DIGESTIVE DISORDERS / GASTROENTEROLOGY
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Rectal Pain and Pressure
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by backspace, Apr 17, 2006
Febuary 21st I noticed I was getting sore in my rectum when I would sit some times. I had  some bright blood earlier that month on my tp, but I have had a small hemroid for many years, so I did not think anything of it.But as the month went on I kept getting sore more and more.I went to my GI, who by the way has been seing me over the last 5 years for Acid Indegestion and IBS Symptoms. I had a Colonoscopy 2 1/2 years ago for pain in abs, came back normal, with a palyop that was sent to pathology, and was also normal. My GI Said at this visit that my pain was hemroids, and gave me some Cortizone cream...2 weeks later, i went back because I was not getting better. He said not to worry that my colonoscpy was negative 2 years ago, and he gave me supposatories this time And we schedualed a Flex Sigmoid for in his office. I seem to be getting worse , and when I called his office he was out of town, so I went to a surgeon. He did a Anoscope, and said he saw a few small Hemroids but did not think they could cause my pain, and to come back in 3 weeks if does not get better. I went back to my GI and had the Flex Sig done, and he said everything looked good , and he saw a few small Hemroids. I told him my pain was intolerable, and that we need to find out why I cant sit, for it is painful, and continues throught the day...I asked if maybe I have Levator syndrome, and he kind of shook his head, and said that was the same as IBS. Well I also asked if maybe I had endometrioses on my rectum, he said not possible... I have seen my OBGYN in between these visits and he is going to do a Laparoscopy 4-18-06 to see if I have any endo on my rectum, he says that if I am having spasms, that something has to be causing them and it could be endo. He does not see that it can be anything else...
I am at my wits end please help me......These are my symptoms
Am feel ok.....kind of
After I have a couple of bowel movements I am sore in my rectum and feel some burning sometimes, not like hemroid burn. then as the day goes by, i feel like I have to have a bowel movement and push but nothing happens and its painfull. I feel pressure in my rectum , when I sit its real painful, so I cant sit. I have a ache in my rectum all day, and some times I feel like there is something in my rectum. The pain never goes away, just varies through out the day, when I got to bed at night it seems to not be as bad, then it starts all over again in am. I take a stool softner and eat alot of fiber and water, so I m not constipated

Please help.....
Answer:
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by Kevin Pho, MDBlank, Apr 18, 2006
Difficult to say without evaluation.  A negative colonoscopy and flexible sigmoidoscopy would make significant GI disease less likely.  

An anal fissure can cause some of the discomfort you are describing - however the surgeon should have considered this.  

If the pain continues, you can consider empirically treating an anal fissure - normally starting with a nitroglycerin ointment over the anal sphincter.  

Another surgical opinion or going to a colorectal specialist can be considered if the symptoms continue.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b
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Member Comments (51)
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by Hudson, Apr 18, 2006
HI there, believe it or not, I am having something similar. Mine started with a flare up of hemorrhoids, which I have had for over 20 years. But, now they seem to be under control and I am still having the rectal pain. I am seeing a GI doc this week for something unrelated and plan on asking him about it. From what I have read, rectal pain is fairly common and usually benign in nature. I suspect levator ani syndrome too. I took a muscle relaxant the other nite for a back problem and miraculously the rectal pain stopped. Hmmm...?

Am wondering if you have been under unusual stress lately that could cause the spasms? I have been and that seems to be when my symptoms began. I also notice it is worse when I am "keyed up". Please post if you get a answer to this one and I will do the same.

Hudson
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by backspace, Apr 19, 2006
I went for my Laparoscopy yesturday, and the surgeon found endo on my rectum and around the lower part of my uterus. He said that this is probably the cause of my rectal pain and pressure. I think he said it could also cause the Levator muscle spasms. He also said I have Pelvic adhesions and my Uterus was very inflamed. Doctor Kevin what is your opinion on Endo on the rectum, do you think it can cause the pain and pressure... I will see my GYN next week to discuss what we will do to solve this problem.
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by backspace, Apr 20, 2006
Just thought I would write back again after my doc app. I wrote earlier my OBGYN said I have ENDO on and around my rectum... He said this could be causing the spasms and pain...Has anyone heard of this...? I wrote back to Doc Kevin and have not heard a response...Please some one respond, I can't possibly be the only one who has pain when I sit in the rectum.....

