Changes in Bowel Movements and Abdominal Pain After Anal Trauma

Inability to fully evacuate bowel movements and changes in stool shape?

Hello Dr.
Ke: A few years ago, I had a girlfriend, and we engaged in a risky sexual activity (role reversal, using a sex toy approximately 12 cm long).
After she inserted the sex toy into my anus, I experienced severe pain in the lower left abdomen that same day, followed by bloating.
I went to a nearby hospital for examination, where the emergency physician performed an abdominal ultrasound and indicated that the area where I felt pain showed no bowel peristalsis.
After that, I underwent a CT scan of the abdomen, which suggested "suspected diverticulitis." I then visited a gastroenterologist for a colonoscopy, but the doctor reported that no diverticula were observed.

This issue has been difficult to discuss, but it has been troubling me for several years.
I find it challenging to have a normal, well-formed bowel movement like I used to.
However, the stool color is normal, with no blood or black stools.
My bowel movements are often thin and in small segments, and I experience bloating easily.
I have the urge to defecate but feel incomplete afterward.
I go to the bathroom two to three times a day, but the amount of stool produced seems disproportionate to the food intake.

I would like to know if there are any solutions to this problem.
I consulted a gastroenterologist who mentioned that taking stool softeners is not a long-term solution, as prolonged use can lead to bowel fatigue, resulting in incomplete evacuation.
I was prescribed medication for irritable bowel syndrome, but it did not yield significant results.
I try to maintain a diet rich in yogurt, probiotics, and vegetables, but for about three weeks each month, I experience abdominal discomfort.
I constantly worry about my bowel movements and feel very uncomfortable, which affects my work and daily life.

Could you please advise if there are any ways to improve this issue? Is it possible that the rectal mucosal nerves were damaged by external force, leading to poor peristalsis? Would it be beneficial to consider resection of the non-peristaltic segment of the colon?

Asha, 30~39 year old female. Ask Date: 2017/05/14

Dr. Ke Fangxu reply Surgery

1.
Although the probability of developing colorectal cancer at the age of 32 is not zero, it is generally very low.
Based on your description, it seems more like irritable bowel syndrome.
I recommend starting with a light diet and maintaining a good lifestyle.
Spicy, irritating, and greasy foods should be avoided.
If symptoms persist without improvement, you may consult a physician for medication or to undergo a colonoscopy.
2.
It is not intestinal motility; it is governed by the sympathetic and parasympathetic nervous systems.
There is no such thing as rectal mucosal nerves.
3.
You are overthinking it.

Reply Date: 2017/05/14

More Info

It sounds like you’ve been through a challenging experience following the anal trauma and subsequent gastrointestinal issues. Your symptoms, including persistent abdominal pain, changes in bowel movements, and feelings of incomplete evacuation, can be quite distressing and may significantly impact your quality of life.

From a medical perspective, the trauma you described could have led to several complications. The initial pain and the finding of decreased motility in the affected area of your colon could suggest that there was some degree of injury to the bowel, which may have resulted in inflammation or even a temporary paralysis of the bowel segment (known as ileus). The fact that you underwent imaging studies and a colonoscopy that did not reveal diverticulitis is reassuring, but it does not entirely rule out other potential issues.

Your ongoing symptoms, such as the production of thin, segmented stools, bloating, and the sensation of incomplete evacuation, could be indicative of a condition known as functional bowel disorder, which includes irritable bowel syndrome (IBS). IBS can manifest with a variety of symptoms, including abdominal pain, changes in bowel habits, and bloating. The fact that you have tried dietary modifications, probiotics, and medications without significant relief suggests that your condition may be more complex.

The concern about the rectal mucosa and its nerve supply is valid. Trauma can lead to changes in the nerve function of the bowel, affecting motility. The bowel's ability to contract and move contents through can be impaired, leading to the symptoms you are experiencing. While surgical intervention, such as resection of the non-functioning bowel segment, might seem like a potential solution, it is typically considered only after exhaustive non-surgical management has been attempted and if there is clear evidence of a structural problem.

Here are some suggestions that may help you manage your symptoms more effectively:
1. Dietary Adjustments: Continue to focus on a high-fiber diet, but consider working with a dietitian who specializes in gastrointestinal disorders. They can help tailor a diet that may alleviate your symptoms, possibly incorporating soluble fibers that can help with stool consistency.

2. Hydration: Ensure you are drinking plenty of fluids, as hydration is crucial for bowel health and can help prevent constipation.

3. Regular Exercise: Engaging in regular physical activity can stimulate bowel motility and may help alleviate some of the discomfort you are experiencing.

4. Medications: If you haven’t already, consider discussing with your gastroenterologist the possibility of trying medications specifically for IBS, such as antispasmodics or medications that target bowel motility.

5. Psychological Support: Since stress and anxiety can exacerbate gastrointestinal symptoms, consider exploring stress management techniques, such as cognitive-behavioral therapy, mindfulness, or relaxation exercises.

6. Follow-Up: Regular follow-up with your gastroenterologist is essential. If your symptoms persist or worsen, further evaluation may be necessary, including additional imaging or even a referral to a colorectal specialist.

In conclusion, while the trauma you experienced may have led to significant changes in your bowel function, there are various management strategies available. It’s important to work closely with your healthcare providers to find the most effective approach for your specific situation. Remember, you are not alone in this, and with the right support and treatment, improvement is possible.

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