rectal pain

I have been diagnosed with IBS (3 years running)...have been treated few times for bacterial overgrowth...but it is recurrent. Also have a hx of GERD...with fundoplication in 2002.

A few months back I changed my diet to "specific carbohydrate diet" - digestible carbs, no grains, no cow's milk (use goat milk), and no refined sugars (use estevia and honey). I'm now off all meds for GERD...and feeling much better.

With one exception: rectal spasms/pain. I've had all the tests: endoscope, colonoscopy, blood work up - all normal.

I've tried:
nitrogylecerin oitment (doesn't work)
prescription-strength anti spasmodics (makes me too loopy to work)
sitz bath (doesn't work)
yoga/relaxation (helps somewhat),
lots of ointments for pain/tenderness (minimal relief)
manually pressing on spasm by inserting gloved finger (helps sometimes)
sitting on heated/massage pad (helps somewhat)

Do you have any suggestions to manage this? I am considering using immodium (low dose) on a somewhat regular basis to slow down my digestive system in general (as it can get riled pretty easy) and help break the spasm episode.

Might this work - since it is an antispasmodic...and would regular use be a problem?

Any other suggestions?

Thanks! Lee

[Kevin Pho, MD]

I agree with the treatments thus far.  Normally nitroglycerin ointment is the first-line conservative therapy.

Other options that have been tried in studies include oral clonidine, botulinum toxin injection, or low-dose intravenous lidocaine.

These options can be discussed with your personal physician, or in conjunction with a GI physician.

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 patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com