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Avatar universal

Bizarre rectal pain

I've been experiencing moderate to severe rectal pain that lasts 5-8 hours a day (but sometimes up to 12).  This pain usually begins about an hour to two hours after having a bowel movement.  Prolonged sitting, standing, or walking more than a very short distance seem to make it worse.  Laying down is the only thing that brings relief.  I have had anal fissures but my doctor confirmed a few weeks ago that the fissure is completely healed.  Unfortunately, the pain has persisted and in fact has gotten worse.  I just had a colonoscopy and the doctor (different one) did not find anything wrong.  

I drink close to a gallon of water a day and eat a high fiber (about 30g) diet.  I take stool softeners and do Sitz baths as well.  Does anyone have any idea what could be causing this?  It's really destroying my quality of life.  It's getting to the point where I'm worried I may have to take an extended medical leave from my job, as the degree of pain becomes so intense at times that I can't concentrate.  

If anyone could point me in the right directon I would really appreciate it.  So far two doctors (both specialists) have come up with nothing.

Oh, I'm an otherwise healthy 27 year old male.

21 Responses
Avatar universal
Well, sometimes hemorrhoids can cause this sort of thing, which there is Preparation H from the drugstore that will shrink them.  Hemorrhoids, if you have them, come from straining too hard from constipation.  Since you are on stool softeners, I am thinking you are indeed constipated.  You are doing the right things for it, tho, with water and fiber.  But you also have to add to that regular exercise where you break a sweat, that helps the bowels move better.

I would like to suggest you try stopping the stool softeners for a while.  In my experience, what happens is they soften the stool, but if your bowel movements are sluggish, the waste piles up and becomes really difficult to pass easily.  I would also like to suggest that hemorrhoids sometimes hurt after passing waste, any fecal matter that naturally sometimes seeps out after a movement will irritate the raw tissues.  So, after bathing, put some plain KY jelly on the area daily.  It will help ease the irritation.  If it starts to feel irritated anyway, then use a damp tissue to apply more.

But it sounds to me like you've got pressure in the region because of hard stool needing to pass, and it sits right there and thus irritates the hemorrhoids.  If you've got stool that is ready to come out but won't quite get out, or only part comes out, then get some Baby Lax at the drugstore, it's a small box with tubes of ointment in there, squirt two in there and within minutes, it'll pass.  You could also try some enemas if waste keeps getting stuck.  But all this advice is just treating symptoms.

Since you've had anal fissures in the past, even tho your doc said everything looks okay, obviously SOMEthing ain't right.  So, consider goign to a different doc and have him look at you, maybe run some stool tests and blood tests, to make sure you don't have an intestinal infection of some kind causing your digestion to goof up.  And it always helps to get a fresh set of eyes on the situation.  Also, in addition to your fiber intake, consume probiotics for a while, they're in Acidophilus milk (Nutrish is one brand in the grocery) or Activia yogurt.  Also, eat dark green salads and whole wheat or whole oat products, along with whatever else you're eating.

If you are on a medication that has as its side effect dry mouth or digestive upset, ask the prescribign doc to switch to another kind.  Also, some vitamin supplements will dry out a person, so swtich to another brand or cut back to taking them just once a week, see if that helps.  Lastly, if you are stressed out from work or whatever, all that tension can do a number on your body, so practice relaxation techniques like deep breathing when you get nervous, and meditation on a favorite object in a quiet room, where you empty your thoughts and breathe deeply and just stare at it.  Then ask yourself, What IS bothering me, and the answer will come to you.

Hope something in all this stuff I wrote will help you out a little bit.  I'd go nuts if I had what you have all the time.  Doublecheck your medications and see a new doc, use the KY jelly too.

Avatar universal
Hey, thanks for the comprehensive response.  I'm pretty sure it's not hemmorhoids - after the colonoscopy the doctor told me I did not have them.  I've had hemmorhoids in the past as well and this pain is nothing at all like that.  Much, much worse.

As for the exercise, I try to get to the gym when I can, but most of the time I am in too much pain to walk short distances, let alone break a sweat.  Which really *****, because before this started happening I used to work out at 5-6 days a week and most of the things I really enjoy doing (hiking, surfing, cycling) involve physical activity.

Thanks for the ideas regarding the hard stool.  Despite the stool softeners, that is a problem I frequently have.  I don't really have constipation issues, though.  I have at least one bowel movement every day.  I think I will cut out using the stool softeners and see what happens.  I'm going to take you up on the probiotics suggestion as well.

Lastly, do you know what kind of blood and stool tests I should ask for?  

