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Rectal pain
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Rectal pain

I have been having rectal pain for 3 months now.  It all started with feelings of to defecation everytime I ate something, then I started to feel as if I had something in my rectum which I couldn't get rid of even after bowel movements.  Doctor supected internal hemorrhoids (none visible from the outside) so I used Anusol HC, creams, sitz bath, citrucel, high fiber diet, etc.. until I had a colonoscopy.  Colonoscopy revealed small internal  hemorrhoids which could not be the reason of my pain. Gastroenterologist is baffled, he prescribed NULEV but does not help because I don't think I have IBS (no abdominal cramps, no gas, bloating, etc..) just something inside the rectum.   It is driving me crazy, sometime is very intense and I end up in the emergency room and some other time is just a dull mild ache.  Only thing that seem to help is Valium and Xanax (I had a few tablets left from years ago).  To me it sounds like LEVATOR ANI syndrome or Proctitis.  I was also treated for H. Pylori at the inset of the problem.  Could this have caused these spasms in the rectum?.  The pain is constant and dull, like an ache and it is very bad when I sit and also when I stand.  I feel better when I walk.  Please help because my gastro doesn't even return my calls!!!
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Levator ani syndrome is a possibility.  This is a syndrome that causes rectal pain due to spasm of this muscle.  Studies have shown that biofeedback can help relieve the symptoms.

If negative, you may want to consider an anoscopy, which can visualize the distal rectum better than a colonoscopy.  A barium enema is another test to consider.

If everything is negative, you may want to consider anorectal ultrasound which can better evaluate the internal and external anal sphincters.  

IBS is also a consideration.  If you have already tried increasing the fiber in your diet, you may want to consider the use of antispasmodic agents to help relieve the spasm.  

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.