PIB
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by Hudson, Apr 20, 2006
Hey PIB, i think I am the only one here who has something similar and mine weirdly is slightly better this week. But, I totally understand the sensation you are talking about and find it annoying. To give you background on my pain, it started in February when I was diagnosed with an ovarian cyst. Gyne thought the cyst was sitting on the bowel and causing pressure. Well, the pressure from that was more "pelvic" in nature. But, the cyst caused constipation and the constipation caused hemorrhoids. I had surgery in March, and had the cyst removed. But, after surgery I was even more constipated and the hemorrhoids returned. I finally got that under control, but was left with the strange rectal pain.

If you find a definitive answer, please post it. I googled rectal pain, and I am sure we are not the only ones with it. There are lots of articles on it. The only reassuring thing, is most causes are benign, but the treatments are kind of "sketchy". As I said, I discovered by accident that muscle relaxants work for me. Also warm baths seem to help.

Have you found anything that eases your symptoms?

Hudson

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by Hudson, Apr 21, 2006
PIB, if you are still out there, just wanted to let you know I saw my family doc today and her do another rectal exam after I described my pain to her. Apparently I have both external and internal hemorrhoids. She also did the test for occult blood in the stool, which was negative. She prescribed a prescription strength cream which I haven't picked up yet from the pharmacy as well as a muscle relaxant (flexeril). I'll let you know if I see any more improvement. Since you have not responded to any of my posts, if I don't see anything from you in the next day or so, I will assume you are no longer interested in this thread. Hope all is well.

Hudson
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by backspace, Apr 21, 2006
Hi Hudson,
I am sure happy for you that your doc found out what your problem was, I on the other hand have an app. with my OBGYN surgeon who did my Lap on Tuesday for next week on Monday....He says I have endo on my rectum and under my uterus and that it could be the problem of pain and spasms he thinks I am having. I am just so tired of having pain in my rectum, its put a stop on my life, I cant go anywhere because I cant sit , and I am not working right now either.... I am trying to keep a possitive mind and not let myself get depressed..I am tired of my doc thinking I am crazy....My gastrointerologist says all my test are neg, just some small hemroids and maybe some spasms, I went to a ssuregeon who did an anoscope, and he said he only saw small hemroids, nothing that could cause my bad pain in rectum...Finally my OBGYN said lets do the Laparoscopy and see if I have any endo, and that is what he found...I am taking Vicodin for pain, but I dont know why anyone just wont try and treat me for Levator Syrome, you know with some Muscle relaxers just to see if it works....I think when I go to my doc on minday, I am going to ask if we start narrowing this down by treatment, and then think of surgery for endo...You said you doc did a test for blood in your stool? did she do that in her office?  please let me know...Thanks for all your help, and I am still here just recovering from suregery....I will be watching for your response..

Thanks PIB
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by Hudson, Apr 21, 2006
HI PIB, I don't really feel like I have an answer to my pain even though the doc reconfirmed the hemorrhoids. I still think mine feels like spasms in addition to the hemorrhoids. But, since it responded to the muscle relaxant when I took it the other nite, she was willing to give me a RX for more. I really think my ovarian cyst aggravated the muscle and now it is still tense or something?

Personally I think both yours and mine sound like levator syndrome. I think your idea of asking to try a muscle relaxant before having more surgery makes sense. It sure is much less invasive and the particular one the doc gave me (Flexeril) is supposedly not habit forming. It does make me tired, so I took only 1/2 tablet at nite. But, believe it or not, it relieved me of my pain for almost the entire day.

I can relate to the not being able to sit for long because that is when this pain really gets going isn't it? I am much better standing or walking.

At any rate, I'll be thinking of you. Please let me know how things are going for you and if I find this RX cream to work, I'll post again. I'd tell you the name of it, but I haven't picked it up from the pharmacy yet. They are out of it and have to order it. I may not have it until Monday. Do you believe it? lol.

Hudson
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by Hudson, Apr 21, 2006
p.s. about the occult blood in the stool. Yes, she did this test in the office. It's just a stool sample mixed with a solution to see if it changes color. No color change= no blood.