Severely overactive rectal sensations

The symptoms I have been having started exactly 2.5 years ago.  Since then I have been experiencing constant discomforting sensations is my rectal area.  These sensations range from a wiggly feeling which is usually accompanied by excessive contractions of my outer rectal area the spinchter muscle.  In the last year it has been accompanied by severe and ongoing passing of gas roughly every 2 minutes.  This makes it very difficult for my participate in any sort committed activity like visiting with friends and inhibits me from sitting still while at functions.  Any still activity I participate in which extends beyond 10 to 15 minutes is extremely uncomfortable and emotionally draining as I am constantly trying to fight the possibility of passing gas.  I have also noticed that I am always fighting the urge to relax my rectal/spinchter area.  I have been told that I have a small hemoroid,  but I know that can't possible be causing this.  I have been to several different doctors just to scoffed at and looked strangely upon and quickly dissmissed with a prescription or suppository that does absolutely nothing and in many cases the suppository seems to aggrevate the condition.  I am a 32 year old healthy otherwise feeling male, who is increasingly bewildered by what is happening to me.  I am planning on returning to school this spring and I remember what it was like  to sit through a four hour class I had last semester, very awkward and constantly leaving the room, I do not feel like I learned much although I passed with a B+.  It has been diagnosed as either hemmoroids (hemorrhoids), a possible prostate/fungal infection by a couple of the doctors I have seen for as I have said each time I was giving a prescription that I was told should take care of the problem.  No one has yet to see the need for any serious testing other then a visual inspection of the area.

[Forum-M.D.-DT]

Thank you for visiting the Family Practice Forum.

I hear your frustration. What you have, while not serious in nature, is obviously causing you great discomfort.

There are several possible diagnoses for what you are experiencing. These include:

1.Proctalgia Fugax (Pain in the rectum)
2.Tenesmus (persistent spasm of the rectum - usually associated with inflammatory bowel disease) and Levator Ani Syndrome are conditions which come to mind.
3.Levator Ani Syndrome

Here is some information from the Merck Manual on Levator (Ani) Syndrome.

Definition:

Episodic rectal pain caused by spasm of the levator ani muscle.

Proctalgia fugax (fleeting pain in the rectum) and coccydynia (pain in the coccygeal region) are variants of the levator syndrome, which occurs in both males and females. The pain is typically unrelated to defecation, usually lasts for < 20 min at a time, may be related to sitting, can occur spontaneously, and can awaken the patient from sleep. The pain is often described as a vague ache high in the rectum. The pain may feel as if it would be relieved by the passage of gas or a bowel movement and usually subsides spontaneously within a few minutes. In severe cases, the pain can persist for many hours with recurrences. The patient may have undergone various rectal operations for these symptoms, with no benefit.

Diagnosis and Treatment
Physical examination can exclude other painful rectal conditions (eg, hemorrhoids, fissures, abscesses). Physical examination is often normal, although tenderness or tightness of the levator muscle, usually on the left, may be found. Occasional cases are caused by low back or prostate disorders.

Treatment consists of explanations to the patient of the benign nature of the condition. An acute episode may be relieved by the passage of gas or a bowel movement, by a sitz bath, or by a mild analgesic. When the symptoms are more intense, skeletal muscle relaxants or anal sphincter massage under local or regional anesthesia can be tried. Physical therapy with electrogalvanic stimulation applied to the lower rectum is usually effective.

I would like to add that there may indeed be an anatomic abnormality which is causing the symptoms you describe. There is a test known as "Anorectal Manometry" which is typically performed by a colorectal surgeon and may help determine the exact cause. Anatomical problems such as anorectal fistula or abcess (abscess) can be ruled out using anorectal manometry and through a thorough examination by a colorectal surgeon.

It may be a good idea to share this information with your doctor and ask to be referred to a colorectal surgeon.

I hope this proves helpful to you!
Dean M. Tomasello, M.D.

[pikamom]

Yes, you should go to that surgeon and make sure they understand how this is affecting your life. I can sympathize with you as I have a similar problem. 11 years ago I got sick with an autoimmune disease of the bladder called interstitial cystitis. I was 26 years old. Ever since I've had bladder spasms constantly, day and night, and I feel them in my urethra. It is excruciating and I feel like I have to pee every 10 minutes. I know what it's like to go to the doctor and describe my symptoms and be told they never had a patient like me. I was in too much agony to just go home and live with it, so I persisted in going from doctor to doctor and finally I had a test in the hospital and got diagnosed and proper treatment. Now I have a urologist who takes seriously my problems. When they looked in my bladder they saw what was giving me all the blood in my urine, little pinpoint hemmorages, my bladder was a scarred and shriveled like it had been burned. I still have blood in my urine even after 11 years. I hope you can find a doctor to help you with this problem.

[Will Scarlet]

I had episodes of extreme rectal pain (high in the rectum) that would awaken me at night.  I would be in extreme pain for several hours.  I too had a lot of gas and discomfort.  I had been using over the counter stool softener with laxative for years.  This solved my constipation problem, but after a colonoscopy, I found it created another problem. My colon was BLACK and tarry inside from this.  My dr. took me off that and gave me a wonderful prescription bulk laxative.   He feels this is what was causing my pain.  And since then, I have had no more episodes.  Just wondering if you, too, are on these??  Hope you find an answer.
These boards are wonderful, becasue sometimes the answer comes from someone that has had the same perplexing problem and found the answer!  Good luck!

[Melc]

Hi,

For the past six weeks I have been vomiting, severe pain in my lower abdomin (abdomen),  sometimes the pain is also under my right breast. They did an ultra-sound to rule out Gall bladder disease. I have been rushed to the hospital on three different occasions and to no unvail, they did nothing except tell me that I had IBS, which I have had for 9yrs, These symptons are nothing like the IBS problems I have had in the past. I went to see a surgeon who told me it was a belly ache and to take tylenol and it will go away, I didn't need to see him to tell me it was  belly ache. My doctor has sent me to see a specialist, finally... and he thinks that it might be my small bowel narrowing. 12 Years ago I had a Internal Hernia. Strangulated and Volvulated segment of Ileum, it was gangoeurs and almost killed me. As the doctors kept saying there was nothing wrong with me. 3 years later they discovered a Redundant Sigmoid colon with partial sigmoid volvulos.

So now the specialists is concerned that maybe were the resectioning was done on the small bowel that it could be narrowing. I have had a barium Enema done and it was normal.

For the past two weeks, I have had extreme rectal pain that doesn't go away unless I am sleeping, I mean I can't walk, sit Lie down or anything, it is a constant ACHE in my rectum area. I was having severe blood in my stool and I informed the specialists and he says that it sounds like fissures. I extreme pain when I go to the washroom, I am not constipated, My stool is very loose, as I eat a high fibre diet for the IBS. And I can't get rid of the pain. I have tried Prep H, Tucks Pads, Ebson Salts and nothing is working, they are so painful I cry and scream when I have a bowel movement and cry harder after because of the pain. Can anyone help me, or tell what I can do to rid myself of the pain? I have tried everything and nothing has worked so far. I am extremley scared that it might be something else and not hemmoroids (hemorrhoids) or fissures.

Thank you so much.