Thanks,
Kevin, M.D.
16 Comments
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are you a  man or a woman??
how long ago is your h pylori treatment and what medication did you take??
if you are a woman into menopause,lack of female hormone could cause rectal pain.
yeast infection after anti biotics treatment could also cause problem in that area.
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I have this same problem and and for me it's hemorrhoids and anal fissures.  It's extremely painful.  One thing I have done is to keep a peri anal bottle in the bathroom and when I have a bowel movement I don't use toilet paper, I fill the bottle with warm water and spray the area really really Good and then pat dry with dry toilet paper. It really controls the spasms, but from trial and error don't use cold water it made the spasms worse.   I feel for you because that is some of the worst pain I have experienced in my life and I've done childbirth naturally lol.  It took about 3 mos for my fissures to heal up but they come back quite frequently and when I get a deep one it causes the spasms.  Good luck and I hope you get some answers soon.
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Sorry, I forgot to mention that I am a 59 year old woman and the medication I took for H-Pylori was a cockail of: Amoxicillin, Metronidazole and Protonix (proton pump) for 14 days.  I don't think it's hemorrhoids or anal fissures because I never had any bleeding and never had any relief with the cream/suppositories (Anusol H1, Preparation H, etc..).  The medication I am taking now, NULEV, isn't it an antispasmodic agent?
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Dr. has now prescribed Flexeril for muscle spasms.  He now thinks that my problem are not hemorrhoids but a spasm in my rectum (levator ani syndrome????).  When I get up in the morning I feel OK, then after my bowel movement (yes, my stools are soft) which occurs right after breakast, my rectum and anal area start to ache and it never stops until I lie down and fall asleep in the night.  I have taken 2 pills of Flexeril so far and they make me very drowsy but no improvement so far.  Should this medication be taken for a few days before it starts working or should I contact the doctor and let him know it doesn't work.
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I JUST STARTED HAVING THESE PROBLEMS. I HAVE BEEN READING SOME OF THE COMMENTS. I AM A 34 OLD FEMALE. I THINK THAT THE HORMONE CHANGE COULD BE THE FACTOR. IT STARTED RIGHT BEFORE MY PERIOD, AND I THOUGHT THAT IT WAS JUST CRAMPS. MAYBE GULLSTONES? I HOPE YOU FEEL BETTER...
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I have been dealing with a constant false feeling of the need to deficate since June 28, 2003.  It is now April 27, 2004.  My problem started out of the blue.  One day I was fine, and the next day I felt like I had ball in my rectum.  It wasn't painful, but it did give me the sense that I constantly needed to go to the bathroom.  I thought mabey I was constipated, but when I finally had a bowel movement it didn't help the sensation.  Before all of this began, I was in great health eating properly, running three miles a day, getting plently of sleep, etc.  And then out of nowhere the problem hits me.  It was 7 days before I was suppose to begin my monthly menestration.  I have felt a constant need to deficate for 10 months now.  I started seeing gastroenterologists who mostly did sigmoidoscopies (sp) and colonoscopies, gave me so many different medications for rectal and colon spasm, as well as, medication for IBS that didn't work, treated me over and over again for internal Hemmorhoids- didn't work. I saw 4 gastroenterologists before I went to a GyN.  It was found that I had severe endometriosis and it had spread slightly to my rectum. One of the gastroenterologist specifically told me there was no way I had endometriosis. Surprise!  I have had three invasive surgeries this year to try and correct the problem with my endo which was stage 4.  This last surgery they went in to get the implants off my rectum and found invisible endo behind my cervix which is between the uterus and rectum.  It has been almost two weeks since the surgery and I don't feel better.  However, the doctors say that the feeling could be coming from the inflamation (inflammation) on the outside of my rectum.  My last gastroenterologist said that the only thing that he has found that causes this sensation is inflamation (inflammation) inside or outside the rectum.  Such as inflamatory bowel disease, colitis, and so on.  He wanted me to get the endometriosis taken care of because he could not find any other reason why I would be having this rectal problem.  Who ever knew that this problem existed.  I am not feeling hopeful today, but mabey I will feel hopeful tomorrow. It seems at this point all I can do is wait!  Lots of crying today.  My poor family doesn't know what to do with me. I have a twin sister who feels completely helpless at this point because she wants to make things better, but doesn't know how. Thanks for listening.
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I have had rectal pain, fissures and colon spasms for over 2 years. Two things I have found that make a huge difference.One being Nitrol 2 percent in vaseline.I put this on my rectum up to 3 times a day using a rubber glove. I had a perscription from the Colon specialist and when I use it , it takes care of the spasms and the fissures heal much faster. Also for my over all health and the spasms, fissures etc I go to a Chinese Accupunture. this has helped my body so much I can't even begin to say. You have to make sure you are totally honest with him or her though. Also make sure he/her is a registered Accupunturist preferably from China. Mine was a Doctor in China with a masters in medicine in China, plus Accupunture, accupressure and massage. He is very good and I continue to see him but my body is healing so I have to see him less and less.
Thought this might help someone out there.
This of course was after I had a colonscopy and all the nessessary tests done for cancer etc.
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I have had rectal pain, fissures and colon spasms for over 2 years. Two things I have found that make a huge difference.One being Nitrol 2 percent in vaseline.I put this on my rectum up to 3 times a day using a rubber glove. I had a perscription from the Colon specialist and when I use it , it takes care of the spasms and the fissures heal much faster. Also for my over all health and the spasms, fissures etc I go to a Chinese Accupunture. this has helped my body so much I can't even begin to say. You have to make sure you are totally honest with him or her though. Also make sure he/her is a registered Accupunturist preferably from China. Mine was a Doctor in China with a masters in medicine in China, plus Accupunture, accupressure and massage. He is very good and I continue to see him but my body is healing so I have to see him less and less.
Thought this might help someone out there.
This of course was after I had a colonscopy and all the nessessary tests done for cancer etc.
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Went back to my colorectal surgeon twice in the last 2 months and I still don't have a proper diagnosis.  First he said I had an anal fissure but when I went back the fissure had healed but I did't feel any better so he thinks that it might be Levator Ani Syndrome.  He has prescribed muscle relaxnts (Lebbid for the smooth muscle and Felexeril 5mg for the skeletal muscle) but I don't feel better.  My symptoms:
1.  When I get up in the morning I am fine
2.  After having breakfast and going to the bathroom (very regular and not constipated, thanks to the high-fiber/water intake, I start having a burning feeling in anorectal area (generally at 12:00 o'clock).
3.  By the time I sit in the car to go to work the burning/pain/uncomfortable feeling (like having a ball inside my rectum) has reached its peak and remains the same until evening.
4.  In the evening I start to feel better and once I go to bed I don't have pain at all.
This is everyday for 8 months now!!  Sitting is real bad for me even on donut pillows, stnding a little better and walking definitely better.  Unfortunately I work at a computer all day long so I have no choice.  Anybody in the forum with the same symptoms?  I read a lot about pudendal nerve entrapment and pudendal neuralgia, could it be one of those?  If so, there are very few doctors in the US who specialize in these conditions.
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Help my boyfreind has been in pain for 5 months it all started out when he had an external hemorrhoid cut and drained then there to follow he had 2 internal ones rubber banded. know he has another external. The pain has been bad for a while.The pain he has know is spasms an ache and pressure in the rectum he can not stand to do anything the only time he feels good is when he is lying down. He dosent feel the pain on the hemorrhiod it is in the rectum all the doctors we have been to can't not give us a reson why he is in this pain. It has taken over his life
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Help my boyfreind has been in pain for 5 months it all started out when he had an external hemorrhoid cut and drained then there to follow he had 2 internal ones rubber banded. know he has another external. The pain has been bad for a while.The pain he has know is spasms an ache and pressure in the rectum he can not stand to do anything the only time he feels good is when he is lying down. He dosent feel the pain on the hemorrhiod it is in the rectum all the doctors we have been to can't not give us a reson why he is in this pain. It has taken over his life
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Avatar_n_tn
Help my boyfreind has been in pain for 5 months it all started out when he had an external hemorrhoid cut and drained then there to follow he had 2 internal ones rubber banded. know he has another external. The pain has been bad for a while.The pain he has know is spasms an ache and pressure in the rectum he can not stand to do anything the only time he feels good is when he is lying down. He dosent feel the pain on the hemorrhiod it is in the rectum all the doctors we have been to can't not give us a reson why he is in this pain. It has taken over his life
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Hello my name is Brent...and i have rectal pain

