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Dr QM Leong

Ulcerative Proctitis Vs Colitis: Symptoms, Causes, And Key Differences

Among the various disorders that can affect the digestive system, ulcerative proctitis and ulcerative colitis are two distinct yet related conditions that are often confused.

In this article, we will delve into the world of these inflammatory bowel diseases (IBDs) and provide clarity on the key differences between ulcerative proctitis and ulcerative colitis. You’ll identify your symptoms and understand the different diagnoses and treatment options for each condition.


What Is Ulcerative Proctitis?

Ulcerative proctitis (UP) is an inflammatory bowel disease affecting only the rectum, the last part of the colon or large intestine. In this condition, inflammation is localised to the rectum and does not extend to other parts of the colon. 

The inflammation in ulcerative proctitis is characterised by the formation of ulcers on the inner lining of the rectum.

Symptoms And Common Indicators Of UP

  • Rectal Bleeding: One of the common symptoms of ulcerative proctitis is rectal bleeding. Blood in the stool or on toilet paper is a common occurrence and is typically attributed to the inflammation and ulceration of the rectal lining.
  • Frequent Urgency to Have a Bowel Movement: Ulcerative proctitis often leads to a strong and frequent urge to have a bowel movement. This urgency can be distressing and may result in multiple trips to the restroom throughout the day.
  • Passage of Bloody or Mucus-Filled Stools: Stools in ulcerative proctitis can contain blood or mucus. The presence of blood is a direct result of inflammation and ulceration in the rectum. Mucus may also be present due to the irritation and inflammation of the rectal lining.
  • Abdominal Cramps and Discomfort: Patients with ulcerative proctitis may experience abdominal cramps and discomfort. These symptoms can range from mild to severe and are often associated with inflammation in the rectum and lower part of the colon.
  • Feeling of Incomplete Evacuation: Some individuals with ulcerative proctitis may feel as though they have not fully evacuated their bowels after a bowel movement. This sensation can be frustrating and is often related to inflammation and the presence of mucus in the rectum.

Causes And Risk Factors Of UP

The causes and risk factors of ulcerative proctitis (UP) can vary, and it’s often a complex interplay of factors that contribute to the development and exacerbation of the condition. These include:

  • Abnormal Immune Response: Inflammatory bowel diseases (IBD), including ulcerative proctitis, are believed to originate from an abnormal immune response within the gastrointestinal tract. The immune system mistakenly attacks and inflames the lining of the rectum in UP, leading to the characteristic symptoms.
  • Family History: Genetics can play a significant role in the development of UP. Having a family history of IBD, including ulcerative proctitis, increases the risk of an individual developing the condition. Specific genes related to immune function and inflammation are associated with an increased susceptibility to IBD.
  • Infections: Infections, especially gastrointestinal infections, may trigger or contribute to the development of UP in some cases. These infections can potentially lead to an abnormal immune response or trigger inflammation in the rectal area.
  • Dietary Factors: While diet alone is not a direct cause of UP, certain dietary patterns and food intolerances may exacerbate symptoms in susceptible individuals. Some individuals may find that specific foods or dietary habits worsen their condition or trigger flare-ups.
  • Stress: Psychological stress is known to exacerbate symptoms of UP and other IBDs. Chronic stress can trigger or intensify inflammation in the gastrointestinal tract, leading to symptom aggravation.
  • Smoking: Smoking is considered a significant risk factor for UP and other forms of IBD. It is known to increase the risk of developing UP and can also worsen the course of the disease. Quitting smoking is often recommended as part of the management plan for UP.


What Is Ulcerative Colitis?

Ulcerative colitis (UC) is a type of inflammatory bowel disease that causes inflammation and sores in the colon, a part of the large intestine. It’s similar to another disease called ulcerative proctitis, but it affects a larger colon area. This condition can cause chronic inflammation and ulcers in the lining of the colon.

Some cases of ulcerative colitis develop from proctitis. The progression happens when proctitis is left untreated or if the inflammation gradually spreads from the rectum to the other parts of the colon.

Symptoms And Common Indicators Of UC

UC symptoms can be more extensive and severe than ulcerative proctitis. Patients often experience the following indicators:

  • Bloody Diarrhoea: One of the hallmark symptoms of UC is bloody diarrhoea. The inflammation and ulceration in the colon and rectum can lead to the passage of stools that contain blood or mucus.
  • Abdominal Pain and Cramping: UC often causes abdominal discomfort and cramping. These symptoms can range from mild to severe and are typically associated with the inflammation and irritation of the intestinal lining.
  • Weight Loss: Persistent diarrhoea, reduced appetite, and malabsorption of nutrients can lead to unintentional weight loss in UC patients. Maintaining a healthy weight can be challenging during active disease phases.
  • Fatigue and General Malaise: Chronic inflammation and the body’s immune response can lead to fatigue and a general feeling of being unwell (malaise). UC patients may experience low energy levels and a reduced sense of well-being.
  • Extraintestinal Symptoms: In addition to gastrointestinal symptoms, UC can also manifest with extraintestinal symptoms that affect other parts of the body. These may include joint pain (arthritis), skin rashes (dermatitis or erythema nodosum), and eye inflammation (uveitis or conjunctivitis).
  • Frequent Urgency to Have a Bowel Movement: UC patients often experience a frequent and urgent need to have a bowel movement, which can disrupt daily activities.
  • Feeling of Incomplete Evacuation: Similar to ulcerative proctitis, some individuals with UC may feel as though they have not fully evacuated their bowels after a bowel movement.

