“There are different immune pathways that can be activated, and we have medicines to target multiple pathways,” Dr. Lerrigo says. Of course, it would be great if a doctor could instantly tell which medication would work for every individual with ulcerative proctitis, but the science hasn’t caught up yet. “We just don’t have a biomarker to tell us that, but we’re getting there—to a more personalized approach to treatment,” Dr. Lerrigo says.
Because ulcerative proctitis is a chronic condition, you will always need to take medication to keep symptoms under control, which can potentially lead to other issues. “If you take any medication long enough and in a high enough dose, there can be side effects, so we have to be mindful of that,” Dr. Lerrigo says. For example, certain medications can reduce the responsiveness of the immune system, which can put you at a higher risk for other infections when taking them.
There is also the potential for your treatment regimen to completely change without warning. “A patient may respond to one particular type of drug for five years, then out of the blue, the inflammation pathway changes and that drug no longer works, so we have to try a different drug,” says Dr. Lerrigo.
When symptoms don’t improve and start to severely impact your quality of life, your doctor may recommend surgically removing the damaged portion of your digestive tract to ensure the inflammation is gone, which is typically reserved as a last resort, Dr. Lerrigo says.
Can lifestyle changes help relieve ulcerative proctitis symptoms?
Remember, ulcerative proctitis is an autoimmune disease, meaning you didn’t do anything to cause it. “Even in remission, there’s a risk of disturbing the very fine balance within the colon that can tip a flare-up,” Dr. Lerrigo says. “It’s not the patient’s fault.”
However, he says there are a few things you can do to try and support a healthier GI tract. (Still, overall gut health is something scientists are just starting to understand and there are lots of unknowns, so keep in mind there’s more research to be done.)
The “perfect” diet doesn’t exist because each person has unique nutrition needs, explains Dr. Lerrigo. That’s why most of his patients work with a registered dietitian. However, experts do know that a diet that closely mimics the Mediterranean diet, one that is focused on fiber-rich whole grains, leafy vegetables, nuts, legumes, lean proteins like chicken and fish, and some dairy if you tolerate it, “promotes a healthy gut ecosystem2 and reduces the risk of ulcerative proctitis flares,” Dr. Lerrigo says.
He also recommends getting plenty of exercise and doing your best to manage stress, both of which can impact the immune system.
What are the potential complications of ulcerative proctitis?
Frequent bleeding due to ulcerative proctitis can lead to anemia, a condition where you don’t have enough red blood cells to carry oxygen to the various tissues in your body, or iron deficiency, says Dr. Yoon. According to the National Institutes of Health (NIH), if your proctitis isn’t treated or doesn’t respond to treatment, complications can also include:
- Rectal stricture, which is an abnormal narrowing of the rectum
- Ulcers, or sores in the lining of the intestines
- Colon cancer