Digestive Disorders / Gastroenterology Expert Forum
Severe Rectal and Abdominal Pain
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Severe Rectal and Abdominal Pain

Please Help!
Problems started with Hysterectomy,1993, and I have been a
mess since then.  Absesses, partial ovary left in - for Endo,
foam, etc. Numerous Abdominal Surgeries to 'try' and repair
damage, hernia, adhesions will not quit with every surgery.
Pain unbearable.  Is there a place for someone to go for
chronic adhesions?  He also said that the tissue inside of me had
seperated from my hip bones and he had to reattach, to the best of his ability.  I am on Pred. Diagnosed with IBD in 1989 - but that is debateable.  I always come out clean with Scopes.
Also, now have beyond belief pain rectally and mid to lower left
abdominal pain.  They say Anal fissure - but I don't think so.
I can hardly walk, sit directly, and most times cannot move from
one side to the other - so in bed.  I am not a whimpie person -
can handle pain - but this is criminal.  Last year a General
Surgeon did what he called a rectal stretch as he felt I was
too narrow to pass stool.  I was not black and blue - I was
black! for a month from my buttocks to the back of my legs.
I FELT stitches.  He says no he did not cut me.  But has recently
given me Depo-Medrol injections and Kenalog injections abdominally AND the scar tissue - insicion is like a C
section but from one hip bone to the next.  Very long.  I am
getting worse with pain since Kenalog.  I cannot poop.  Takes
me 3 days just to have a bowel movement and most times, it is
just a very small amount of stool that comes out anyway.
Perscribed Lactalose, Valium, Vicoden, Proctofoam - which I
won't use as it burns badly.  I cry and cry and cry with this and
I am not the crying type.  Please any input?  Colorectal surgeon
dropped me, in essence, as I believe the steroid shots have
scared some of my regular Docs off and now they won't either
see me or do anything about this.  Told me he was too busy with other patients and just go to the ER if the pain was that bad and
he was the one that diagnosed the anal fissure.  He also said that rectally I was twisted in the wrong direction.  Can that
actually happen to a person?  Also said, I can do no more for you when the last visit I had with him he said HE may have to do
surgery.  What, in God's name do I do about this?  I am only
46 years old and a mess.  Please, Please advise me.  What
do I do about this?  I can hardly move and am in agony.  Oh, the pain is bad after any kind of bowel movement. Can't even stand up straight and it radiates up to my lower spine to mid spine.
Thank you
Related Discussions
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If an anal fissure is the diagnosis, then there are several options you can consider.  An anal fissure can certainly be a painful and furstrating chronic disorder.  You have mentioned that the endoscopies have been negative.

Medical treatment such as topical nitroglycerin is usually one of the initial treatments that can give some relief.  Another option would be injection of botulinum toxin.  Studies show injection of this is successful in those who fail initial treatment.  

Other medical options would include oral medication such as calcium channel blockers which has been shown in some studies to help with the symptoms and promote healing.  

If the medications aren't working, then surgical treatments such as sphincterotomy should be considered.  

I would suggest a second opinion from a colorectal surgeon or gastroenterologist to see if any of the options outlined above would be beneficial to your case.  

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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I am sorry that I failed to mention that I have also
been prescribed Panlor DC and Tylenol 3.  
Even with all these med's - nothing is helping.  
I use heating pads, ice packs, abdominal braces, etc., anything that I can possibly
think of and I burn like you would not believe rectally - outside
and on the inside and the burning is like fire,
on a 24/7 basis.  I have been prescribed creams - mostly
steroid creams and I do not have hemmorhroids (sp).
Can you direct me to a Specialty Clinic or hospital somewhere
here in the U.S. so that I can get a life back?  The last abdominal surgery I had was in 2002 and that makes it about 8
of them in the same incision-  This General Surgeon told me that
he had never seen anything like this in his career and could not
figure it out.  Just did what he could do to fix hernia, which he said was quite large, adhesions, plus remove adhesions from colon, and reattach some
of the skin tissue that was left to my internal bones.  I have
also had every GI test known to man and I am absolutely getting
no where except worse.  I am cannot drive anymore, let alone
walk properly, limping or no walking at all because I can't
without the pain nearly driving me to my knees.  Please, can you possibly come up with anything that explains all this and help me
figure out what to do?  My husband and I are at a complete loss
and I at the point of just saying forget it.  I can't, but I do
continue to try, keep this Doctor, problem, thing up anymore.  It's been 10 years of abdominal agony and now it's abdominal AND
rectal, not to mention the spine pain from going or even not going to the bathroom.  Isn't 3 days at a stretch of not going at all saying something is wrong?  Anal fissures don't do that do they?
Thanks, again
Empreinte
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i am not a doctor,but it sounds like you are going thru hell.
you may want to try this,if it does not work,you have little to lose.
before you go to bed,smear generous portion of plain yogurt onto a clean sanitary napkin and wear it to bed,make sure it covers the anal area.
the best is the plain flavorless yogurt from health food store,f you dont have it ,then use the plain or vanilla yogurt one.
you should get a soothing effect from wearing this napkin.
if it does not work,then discard it.
if it works,you may have to repeat it for several nites.
let us know.
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Hi Yoshi,
Thank you so very much for responding to my post.  
It was greatly appreciated.
Yes, this has turned into a 'living hell' and I am trying
to do anything and everything that I can think of to get
this problem corrected.
I see a Gastro Doc tomorrow, so hopefully maybe some help
there.  If not, I will give your advice a go.  Thanks again -
I am willing to try anything.
Have you ever had this problem?  If you have or did - how
long did it take you to get it corrected?  The agony is
beyond words.  I am so wiped out from this and my life is not
going in the directions that I want it to - at this time in my
life.  But I am not one to give up - although, I do have many,
many times that I am over the top with frustration, not to mention the pain of this.  Criminal pain.  
Thanks again, for caring to respond and please, if you have
ever been down this road will you write me back and tell me
what you did or went to get this fixed?
Sincerely,
Empreinte
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no,i never have series of surgery ,the only one i have is appendicitis and they removed my appendix when i was 15.
i spent a few days in hospital and then stayed home to recover,under doctor advise that i should have small meals every 3 hours ,my family brings me goodies to eat many times a day.
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Doctor,
Although I do appreciate your response and suggestions of
a second opinion - as it so happens I am seeing a Gastro
Doc this morning - could you please answer the questions
that I had.

