Anal discomfort

In Feb 2003 I had my first colonoscopy (age 33), looking for possible inflammatory bowel disease, due to IBS symptoms.  I had my one and only baby Sept 2002- difficult delivery and big baby.  Colonoscopy looked normal.  But starting after the colonoscopy, I had a feeling there was something there on the right side.  Gastroenterologist thought inflammed papillae, so I tried hydorcortisone cream and sitz baths.  Then discomfort worsened and felt like I was being cut when having a BM.  I was referred to a Colorectal surgeon suspected a fissure and so I went in for a sphincterotomy after trying Diltiazem for 6 wks.  He saw no fissure (so he did not cut) but scraped inflamed areas (Cryptectomy), but said he really did not need to do much.  Started seeing another Dr. in June 2004, who said I had internal hemorrhoids.  He banded the right side and endolazed the left.  The left side swelled enormously, then decreased, then left a tag.  The right side had some granulation, so Dr applied liquid nitrogen; it stopped after 2 weeks.  Still feeling the area some, then had bleeding in Sept 03. I went to a naturopath who saw "size 3 hemorrhoids in rt posterior, right anterior, and left side".  He treated right anterior with negative galvanic electricity (Keesey) and the next week treated rt posterior.  But I felt horrible afterwards, with burning sensations.  The follow up report was that both areas looked good and smooth.  Still uncomfortable, went back to second Dr. who said the area looked better after the Keesey txs.  He rec'd just leaving the area alone.  Still uncomfortable, went back in Dec 2004 and Dr. said he saw a big external hemorrhoid (had been mainly looking internally before).  He injected it with a chemical. Still some bleeding, so in Jan, he injected the area on either side of the hemorrhoid.  Still uncomfortable and went to see a 3rd Dr who did not see a problem with hemorrhoids, but saw prolapse and wanted to do a cystodefecography.  I was not up for doing the Fleet preps (as I suspected the diahrea associated may have caused initial discomfort, possibly hemorroids (hemorrhoids), at the time of the Colonoscopy).  Decided not to go this route, b/c the discomfort is with one small area of the anus and no other symptoms.  Finally, saw a 4th Dr in March, 2004 who said the anus looks 99% normal and not to do anymore treatments.  But, I still don't know why this started, if I really had significant hemorroids (hemorrhoids), and if the discomfort I feel now is due to inflammation from the txs.  The area looks bluish (maybe this is normal) and touching the area seems to disrupt it and makes feeling worse.  This spot is not ballooned up (I don't really know what a hemorrhoid looks like).  Also, over the last year, I have seen a naturopath who has helped me with reducing my problem of loose stools and gas, to where my BMs have been fairly normal for the past 6 months or so.  The feeling is very distracting and I worry about when/if it is going to go away.

[Kevin Pho, MD]

Indeed, the symptoms may be suggestive of a hemorrhoid or anal fissure, with hemorrhoids being more likely.  Without seeing the lesions myself, I cannot be sure.  Hemorrhoids are essentially dilated veins that become inflammed when a clot forms within them.  There are several approaches to them, including cryotherapy (freezing them), laser therapy, banding, sclerotherapy or surgery.  

If the last physician suggests that everything looks normal, perhaps no more treatment is needed.  If not, perhaps some of the mentioned options can be considered.

Another consideration if the colorectal route is non-revealing would be a dermatology referral to ensure there isn't an area of inflammation present that is unrelated to the anus.  

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.
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