifestyle changes to address both the symptoms and the underlying condition.

In this article, we explore symptoms of ulcerative proctitis, its diagnosis, lifestyle and dietary adjustments that may help, and its outlook. We also discuss medication and surgical options that can help treat ulcerative proctitis.

What is ulcerative proctitis?

a person with ulcerative proctitis is experiencing stomach cramps
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Ulcerative proctitis is a mild type of ulcerative colitis. Ulcerative colitis is a chronic inflammatory bowel disease (IBD) that causes inflammation and ulcers in the large intestine.

With ulcerative proctitis, the inflammation starts in the rectum, which is between the end of the large intestine and the anus. It does not grow to more than approximately 6 inches into the colon.

According to the Canadian Society of Intestinal Research, around 25–30% of people with a diagnosis of ulcerative colitis may actually have ulcerative proctitis.

Ulcerative proctitis is the most common form of proctitis. Other types include infectious proctitis, which can come from food poisoning or STIs, and radiation proctitis, which can happen if you have recently undergone radiation therapy.

Learn about proctitis.

What are the symptoms of ulcerative proctitis?

Ulcerative proctitis only affects the rectum and entrance to the colon.

When there is inflammation in the rectum, passing stool can be painful. The ulcers can bleed, leading to blood in the stool. 

The symptoms of ulcerative proctitis depend on the severity of the condition. They can also include:

  • cramps or strains in the rectum or anus
  • diarrhea
  • lower abdominal pain
  • a constant urgent need to have a bowel movement
  • passing blood or mucus from the rectum or with stool

If you have ulcerative proctitis, you may go through periods of remission where these symptoms disappear. It is also possible to have relapses.

What causes ulcerative proctitis?

Having ulcerative colitis or Crohn’s disease means you have a higher risk of developing proctitis. According to a 2022 review, about 30% of people with ulcerative colitis only have rectal involvement of the condition.

Experts are not entirely sure what causes ulcerative proctitis and ulcerative colitis. However, scientists believe that there is a genetic disposition that may contribute to ulcerative proctitis and other forms of IBD.

Environmental factors can also play a role in the development of ulcerative proctitis. Scientists are still researching how this plays with the genes, immune system, and the body’s microbiome to change an individual’s chances of getting the condition.

How do doctors diagnose ulcerative colitis?

A clinician will first take your family and symptom history.

Next, they may perform several tests to:

  • check your blood pressure, heart rate, and temperature
  • listen to your abdominal sounds via a stethoscope
  • check your abdomen for tenderness or lumps
  • a digital rectal exam to check for blood in the stool

This can help them understand if you have ulcerative colitis or signs of other infections or digestive diseases.

Once the doctor determines that you have ulcerative colitis, they will typically perform an endoscopy with a biopsy. 

During an endoscopy, the doctor uses a special tube with a light and camera to look at the lining of the large intestine. 

During a biopsy, they take a sample tissue from the large intestine to analyze it under a microscope. 

A biopsy and an endoscopy can help determine how much inflammation there is in the large intestine and eliminate other more serious conditions.

What is the outlook for ulcerative proctitis?

The symptoms of ulcerative proctitis, like those of ulcerative colitis, can come back within weeks to years after treatment. However, treatments can help you manage these.

Doctors can also prescribe medications that help reduce inflammation and treat any complications, such as hemorrhoids.

Ulcerative proctitis does not raise a person’s risk of developing colorectal cancer.

Learn about the outlook for ulcerative colitis.

What are some lifestyle and dietary adjustments for ulcerative proctitis?

Ulcerative proctitis may cause some people to eat less and not get enough nutrients. Therefore, it may be important to visit a nutritionist.

Experts have not yet identified certain foods that worsen symptoms of IBD. However, keeping a food diary can help you identify any trigger foods that might cause flare-ups of your own symptoms.

How can I manage the symptoms of ulcerative proctitis? 

If you have ulcerative proctitis or ulcerative colitis, here are some treatment options your doctor may recommend to help manage and reduce the symptoms.

  • For pain: To help reduce pain, doctors prefer to prescribe acetaminophens, such as Dayquil or Percocet, over nonsteroidal anti-inflammatory drugs, such as ibuprofen.
  • For hard stool: A doctor may suggest stool looseners that can help.
  • For blood loss: Doctors may recommend you start taking iron supplements.
  • For diarrhea: Anti-diarrheal medications or lifestyle changes can help you ease diarrhea, including codeine, plant-based fibers, dietary adjustments, and more.

In case of complications that require hospitalization, a doctor may prescribe antibiotics, or order a blood transfusion, electrolytes, or IV fluids.

Learn treatment options for ulcerative colitis.

What are the anti-inflammatory medications for ulcerative proctitis?

If you have ulcerative proctitis, your doctor may prescribe anti-inflammatory medication to lessen inflammation in the large intestine.

These drugs include:

  • 5-aminosalicylic acid (5-ASA), such as sulfasalazine, mesalamine, and olsalazine as a first-line treatment for mild to moderate ulcerative colitis
  • corticosteroids, which are short-term steroids that are used when inflammation does not respond to aminosalicylates or to treat moderate to severe ulcerative colitis
  • immunosuppressants, which doctors may prescribe during a person’s hospitalization to treat moderate to severe ulcerative colitis

A doctor may also prescribe some of these to keep ulcerative proctitis in remission.

What surgery might be needed for ulcerative proctitis?

It is rare that ulcerative proctitis will require surgery.

Learn about the surgical options for ulcerative colitis.


Ulcerative proctitis is a chronic inflammatory disease that is a milder version of ulcerative colitis. Symptoms include abdominal pain, cramps, and passing blood in the stool.

Ulcerative proctitis symptoms can progress but improve with medication. They can also come back from remission.

There are numerous medication and treatment options available to help people manage the symptoms of ulcerative proctitis and live full lives.

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Medical Reviewer: Saurabh Sethi, M.D., MPH
Last Review Date: 2022 Dec 21
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