Problems sitting

Hi,

I'm a 24 year old male. I had hemorrhoids 3 years ago and since then i've been having problems sitting. I have done just about everything. Colonoscopy, and endoscopy and rectal tests (all of which show nothing to be concerned about). I've also checked with my doctor's and my hemorrhoids are no longer inflamed (back to normal). I went to a surgeon and he didn't feel it was bad enough to require surgery.  I have pruritus ani (anusitis). I've even done kegel exercises but to no avail. If I eat any spices my rectal area burns and hurts a lot. I also have a little pimple around my anus (outside skin) that swells up if i get diarrhea and is very uncomfortable until I bleed from it. After which point its back to normal. (its not a fistula or fissure (or so my doc said)) and my doctor said that its nothing to be worried about. Regardless of that, it stills fills up every once in a while (especially if i sit for a while)

when i sit down (on the chair) i'm fine for the first hour. After that i get a sharp pain in my anus that continues as long as i stay seated. The pain decreases if i stand up and don't sit for the rest of the day but if i try to sit again, I'll get that sharp pain again. My anal area becomes inflamed and the only way around it is to sleep for a while (at which point it gets back to normal). This sharp pain will come back after bowel movements. After bowel movements it takes me atleast 5-10 mins to get back to normal. If I try to sit on the floor (cross-legged), i'll have pain in my anus within 10 minutes and the sharp pain will come.

Any ideas to what the problem might be and how to go about solving it and which type of doctor to consult.

[Kevin Pho, MD]

Difficult to say without evaluation.  It appears that you had a comprehensive workup, including endoscopies, and a referral to a surgeon.

One consideration would be a condition known a proctalgia fugax, which is a type of episodic rectal pain that is of unclear etiology.

Possible treatment options if this is the case is oral clonidine, topical nitroglycerin, or an injection of botulinum toxin.

I would discuss these options with another GI opinion, preferably at a major academic medical center.

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 Pho, M.D.

KevinMD.com
Twitter.com/kevinmd