Proctitus questions

[ARTB]

For about 4 weeks I have been struggling with rectal pain.  The first time I noticed was about 4 weeks ago when I had cramping similar to you would have with diarrhea.  The BM was hard and difficult to pass.  Upon standing up I had a severe pain in my rectum that took about 10 minutes to resolve.  After that no real problems until a week later when basically the same thing happened.  The pain lasted longer feeling like pressure and fullness in my rectum with occasional pains in my butt muscles.  I went to see the doctor after noticing blood on the tissue after a BM.  He did a rectal exam with a anoscope and told me I did not have hemorrhoids but rather proctitus.  He prescribed a cortisone suppository and wants to check in 2 weeks and schedule a colonoscopy.  
The pain has persisted along with the pressure with little to no relief.(maybe even worse at times).  The only relief is when I lie down.  I wake up fine in the morning but then things gradually go downhill as the day progresses. I do have an occasional pain in my right side that almost feels like a stitch you would get wen you are exercising.
I did notice that for about 4-6 weeks prior to the first episode that my stools were sometimes loose and usually floating.  Doc said proctitis will do this.
I am taking atenelol for PATs and nexium for some heartburn issues I had a few months ago.  The doc recommended fiber and a stool softener which I have been taking.  I do get some relief after a BM or passing gas.  Sexual practices are normal with only my wife as a partner.  My questions are:
1.  How long does it take to get relief from the suppositories?
2.  Does something like this come on suddenly like this?  I have always had a somewhat touchy digestive system.
3.  Does the side stitch bring anything to mind?
4.  Does the course the doc is following seem sound to you?
5.  Are there any other things I should consider?

Thank you.

[Kevin Pho, MD]

To answer your questions:
1) If the suppositories are going to work, they should take effect after a few dosages.

2) It is possible for proctitis or colitis to present later in life and have intermittent episodes.  The colonoscopy can better define the cause of the symptoms via a biopsy.

3) Colitis, diverticulitis, a kidney stone, or muscle pain can lead to the right-sided pain you are describing.

4) Yes, the colonoscopy is the next reasonable test.

5) Malabsorption, celiac disease, and infection should all be considered.  The stool can be sent off for analysis and culture, and blood tests done to rule out celiac disease.

These options can be discussed with your personal 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 patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[ARTB]

I know that you do not usually answer follow up questions but in regards to question # 3, could the stitch, your anwer to #3 (colitis, diverticulitis, kidney stone) be at all related to the proctitis?  I do not want to second guess my doc but I would like to be as informed as possible when I go to see him.  Thank you.

3. Does the side stitch bring anything to mind?
3) Colitis, diverticulitis, a kidney stone, or muscle pain can lead to the right-sided pain you are describing.

[lizziecee]

Hi - the doctor never answers second time around in my experience of posting on this forum. You have to shell out the moola and ask again unfortunately.

Side stitch? I am obviously not a doctor, just someone who has had Crohn's disease for some 37 years and as well informed as any of my GP's or indeed, gastros.   I was ill for some 9 months with diarrohea and severe weight loss - dropped to some 60 lbs,was in some 5 different teaching hospitals in London,England whilst they tried to figure out what was causing the problems. I did not "present" normally for Crohn's as I had no pain. There was a Eureka moment when in hospital as I woke in the night with a "stitch" like I would get from playing squash racquets. The pain was on the right side of my mid abdomen, in the terminal ileum area, next to the appendix. A classic sign of Crohn's I later found out. Unfortunately, those many years ago, colonoscopy was unheard of in England, and I doubt in the US. I had a laparotomy where they found some 15 lesions in the small intestine - too many to resect, so I was put on some 60 mg of prednisone daily - doubled my weight in 6 weeks!
Today, it is relatively easy to diagnose Crohn's or Ulcerative Colitis by a colonoscopy and biopsies. I am doing fine these days, although have breast cancer (duck soup compared to Crohn's) on weekly injections of methotrexate.
I hope you get your problem sorted out. If I can be of any further help, please email me:***@****.
Take care,
Liz.

[ARTB]

Thanks for your comments.  This is really frustrating.  It is not excruciating pain but is very bothersome nontheless.  I will be going to the doctor on Friday and will see what he has to say.  I have stopped the supposotories as they seemed to make things worse.  He said initially that he wanted to do a colonoscopy and I am sure he will follow through since things have not resolved at all.  I am hoping it is not something like Chrons but any answers would be welcome at this point.