Proctitis is inflammation confined to the distal 12–15 cm of the rectum. It may be acute or chronic, infectious, inflammatory, radiation-induced, or ischemic. Because the rectum serves as the final stool reservoir, even limited mucosal irritation produces prominent local symptoms that patients notice immediately and often attribute mistakenly to hemorrhoids.

1. Cardinal rectal symptoms
   • Tenesmus: a persistent, sometimes painful urge to defecate despite an empty rectum; may interrupt sleep and mimic urinary urgency in severe cases.
   • Urgency: a sudden, compelling need to reach a toilet; accidents occur if access is delayed even a few minutes.
   • Frequent, small-volume stools: five to ten passages daily, each <50 g, occasionally consisting only of mucus or blood.
   • Rectal bleeding: bright red streaks on toilet paper, blood coating formed stool, or drops into the pan; clots are rare unless deep ulceration exists.
   • Mucus discharge: clear, white, or blood-tinged slime expelled with or between stools.
2. Associated discomfort
   • Burning or aching in the anal canal during and after defecation, often worse when stools are hard.
   • Sensation of incomplete evacuation or “blockage,” leading to repeated straining that further traumatizes the mucosa.
   • Mild cramping in the suprapubic area; pain rarely localizes to the right or left lower quadrant because the inflamed segment is midline.
3. Systemic and context clues
   • Low-grade fever and malaise: suggest bacterial or sexually acquired proctitis.
   • Nocturnal diarrhea: uncommon; if present, consider proximal extension (proctosigmoiditis).
   • Concurrent skin or oral lesions: psoriasis plaques, erythema nodosum, or aphthous ulcers point toward inflammatory bowel disease.
   • History of anal-receptive intercourse, recent antibiotic use, or pelvic radiation: guides microbiologic testing and timing of onset.
4. Specific patterns by cause
   • Radiation proctitis: painless bleeding 6–18 months after pelvic radiotherapy, often with rectal pain and spasm.
   • Ischemic proctitis: sudden bloody diarrhea in older adults with vascular risk factors; pain out of proportion to visible bleeding.
   • Diversion proctitis: mucus discharge and urgency months after colostomy formation in an unused rectal stump.
5. Red-flag combinations
   Continuous bleeding with orthostatic dizziness, passage of large clots or melena (implying a more proximal source), severe anal pain suggesting abscess or fistula, and weight loss >5 % within four weeks.

Summary table