Questions in the Gastroenterology and Liver Diseases Forum have been answered by Dr. Kevin Pho who is board certified in Internal Medicine and by doctors from Henry Ford Health System.

Question Title: Anal Discomfort

Forum: The Gastroenterology and Liver Diseases Forum
Topic: Digestive


Hello:

I have been experiencing anal discomfort after my bowel movements and this pain lasts most of the day. I have shown this to a doctor and had flex sigmoidscopy and the results were negative. But the doctor also mentioned that I might have had mild haemmoroids. So, he recommended that I take Hydrocortisone 25 mg supp rectally whenever I had the pain. But, this doesn't seem to relieve me of any pain. The pain increases if I sit. If I lie down the pain seems to be less. Also, it is important to note that it happens only after my bowel movements. The bowel movements are normal. Hope some one can help me.

Thanks in advance.

____
Dear skipper,
Yourlittle buddy Gilligan may be right. Your symptoms suggest a fissure which is a tear in the lining of the colon that reults from straining at defecation. The pressures in the colon pull on the mucosa causing the tear. It is not the result of hard stool tearing the lining.

The treatment consists of allowing the mucosa to heal and then initiating measures to increase the size of your stool so that you do not have to strain as forcefully to defecate. In the short term, warm Sitz baths will relieve the pain. You should increase the amount of fiber in your diet. This will produce soft stool. Finally, if you suffer from recurrent or refractory fistula, you may ask your doctor about injection of BOtox (botulinum toxin) into the rectal sphincter. This manipulation interferes with muscle tone allowing for less straining at defecation.

This information is presented for educational purposes only. Always ask specific questions to your personal physician. If you are in SE Michigan and wish to be seen by us at the Division of Gastroenterology at henry Ford Hospital in detroit, you can call our Physician referral Line at (800)653-6568 and request an appoinment with Dr. Fogel, one of our experts in gastrointestinal disease.

HFHSM.D.-rf
*keywords: rectal fissure
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