ischial tuberosities

[lilwe]

I have written before on this subject and a surgeon responded, it would be great if another surgeon or the same would answer these questions.  My defecating protogram said anorectal junction is at the level of the ischial tuberosities and changes to approax. 3cm below the tuberosisites during defecation, the surgeon said it looked normal. I will be seeing the doctor soon who ordered this test, however, I would like to know if you have a spine or SI joint problem which this is looking like I may have, cause my bowels because to constantly either be constipated or really soft stools.  I have alot of bloating also.  Ever since this surgery to removed adhesions and my bowels were stuck to my left pelvic and abdominal wall I have alot of problems in this area and unfortunately with my bowels which I never had before.  So far, no one can diagnose me, my muscles psoas and ilio psoas are for sure not working or functioning right according to my therapist so thatfrom what I understand could be a problem with my bowels having problems in those muscles are constantly in spasm. I know my bowels might be sticking again also.  Anyways not to go off the subject,

1} What if any could the 3cm change with my ischial tuberosites mean, I know you said it looked normal but what actual does this mean, that they move slower, move different or what and

2} why after bm's, does my mid to upper back, a few inches from my spine  on the leftside ache, is this from a muscle, it sometimes burns also  Any insight?? Thank you

[Kevin Pho, MD]

First off, it is impossible to offer concrete diagnosis over the internet.  I would have to agree with the comments below.  



1) The ischial tuberosities is simply a marker.  The study simply states that the anorectal junction is 3cm below this marker, and the interpretation was normal.  Without seeing the studies themselves, I cannot on the movement.



2) Again, it is difficult to say why you have muscle aches after bowel movements.  I would suggest a colonoscopy for a comprehensive GI evaluation.  If negative, a neurology referral may be appropriate - including lumbar MRI to evaluate whether any nerve pathology may be contributing to your symptoms.



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.

[surgeon]

One can only go so far in "diagnosing" problems from an online description. The rectal tissues are supposed to move downward during defecation, and your report says yours do. The ischial tuberosities are simply a landmark for measuring that movement, like saying I live a block from the fire station. The fire station has nothing to do with where you live other than a marker to measure from. The ischial tuberosities show on an xray as a point from which to measure and have no other signficance in terms of this particular study. I'd also say it's unlikely that function of the psoas muscles, or iliopsoas, has any relevance to defecation directly. People who have paralysis or other nerve dysfunctions may also have defecation problems; so if there were a neurological disorder that affected muscle function, it could also affect bowel function. A neurological evaluation would be a thing to consider, depending on what your doctors think is or is not going on.