Scared!

[Pattimcm]

Hello.  I am a 30 year old female.  About 3.5 years ago I had a tubular adenoma removed after having bright red blood in my stool for a few months.  After the removal of the polyp, I had no bowel problems.  2.5 years later I had a follow up scope that showed no polyps, but the doctor told me he removed a "red dot" at the site of the previous polyp.  After that day, I had some problems for a few monbths with sudden onset, almost uncontrollable diarrhea.  It eventually resolved. I was worried about possible contaminants from the scope?  But it resolved.  For about the past 6 or 9 months I know have had major changes in my bowel movements.  The stools look a little different, but I never see blood.  The major concern is I will feel pressure like I have to have a bowel movement, but I cant push it out. Unless I take a Colace every day, I have major problems! A few days ago I had an episode where I felt like I was about to have diarrhea, was sweaty, heart racing, shaking, but could not go to the bathroom.  After about half an hour and about 8 episodes of this intermittant sweating, heart racing, shaking, feeling like I was about to vomit, I eventually went to the bathroom.  Under normal circumstances, as soon as I felt the sweating, heart racing etc I would go right that second.  This has happened about 10 times in the past 6 to 9 months.  Now I am 4 weeks pregnant and very worried because I know I should not be scoped.  I have an appointment with my GI doc next Thurs., but am a little nervous and just wanted some advice. Let me know what you think.

[Kevin Pho, MD]

Hello - thanks for asking your question.

You seem to be describing tenesmus.  It is defined as the constant feeling of the need to empty the bowel, accompanied by pain, cramping, and involuntary straining efforts. It is generally associated with inflammatory diseases of the bowel of both infectious and noninfectious origin.

Common causes include the following diseases:
Inflammatory bowel disease (IBD)
Crohn's disease
Ulcerative colitis
Anorectal abscess
Infectious colitis (infection of the colon)
Colorectal cancer or tumors
Radiation proctitis or colitis (inflammation of the colon or rectum from radiation)

Tests to consider include stool cultures, an abdominal CT and endoscopy to evaluate for colitis or inflammatory bowel disease.  Although colonoscopy should not be performed during pregnancy, you may want to consider a flexible sigmoidoscopy (which does not require conscious sedation and is safe during pregnancy).

Note that colace should not be taken on a long term basis or it will lose its effectiveness.  One suggestion would be to increase fiber intake (i.e. metamucil).  Other laxatives to consider would be lactulose or dulcolax.  

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.

Thanks,
Kevin, M.D.