1.  Is there a specialty clinic in our Country that deals
    with chronic adhesions - I just recently was made aware
    that an adhesion barrier 'could have' been put in place,
    and of course, was not.

2.  Is it physically possible for an individual to be
    rectally twisted in the opposite direction - or even
    tipped in a direction where one should not be.

3.  Is it considered 'normal' for an individual to NOT go
    to the bathroom, as in bowel movements, for 3 or more
    days at a time.  And if this is not normal, what
    could possibly be the problem here, besides constipation.

I understand that you deal in research so these questions -
and forgive me if I am coming across as rude, as I do not
intend to be - should be somewhat easy to answer?
I am using this website for help and direction - of course one
would go for a second opinion, as I am doing today.  
The outcome of that opinion, I will not know until later today.
Would you be interested in hearing what this Doctor's advise
is and recommendations?  Are you willing to help me in any
way to resolve or at least place me in a different direction than the one that I am in according to what I have described above?  Also, can Steroid Injections, such as Depo Medrol and
Kenalog have an affect on the colon, rectum, or any other
internal organs?

Thank you, again, for your time ~~~~~~~~~~~~
Empreinte
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adhesion barriers are available and the results have been mixed at best. The people who make them (they are sheets that are laid over the intestine before closing the incision, and they dissolve slowly) claim great results. The people who use them, in general, haven't found it to be so. Myself included. There's no place that "specializes" in adhesions. However, any major medical center/university hospital gets lots of referrals for complex problems. What you describe doesn't necessarily sound adhesion related; but a referral to such a place might be useful.

"Normal" bowel frequency varies from several times a day to every few days: it's not the frequency, it's the character. If when a movement occurs it's extremely hard, requires straining, is painful, etc, that's not normal. If it passes without great difficulty, has some bulk and moisture, then it's "normal" no matter the frequency.

I don't know what it would mean for the rectum to be described as twisted in the wrong direction. There is some variation in the rectal anatomy, such that passage of a scope would be more or less difficult. There are people with complete transposition of all organs (situs inversis totalis) where the heart's on the right, liver on the left, etc, which would affect the rectal direction as well, but such a thing would clearly have been noted in prior operations you had. I'd say that unless the rectum is actually narrowed (stricture) then it's not a significant finding.

Please note I'm not the same person who officially answered your question; I'm a general surgeon who occasionally offers input here, uninvited. Dr. Pho may see that you directed further questions to him. If not (I think sometimes they don't look at all the comment threads) you could post a fresh request for his further opinion.
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Thank you very much for your invaluable information, which
is appreciated.
If you do know Dr. Pho could you ask him or her to please
READ the posts and if possible reread mine?
That would be so helpful.
I don't know why you say 'uninvited' - as you have supplied
me with more info and help then initially given - and
I thank you for that and your time.
Sincerely,
Empreinte
ps Is there anyway - other than the forum that we could communicate?  I have some very personal questions and any
input from you I would be grateful for.
Did you have Endo by chance?  I was told that it would all go
away after my Hysterectomy and it did not.  It kept coming
back, again and again and again and had to go thru nearly
a year and a half of Lupron Shots.  The highest doseages.
I know now that that was inappropriate treatment as I was
receiving those nearly on a weekly basis.  Between the Lupron
and the Pred - which I have been on for 17 years with no breaks
at all has caused fractures and I have osteoporosis.  They say
it is severe.  At one point, 4 years ago, I actually fractured
6 ribs at one time - 4 on one side and 2 on the other.
Can you believe all this?  I wish that I had never had the
Hysterectomy, now, as that is what has caused me to have
this domino effect of health problems.  I am only 46 years old
and personally what a waste and a mess this has been.  All at the
hands of Doctor's  - nothing personal - as I do believe that
there are exceptional ones out there.  I have a GP - who is
a very caring individual but is honest enough to tell me that
he has his limitations as only a GP.  He finds the majority
of my health situations appalling, and isn't afraid to say so.
Thanks again.
Thanks again, and thanks for listening~~~~~~~~~~~~~
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FOR A GASTROENTEROLOGIST DOCTOR OR A COLORECTAL SURGEON DOCTOR -