Thanks again for all your suggestions.
Avatar universal
See another doctor!!!  Trust me on this.  I've had an extreme amount of experience with GI doctors and GPs, and while you may think that if they don't know the answer, they will find it, or refer you to someone better equipped to handle your problem....THEY DON'T!  There is obviously something wrong, be very pro-active until you get answers, don't rely on just 1 or 2 doctors.  I had to take my teenage son to Cleveland Clinic, and I brought up the point about his doctors not referring him to another, or researching for an answer.  Now this is a very skilled, well respected surgeon at The Cleveland Clinic and he said to, and I quote "their ego's will not allow them to do this, plus sometimes they just don't want to lose you as a patient."  You know what they called the medical student that graduates at the bottom of his class?  Doctor.  I once worked for 2 GI doctors, and one could never pass his boards, yet he was performing surgery.  I once heard him and the other doctor discussing a patient that died during a procedure he'd done on him, they were both laughing!!!  I quit my job that day.  I am glad we have doctors, we need them, but the good ones are few and far between.  My son and grandson are gone because of botched surgeries and negligence, my son at 31, and recently his son at 18.  If you want more details on them and their care, or lack of, I would be happy to elaborate.  This is not to scare you, but you are young and probably put a lot of trust in your doctors....don't.  If they can'y help you, find someone who can!  They work for you and if they aren't doing their job, fire them and move on!!  Good Luck to you!
Avatar universal
You shouldn't have to go on a blog to find out what YOU need to tell the doctor.  Please, seek another doctor's opinion.  It sounds to me like there is something putting pressure on your colon when you are on your feet, as it goes away when you lie down.  In the meantime cut back on the fiber, salads, etc., eat food that are easily digested and see what happens.  Too much fiber can reak havoc with the colon, as not enough does.  Have you been asked about Irritable Bowel Syndrome?  I have this and get a lot of pressure on my bowel, like I have to go to the bathroom and can't.  Sitting long periods of time causes me stomach pain.  One pill a day is all you need for this.  I was just a little older than you when mine started, and after taking the pills for a few weeks, it has been years since I have had a problem or taken a pill.  I don't think it's anything serious, but I'm not a doctor.  May I ask why you take stool softeners?  I would stop these, continue the water, and eat foods that are easy to digest, and look for another doctor.  I know it's frustrating, but will be worth it.  If you live near a teaching hospital, maybe you need to show up at the ER, or at any hospital, this sometimes gets excellent results.  Keep us posted
Avatar universal
I re-read your post, and I have never heard of anal fissures going away!  They are little pockets in your colon that certain foods get trapped in causing severe pain.  I know a lot of people with these, and it is something they have had to learn to live with.  They control the pain by not eating things like nuts, peas, corn, anything not easily digested, or that has a skin like corn and peas.  My husband had to have surgery to remove a small part of his bowel where he had these, because the pain was so bad and the diet wasn't doing the job, and they told us that surgery was the only way to get rid of them.  This makes a lot of sense, because the bowel is trying to pass the trapped food and can't causing the pain, and no amount of stool softeners, probiotics, fiber, etc can help.  I think at this point I would go to the ER, not because it is an emergency, but to get answers and save you time and suffering.  Just tell them you're in unbearable pain.
Avatar universal
Thanks for all your responses, Sad to say I think you've spent more time thinking about my problem than any of the doctors I've seen!  I'm definitely going to try to find another doctor.  I don't suppose you have any recommendations for doctors in Southern California?