Causes And Risk Factors Of UC

The causes and risk factors of ulcerative colitis (UC) are multifactorial and involve a complex interplay of genetic, environmental, and immune factors. Here’s a breakdown of these causes and risk factors:

  • Genetic Factors: UC is believed to have a genetic component. Individuals with a family history of IBD, including UC, are at a higher risk of developing the condition. Specific genes related to the immune system and inflammation have been associated with an increased susceptibility to UC. However, having a genetic predisposition does not guarantee that an individual will develop the disease.
  • Environmental Triggers: While genetics play a role, environmental factors are also thought to contribute to the onset of UC. These factors can include dietary choices, exposure to infections, and other environmental elements. However, the precise environmental triggers are not fully understood and may vary from person to person.
  • Immune Dysregulation: UC is considered an autoimmune disease, where the body’s immune system mistakenly attacks its own intestinal lining. Immune dysregulation is a key factor in the development of UC, as the immune system becomes overly activated in the gastrointestinal tract, leading to chronic inflammation and damage.
  • Smoking: Smoking is associated with an increased risk of UC development, but paradoxically, it may have a protective effect against UP (ulcerative proctitis). However, the reasons for this difference are not fully understood, and the overall health risks associated with smoking outweigh any potential benefits related to UC.


4 Key Differences Between Ulcerative Proctitis Vs Colitis

When it comes to distinguishing between ulcerative proctitis and ulcerative colitis, it’s essential to recognise the key differences that set these two conditions apart:

  • Location of Inflammation: One of the primary distinctions between the two is the location of inflammation. Ulcerative proctitis is localised to the rectum, whereas ulcerative colitis involves inflammation that extends throughout the colon. This distinction has significant implications for symptoms and treatment.
  • Extent of Inflammation: Proctitis is considered a milder form of inflammatory bowel disease because it affects a limited area. In contrast, ulcerative colitis often affects a larger portion of the colon, leading to a broader range of symptoms and potential complications.
  • Potential Complications: The limited scope of ulcerative proctitis reduces the likelihood of certain complications that are more common in ulcerative colitis. For instance, severe inflammation throughout the colon can lead to complications like colonic strictures, fistulas, or an increased risk of colorectal cancer
  • Disease Severity: The level of severity can vary in both proctitis and ulcerative colitis. In ulcerative colitis, it is described as mild to severe, depending on the extent and intensity of the inflammation. In contrast, ulcerative proctitis is often categorised as milder. The severity of the condition plays a critical role in determining the appropriate treatment approach.


Similarities And Overlapping Symptoms Of Proctitis And Colitis

While ulcerative proctitis and ulcerative colitis have distinct characteristics, there can be some overlap in symptoms, which can complicate the diagnosis process. Common overlapping symptoms include:

  • Rectal Bleeding: Both conditions can result in rectal bleeding, which may manifest as blood in the stool or on toilet paper. Rectal bleeding is a hallmark symptom of ulcerative proctitis but can also occur in ulcerative colitis.
  • Frequent Urgency: The urgent need to have a bowel movement is a shared symptom of both diseases. Individuals with either condition may experience a strong and sudden urge to use the restroom.
  • Abdominal Discomfort: Abdominal discomfort can be present in both conditions, including cramps and pain. This discomfort can vary in intensity and location.
  • Diarrhoea: Diarrhoea is a common symptom in both ulcerative proctitis and ulcerative colitis, although the severity and frequency can differ.
  • Mucus in Stool: The passage of mucus in stool is another sign both conditions share.
  • Weight Loss and Fatigue: These systemic symptoms may affect individuals with either condition, particularly when inflammation is more widespread in ulcerative colitis.