we'll how else do you start off.  We all know it sucks.  We all know that its taken over our lives.  Yet we continue to read what we can hoping to find an answer to stop the pain.  I'm sorry, but i dont have one.  I suffer every day just like you.  Some days are better than others and some hours are better than others, but the reality of it all is that its probably never going to go away.  Are there any success stories out there because i'd like to hear a few and not from someone trying to capitalize on my pain by trying to get into my pockets for "JUST 29.95". Heres my story....... I'm 36 years old and when i get up in the morning i'm fine, but after i pass a stool(soft) here it comes the burning pain. It may last all day, part of the day, hours in an out through out the day,and probably a hundred other different combinations.  I use a prescriptio called "AnaMantel" and it seems to help. Its new (i was told). Its got three different types of medication in it. You might want to check into it.  Other than that i have nothing else. I would like to encourage those that are having to live with someone like (us) to do all you can to be supportive and patient.  We know your tired of hearing about it Believe me were tired of living with it.You see, when you have finical problems, spouse problems, work related problems, or even problems with your kids you can take a break by doing something to get it off your mind even if its just for a little while,but we cant. Remember the pain goes with us every where we go. We can't go to the mall,fishing,a ballgame, or even church to get away from it.
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Hello my name is Brent...and i have rectal pain

we'll how else do you start off.  We all know it *****.  We all know that its taken over our lives.  Yet we continue to read what we can hoping to find an answer to stop the pain.  I'm sorry, but i dont have one.  I suffer every day just like you.  Some days are better than others and some hours are better than others, but the reality of it all is that its probably never going to go away.  Are there any success stories out there because i'd like to hear a few and not from someone trying to capitalize on my pain by trying to get into my pockets for "JUST 29.95". Heres my story....... I'm 36 years old and when i get up in the morning i'm fine, but after i pass a stool(soft) here it comes the burning pain. It may last all day, part of the day, hours in an out through out the day,and probably a hundred other different combinations.  I use a prescriptio called "AnaMantel" and it seems to help. Its new (i was told). Its got three different types of medication in it. You might want to check into it.  Other than that i have nothing else. I would like to encourage those that are having to live with someone like (us) to do all you can to be supportive and patient.  We know your tired of hearing about it Believe me were tired of living with it.You see, when you have finical problems, spouse problems, work related problems, or even problems with your kids you can take a break by doing something to get it off your mind even if its just for a little while,but we cant. Remember the pain goes with us every where we go. We can't go to the mall,fishing,a ballgame, or even church to get away from it.
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Avatar_n_tn
Glad to have found this forum. I have many of the same symptoms
described by a couple people. My symptoms:  mornings generally
Ok with just mild discomfort, sometimes almost no discomfort.  As soon as I have a bowel movement, about ten minutes to an hour after
I start having pain.   Usually the pain escalates as the day goes on.  Evenings I've had intense pain, on scale of 1-10 (at least a 12 -- i.e. over the top) Only thing that has helped so far is hydrocortisone.  Ive been to four docs.  All with different ideas.
First one  did hemmroid  injections  on two internal hemorhoids,
that was 5 weeks ago.  Since then the pain is worse. Two docs indicated some sceptism about whether the  hemorhoid injections were needed as I had no bleeding. The second doc,  said  I had
proctitus and  levator syndrome.  The third doc said no proctitus, and didn't believe in the levator syndrome.  The fourth doc says no proctitus, believes in levator, but says I don't have it. Thinks
I have a small fissure that should heal and  is not the major cause of my pain.  Major cause according to him is something to do with the pudental nerve, but he did not explain how or much about it.
Said  I should go to a chiropractor.  This makes no sense to me, I need to know more.    Unfortunately I think I still need another opinion.  
I was interested in the comments about  possible endometrious.
I'm wondering about that.

Anyone know about the pudental nerve and  how that might be involved?  Any other thoughts welcome.

This all started about  10 weeks ago after a bout of terrible bloating and gas  following    three courses of antibiotic (CIPRo
over the summer June , July, Augst  for what was thought to be diverticulitis.  The pain  and rectal pressure started as the
bloating and gas subsided.  There may have been some overlap in these symptoms I'm not sure.

Well, this is getting long.  I'll  wait for comments and hope
I can get some direction from all of you.  This is terribly disruptive and depressing.  Thanks for any help.
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