I've thought IBS might be the problem before as well.  Do you recall what you took for it?  
Avatar universal
It sounds like we have the same sort of pain.  A little background information:  I'm female, 29 years old and have never had any children.  Within the last 3 years my rectal pain has been getting worse.  I first noticed it on my wedding night three years ago.  I had been standing on my feet all day and the pain was unbearable by the time I got back to the hotel afterwards.  I spent the next couple of days doing as little as possible because of the pain.  Since then the pain has become worse and more frequent.  Last year I saw my GP about it and he said that I might have some small hemorrhoids but nothing that should be causing severe pain like I have been experiencing.  He sent me to a colorectal specialist who did an internal and external exam and basically said the same thing.  He originally thought I had an anal fissure but I don't experience any pain during bowel movements which is a classical sign of a fissure.  I have basically suffered through the pain over the past year.  On New Year's Eve this year I stood up at a party all night and was in SEVERE pain when I got home.  I missed several days of work because of the pain and it actually took me at least a week to where I could get back to my normal routine.  A couple of weeks ago I went back to the specialist again and he told me that he still had no explanation for the pain. Last week he sent me to get a pelvic CT scan.  I am supposed to go back to see him again in a couple of weeks for the results.  I don't think that anything abnormal will show up on it.  Honestly, I think I do have hemorrhoids but maybe not a usual case of them.  When I stand up for a while I can feel something protruding and can push it back inside but it doesn't stay there long.  I am very active and having to spend days in bed at a time when the rectal pain flares up is unbearable.  It is really having a negative impact on my quality of life.  I have been very vigilant about getting enough fibre and drinking lots of water but I don't think it's really had an impact on the pain.  It isn't the bowel movements that cause the pain, it is the standing up for any length of time.  I have to stand a lot at work and just going shopping or walking causes it to hurt.  Sometimes the pain is more pronounced if I have had a bowel movement that day but it also hurts on days I don't have bowel movements.  The only common element to the pain is the standing up.  
I think I might get a second opinion if the CT scan doesn't show anything.  When I saw the specialist the last time I burst into tears when he said he had no explanation for the pain I was experiencing.  All I could think was "I'm going to have to live with this pain the rest of my life".  Hopefully that won't be case.  

Please let me know if you find any relief for your pain!

Avatar universal
That sounds almost exactly like what I have...I can't believe you've been living with it for three years!  I'm sorry for what you're going through, but it makes me feel a little bit better that somebody else is experiencing the same thing.  The worst part for me is the frustration of not knowing.  At this point I feel like they could tell me anything and I'd find a way to deal with it

Good luck with your CT scan, let me know if it yields any results.  I will let you know if the next doctor I try has any ideas.  
Avatar universal
Google "Top Doctors in Southern California" and you will find many in this field.  One in particular was named best doctor in this field in L.A.  His name is Dr. Panitch.  But I then "googled"   "Pain and pressure in rectal area" and there was a lot of info on there.  A lot of people still suffering like yourself, who have had all the tests done, but nothing was found. One young man said he had it all done, and was finally diagnosed with "Proctal Fugax" and is now fine.  He got so frustrated as his doctor would just sigh as he didn't have a clue.  He said this is a rare condition, and many doctors are not aware of it, but worth looking into.  There were also mentions of muscle spasms due to IBS, Pelvic Floor Dysfunction, and Prostatodynia.  You can "google" any of these and see if your symptoms fit.  I was going to do it for you, but only you would know exactly what you feel.  One website on there takes you to this one, but I haven't found it on here.
Let me know what you find, and if I can do anything to help with your research, please let me know.  Good luck!
Avatar universal
Sorry, I don't remember what I was taking.  I thought I still had some but then remembered throwing them out because it's been so long since I've needed them. If you are having so much pain that you are unable to work, I would recommend you go preferably to a teaching hospital, or one with a good rep. to the ER.  Go while you are in pain, and tell them the tests you've had.  If you have ins., it will cover it.  If you were my son, I'd insist on you going to the hospital while in pain.
Avatar universal
I agree, it does help to know that I'm not the only one experiencing this sort of pain.  I've had to make a significant change in my life to account for the pain I experience when standing: at parties and social functions I sit down as much as possible even if I'm the only one there not standing up and at work I have to sneak off and sit down whenever I get a chance (which can be very difficult when I work at a customer services counter where sitting is not an option).  I know that if I don't take little opportunities to sit down throughout the day that the pain will escalate into a full-blown episode and then I would be bedridden for days at a time.  What's interesting is that walking for exercise doesn't seem to make the problem any worse.  I normally walk to and from work every day (several miles) and it doesn't seem to exacerbate the problem (although I avoid walking if I'm already in lots of pain).  But if I'm out shopping and am taking my time walking around the mall, I feel the pain creeping up.  But it is mainly standing in one spot for too long that really makes the pain worse.  For instance, I don't wash dishes anymore (my hubby does it) because standing at the sink for too long really makes the problem flare up.  
You're right, I'm also getting to the point where I'd just like to be treated for something, anything!  It is next week that I see my specialist again so I will keep you updated as to the results of the CT scan.
Avatar universal
Dear Basman:
You asked about what blood and stool tests could be done.  They can draw blood and look for bacteria or other organisms that might cause an intestinal infection, like H. pylori.  They do a stool sample to look for blood and other stuff.  They can do a urinalysis to make sure the kidneys are okay, which occasionally urine can back up into the prostate and cause pain.  There are a million things a doc can test for if he's got the symptom of constant anal pain, especially when standing.  

