Anal Leak - Need Help and Advice

[Thomas_D]

I have been having recurring anal leakage for about 4 months now. It started after a rather severe bout of diarrhea - 2 weeks duration + a couple weeks after of soft stools, much gas/bloating - that I had in late January/early February after returning from a trip to Mexico. I saw a GP who recommended a stool sample but tests came back negative. My symptoms are primarily that I need to continue to re-wipe my rectum in the minutes to hours after bowel movements. For example, I have a BM at 10am and wipe, then I need to go back about 30 minutes later to rewipe and it looks like I never wiped in the first place. Also, throughout the day I'll need to go back and re-wipe again and again with often the same results - a yellowy-brown stain on the toilet paper of varying amounts, sometimes much, sometimes almost nothing; however, the itch and need to re-wipe is quite consistent. Usually this condition is aggravated by exercise and even simple walking, which I need to do for work. I do have feelings still of bloating, gas, flatulence (sometimes without control), and occasional heart burn that are ongoing, as well as the feeling that after a BM that things haven't fully been expelled. I also have what feels like tingling or tickling in my rectum on occasion and it seems that sometimes I can feel "things" leaking or coming out, sometimes as if worms are crawling, though I haven't seen any. I have tried taking chewable fiber pills (up to 9 daily) which helped somewhat previously but did not entirely eliminate these symptoms. I have also been exercising regularly and eating a decent diet. Overall, this condition presents a very uncomfortable feeling that leads to much rectal itching, discomfort, embarrassment, and worry and is starting to interfere with my daily work and lesiure activities. I have recently moved to a new city and do not have access to a family doctor but still need to pursue this. Any advice or recommendations would be welcomed. Thank you.

[Tiro]

I suffer similar symptoms to yourself.  What  I was told some 4 years ago is to resist the urge to evacuate,  and only go to the toilet when you are absolutely busting to go and that it should be one motion.  Also,  to not spend ages in the toilet and avoid reading.

The other suggestion also was a dietary change.  That is, to not eat fibre-enriched foods, eat  white bread instead of wholemeal and to not eat too much fruit and vegetables.  Also to avoid spicy foods.  Apparently. according to the Bristol Scale of  Bowel Motion, the  perfect stool to aspire to is the smooth formed like a banana.  I suspect  yours is a bit formed, but broken up and watery and not completely voided as bits are left behind just inside the rectum wall - hence the leakage.

You can take a tablet to form up your stool which will solve the problem right away, as you will notice when you pass a formed stool the sphincter muscle closes tight and there is hardly any need to wipe with toilet paper.  Like yourself, I began experiencing these symptoms when I was exercising heaps and in particular when I was running.    Now that  I have ceased exercising, my BMs remain the same.  Rather than take a tablet or change my diet, I fold up a tiny piece of toilet paper and "pad" up my anus till the next visit to the loo.  A little uncomfortable to begin with but I have become accustomed to it - it sure beats the itchy ******* which one cannot r eadily scratch in public !!

[Kevin Pho, MD]

A colonoscopy or flexible sigmoidoscopy would be a reasonable next step.  Any anatomical mass or lesion can lead to anal leakage and needs to be excluded.

More specialized tests like anorectal manometry or an endorectal ultrasound can also be considered to evaluate the sphincter tone of the anal muscles.

These options can be discussed with a GI specialist.

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