I saw the Gastroenterologist Doctor yesterday and he says he did not feel a fissure, but was not for sure.
So, he wants to do a Proctoscope and have me use 2 fleet
enema's on the day of the exam - which is November 20th.
My question is this - If I do in fact have a fissure will
a ProctoScope plus using the fleets make me tear even further?
Is that a possibility?  IS THIS RISKY?
Here I have a Colorectal Surgeon saying that I do in fact
have a fissure and now a Gastroenterologist saying that there
is a good possibility that I don't.  That he won't know unless
he uses the Proctoscope.
Can anyone PLEASE help me with this?  I am definitely worried
about this and do not need anymore pain or possible damage than
I already have.
I would be grateful - extremely - for an opinion on this.  This is why I joined this Forum and contributed to it - for HELP.
He says stay on the Lactulose, prescribed Analpram cream, and
wants me to continue with the Valium at 10 mg - 3 times a day.
I have been on Valium now since May of this year. The Valium
is suppose to help with possible rectal spasms.
Please - I do really need some advice here and if the ProctoScope
is not the answer then what testing should be done? Or in otherwords, is there another procedure that could be done - such
as Xray's, a different type of scoping procedure, etc.....
I still have time to cancel this procedure if it possible that
I could rip further by the use of such scope.
Thanking ANY DOCTOR in advance,
Empreinte
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Hello,
Could you please read my post as of today, November 15, and tell me what you think?
I don't know if I will get a response back from anyone
in the specialty of Gastroenterology or Colorectal.
I am getting desperate here for information and would appreciate
it very much if you could give me some input from my most
recent post.  I am very worried and I am in terrible pain and
extremely afraid of this procedure - please tell me if this can
cause more of a problem than I already have.  I do still have
some time to cancel this and go in another direction and if
you think that I possibly should, could you tell me what do I
do now and where or what direction can I go in?
Thank you very, very much,
Empreinte
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the doctors may not read your posts ,you may have to start a new thread to get them to respond.
it seems you need a family doctor who can help you decide what to do with all the input from diff specialists.
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Hi,
Yep, I gave that some thought.
But if this forum is going to just be only about the
money in order to get help and or some answers -
I believe that I will look elsewhere.
$15.00 per question isn't going to break the bank, so to
speak, but for me it's the principal of the whole thing.
I am very disappointed with the initial response that I got
but got more help from the General Surgeon, who must have
a heart, to take the time to try and help me with this
situation.  
Thanks anyway,
Empreinte
ps Problem getting much, much worse.  It amazes me that if
the original Doctor's on this forum don't check back, well,
it pretty much tells me that they really don't care.
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the docs cannot keep checking on past threads.
you should see your family physician and ask him to help you evaluate what all these specialists have diagnosed.
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HAVE ALREADY DONE THAT - WENT NO WHERE AS HE SAYS HE
IS ONLY A GP AND THAT SPECIALTY DOCTORS 'HAVE' MORE INFO
THEN HIM.
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Sounds like surgery and those meds have been a disaster for you.
I worked with a young man who could not swallow anything.  It would stick and give pain in the esophogus.  The Dr. had him on valium.  He was not getting better.  He was going to be hospitalized and I told him I had read that fruit is healing to the digestive tract.  He thought it would burn but out of desparation tried some peaches.  He was amazed as they went down and slowly he could start eating again.

I have notice you have said nothing about diet.  If I was in your situation I would find alternatives to the prednisone and valium ASAP.  
I am 46 also and when I was 38 came down with IBD, very sever with bleeding and terrible pain.  The meds worked at first but after another flare up I went to a good naturpath and found alternative methods for controlling bowel troubles.

If you are only having a bowel movement every 3 days sound like you have little or no intestinal flora in your large bowel.
Feces is largely made up of bacteria and prednisone is damaging to the good bacteria in the bowel.