Dear Basman and Berry:
Please see the star* portions of the below points I make.  You two may both have an anal abscess of some kind, and I think you should both pursue this idea, as it can get fairly serious if left untreated.  Berry, I hope your scan comes out okay.  

Dear Mammo and other posters:
I am finding some terms getting perhaps a little confused in all these posts.

An anal fissure is a tear or cut, usually obvious to see.  (this is what Basman had)
An anal fistula is a tunnel formation, sometimes missed on exam.
*An anal abscess is a pus nodule, can be felt on exam.

*I think there is a possibility both Basman and Berry might have that anal abscess.  Here is a link that tells you about it, but there are other good websites if you search:

Now, as for pockets that can form and collect food, as Mammo referred to, there are two kinds:
Diverticulitis happens thruout the bowel, patients have to avoid nuts, peas, etc.
An anal fistula can sometimes open at one end and collect some waste.

Also, an anal fistula can occasionally be a reason why a person can get an anal abscess, altho normally anal abscess is caused by other problems.  This is an excellent website that clarifies what that fistula abscess is and a lot of other bowel disorders:

I hope this helps everybody.  GG
Avatar universal
Thanks for your suggestions.  I've looked up the info about anal abscesses.  Although it is a possibility, I feel that I don't have the classic symptoms such as discharge or fever.  Also, it seems that abscesses are usually found on examination.  My specialist has not mentioned anything about an abscess and I'm not sure how he could not pick up on it if I did have one.  I will ask him about it next week when I see him to see what he thinks.  I want to give him the benefit of the doubt but depending on how things go next week I will probably be seeking a second opinion.

Thanks for the time you have put in to researching this!
I had an abscess, it took three weeks to be diagnosed by which point  I was completely immobile, unable to urinate or walk and in the worst pain fo my life. I did have the fever early on in the process before the unbearable pain started but then the fever left and the pain got worse. Ultimately the abscess was found by doing an MRI
Avatar universal
I just got home from the specialist. My CT scan was normal (as I figured).  He has decided to band my hemorrhoids next Friday to see if that brings me any relief.  He flat out told me that he considers my hemorrhoids to be pretty insignificant and that they shouldn't be causing so much pain but that banding them seems to be the only option at the moment.  I think he's doing it as a last resort because he doesn't know what else could be causing the pain.  In a way I am pleased that he is doing the banding because I feel that at least it's better than doing nothing at all.  I really hope that my pain will go away after the banding.
Avatar universal
I have had rectal/bowel spasms so severe that it makes me nauseous and dizzy and i fall to the floor if I don't get myself down first.  My blood pressure drops severely.  It wakes me up at night or happens after a bowel movement.  There isn't a doctor anywhere who knows anything about why this happens.  I have been to many and read an untold number of blogs, Q&As, medical advice online, etc.  The pain is so bad and puts me in a semi-conscious state with the low blood pressure (vaso-vagal?) episode.  I once had a shot of morphine during a spasm and the pain went instantly away.

If someone can't come up with a medication I can take at home, I don't want to continue.  The pain is too severe and lasts too long.  I've had enough.  I'm 59 and have had it most of my life.  I'm just done with it.  Done with everything and fed up with the medical community.

Sorry, all.  There is no explanation, no relief and no cure.
Avatar universal
Please post your question as its own post because this one is so old.
Avatar universal
I may have some insight to this. A pelvic floor specialist will quickly determine if someone has dysfunction in the pelvic floor muscles and you will know it immediately. This can be a common cause of chronic prostatitis. Anxiety and stress do not help. Short Wave Diathermy is a soothing form of deep heat that may help. Also IBS may contribute. I have a lot to of thoughts if you are still having a problem when it comes to Internal hemorrhoids, Chronic prostatitis, IBS pelvic floor dysfuction etc
Avatar universal
I have the same severe levetor muscle or large rectocoele any help. Pain when standing up.
Avatar universal
You should have an MRI of your low back.  Often times a disc herniation or bulge can result in anal pain which is increased on standing and decreased on lying done.  Increased compression caused by standing can irritate the nerves going to the pelvic plexus which innervates the rectum.  That's the problem with certain specialists they never think outside the box.  I am currently treating a pt with decompression therapy for this condition.  If he does not improve the next step is to set him up for an epidural and/or a hypo gastric pelvic block.
Dr. A
Avatar universal
I am experiencing the same thing unfortunately. It is severely effecting my quality of life.  I have been to 3 doctors and 2 specialists and they have no idea. I am considering going to the ER. I have missed several days of work and spend days in bed away from my family. If you find relief or answers please share.
Avatar universal
Does anyone in this blog found out the cure for this symptoms, please?
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