Diagnosing Ulcerative Proctitis Vs Ulcerative Colitis

Diagnosing ulcerative proctitis and ulcerative colitis involves a comprehensive evaluation by healthcare professionals or Gastroenterologists. Here’s an overview of the diagnostic process:

  • Medical History: A detailed medical history, including a discussion of symptoms and any family history of inflammatory bowel disease, is important for accurate diagnosis. 
  • Physical Exam: Doctors may also require a physical examination to assess the patient’s overall health.
  • Laboratory Tests: Blood tests can help identify signs of inflammation, anaemia, or nutritional deficiencies associated with both conditions. Increasing C-reactive protein (CRP) levels or erythrocyte sedimentation rate (ESR) may suggest active inflammation.
  • Stool Samples: Analysis of stool samples can help rule out infections and check signs of blood, mucus, or pathogens. Stool tests can provide valuable information to aid in diagnosis.
  • Colonoscopy: Colonoscopy is a crucial diagnostic tool for both ulcerative proctitis and ulcerative colitis. Using a flexible tube with a camera helps visualise the colon’s lining and identify areas of inflammation. Biopsies may be taken during the colonoscopy to confirm the diagnosis and rule out other conditions.
  • Flexible Sigmoidoscopy: In cases of suspected ulcerative proctitis, a flexible sigmoidoscopy may be performed to examine the rectum and lower part of the colon specifically. This procedure is less invasive than a full colonoscopy but can provide valuable diagnostic information.
  • Imaging Studies: In some instances, imaging studies such as CT scans or MRIs help evaluate the extent and severity of inflammation, especially in cases of ulcerative colitis.


Treatment Options For Ulcerative Colitis And Proctitis

Treatment for ulcerative proctitis and ulcerative colitis is aimed at achieving symptom control, inducing and maintaining remission, and improving the patient’s quality of life. It depends on the severity of the condition and may include the following options:


  • Anti-Inflammatory Medications: Aminosalicylates, such as mesalamine, are often prescribed to reduce inflammation and symptoms in both ulcerative proctitis and ulcerative colitis.
  • Immunosuppressants: Immunosuppressive medications like azathioprine or methotrexate may be used to modulate the immune response and prevent inflammation.
  • Biologics: Biologic therapies, such as infliximab or adalimumab, target specific molecules in the immune system and can be effective in managing symptoms and inducing remission, especially in moderate to severe cases of ulcerative colitis.
  • Steroids: Corticosteroids may be prescribed for short-term use to rapidly reduce inflammation during flare-ups, but they are not suitable for long-term maintenance due to potential side effects.

Lifestyle Modifications

Making dietary changes can help some people deal with their symptoms. For example, avoiding certain trigger foods or adopting a low-residue diet during flare-ups can bring relief. 

Additionally, managing stress is essential, as it can worsen symptoms. Mindfulness, yoga, or counselling may be helpful techniques to reduce stress.

Colectomy Surgery

A colectomy is a medical procedure done to remove a portion or the entire colon. If medications fail, surgery may be needed for severe ulcerative colitis or life-threatening complications like bleeding, colon perforation, toxic megacolon, or developing colorectal cancer. Chronic symptoms like pain, diarrhoea, and weight loss can also be improved with surgery.

Treatment plans are highly individualised, and healthcare providers work closely with patients to tailor approaches to their specific needs and goals. Regular follow-up appointments and ongoing monitoring are important to ensure the treatment’s effectiveness and to adjust the management plan as needed. 

Ultimately, the goal is to provide patients with the best possible quality of life while managing their condition.


Conclusion Ulcerative Proctitis Vs Colitis

Ulcerative proctitis is localised to the rectum, resulting in symptoms such as rectal bleeding, urgency, and discomfort. On the other hand, ulcerative colitis involves inflammation throughout the colon, leading to a broader range of symptoms and potential complications.

If you or someone you know is experiencing gastrointestinal symptoms, we strongly encourage you to seek medical attention promptly. Early diagnosis and proper management are crucial for controlling symptoms, preventing complications, and maintaining a good quality of life.

We also recommend considering Advanced Colorectal and General Surgery as a trusted resource for diagnosis and treatment. With cutting-edge technology and a specialist surgeon in Singapore dedicated to digestive health, they can provide tailored advice and care that meets your unique needs. 

Book an appointment today to take the first step toward understanding and managing your gut health. Your well-being is our priority.


Frequently Asked Questions About Ulcerative Proctitis Vs Colitis

When Should I Seek Medical Attention If I Suspect I Have These Conditions?

If you experience symptoms such as rectal bleeding, persistent diarrhoea, abdominal pain, or unexplained weight loss, it’s essential to consult a doctor promptly for the correct diagnosis and treatment plan tailored to your specific needs.

Is There A Cure For Ulcerative Proctitis Or Ulcerative Colitis?

While there is no known cure for these conditions, they can often be managed effectively with medication and lifestyle changes to achieve symptom control and remission.

Are There Specific Dietary Recommendations For Individuals With Ulcerative Proctitis Or Ulcerative Colitis?

Dietary recommendations can vary from person to person. Some individuals may benefit from dietary modifications, such as a low-residue or low-FODMAP diet, while others may require no specific dietary changes. Consulting with a professional dietitian or healthcare provider can help determine the best approach.

Can Children Develop Ulcerative Proctitis Or Ulcerative Colitis?

Yes, children can develop these conditions. Paediatric gastroenterologists specialise in diagnosing and managing inflammatory bowel diseases in children.