Sugar and starch also can be damaging to the intestines.  Hopefully you have cut out sugar and flour.  Steamed and raw vegetables are also helpful to gut flora except for potatoes and corn.
I could write pages of information but it's helpful to get specific advice and I recommend finding a competent nutritional or alternative health care provider such as a naturpath.

All the best hope for you.
-Dave P.
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Dear Dave,
Thank you for writing to me and with loads of advice!
More than I am getting here.
Some of your recommendations I really had no idea about that.
I did not know that Pred has that effect on the bowel, and for
that I thank you.  
The problem is this -
I have been on Pred for 17 years, with not even one break in
all those years for Crohn's Disease, or so they say.
I cannot get off the Pred - I have tried and even to lower to
1 milligram causes me such terrible, wicked side effects.
Right now I am at 10 mg per day but going 9 mg on one day and
then 10 the next so that my body can get used to the drop.
The lower the Pred - the better - that at least I do know.
I did not know about the sugar or the corn and have found that
I have such unbelievable cravings for them both.  I went for
awhile with nothing but baked potato binges.  I could not get
enough of them - and could not figure out why - when I was never
like this before.
I do not know what a NuroPath is or how to go about finding one
or at least someone who could help with me with my nutrition.
There are days that I just CANNOT eat - especially when I am
dropping on the Pred.
Do you have any Web Sites that I could go to or anymore advice
for me?  If you do, I would be forever in your debt.
Thanks for caring enough to respond as I am in dire agony, at the
present, and now it is getting to be 5 to 6 days without a
bowel movement.  I just had a Sig Flex, Sitz Marker Test, and
am now scheduling for something called a Defecogram or something
that sounds like that.  This test is where they shoot barium
straight up your butt and make you sit on a pot and a Radiologist
takes films as the barium is passing through you.  Embarrassing
as all hell but I am willing to do anything to get straightened
out again - well, I will never be the same as I was once, but
an improvement over this would make me extremely happy, once
again.  
The Valium is for what they are saying are severe rectal spasms
from which I believe was caused by a General Surgeon who did
a 'Rectal Stretch' last year, as I could barely pass stool even
then and was leaking all the time.  
If you do know anything about med's, I am on -
Pred
Asacol
Zantac
Panlor DC   for pain
Tylenol 3 - which is almost finished and they won't refill that
I do have Vicoden by the score here - but I am sick to death of
taking that so right now I am not.
I was also prescribed Skelaxor for Muscle related damage due
to the 17 years of continous Pred useage.  I also have
oesteoporosis - again, the Pred has done that.
I have seen many, many Doctor's, over the years, to include
being flown to Baylor Medical Center as I was failing fast -
to the point where one of my Doc's asked me if I wanted a Priest
or something for last rites.  That was in 1988.  So, still here
but suffering terribly from my IBD and the side effects.
I also recently received 2 Depo Medrol Injections and one
Kenalog 40 mg injection directly into my abdomen and the one
and only incision that they keep opening up every time they go
in.  I don't know if these shots have done me further damage.
I am trying to be proactive but it has been a *****.  Some of
my Old Doc's dropped me as one actually said that they are afraid
that I may become a 'liability' - meaning, maybe I might want to
sue some of them for gross incompetence.  Not my intention -
Just want to get better.  Doctor's to me are bad enough and
to throw in Lawyer's would send me over the edge!  lol
Thanks again and please write back if just even to talk - I
would really appreciate it and please any further diet info
I would give it a try - even peaches.  I plan to go get some
today and give it a try, as yesterday I could not eat not one
thing.  In pain and hurting terribly.
Thanks again,
Empreinte
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Dave,
If you could - could explain flora to me, as I do not understand
that part.
Is there a specific test for that - how would one know?
I have always believed that knowledge is power but I am at
a loss right trying to figure this out.
I don't trust any of my Doc's, at the present moment, and
very understandable after some of the stuff that they have done
to me.  I have a GP who is trying and a GI Doc that I think,
possibly?, is trying to help, but I am having a hard time
trusting him, right now.  My husband and I are not sure if he
is doing right by me with these tests - as one nurse said to
me the day I had my Sig Flex - Nov. 20 - of this year -
that is possible that I may be obstructed.  OMG!  If a Doctor
might suspect that, don't you think that they would jump on that
fairly quickly?
We just don't know what to do.
Thanks again, Dave, and if you could or would could you please
tell me what your experiences have been with IBD?  Like, what
have they prescribed to you and how have you managed to cope with
this?  Also, what symptoms did you have before you were diagnosed
and what symptoms are you having now?  This is a life long gig,
right?  Meaning, no cure for this?
Thanks again ~~~~~~~~~~~~~~~~~~~~
Empreinte
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A related discussion, I just read all this and surprised was started.
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A related discussion, sorry about your pain was started.
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A related discussion, for your help was started.
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A related discussion, have you tried Adoration was started.
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