Unexplained Green Rectal Discharge: Causes and Solutions - Internal Medicine

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Understanding unexplained green rectal discharge can be quite concerning, especially when it has persisted for several months and is accompanied by discomfort, itching, and a foul odor. Based on your description, it seems you have already consulted multiple specialists and undergone a colonoscopy, which did not reveal any significant issues. However, the symptoms you are experiencing warrant further exploration.


Possible Causes of Green Rectal Discharge
1. Infections: The green color of the discharge could suggest a bacterial infection, such as a sexually transmitted infection (STI) like gonorrhea or chlamydia, particularly if you are sexually active. Other infections, such as those caused by certain bacteria or parasites, could also lead to unusual discharge.
2. Inflammatory Conditions: Conditions like proctitis (inflammation of the rectum) or colitis (inflammation of the colon) can cause abnormal discharge. These conditions can be due to infections, inflammatory bowel disease (IBD), or even radiation therapy.

3. Fistulas: An anal fistula, which is an abnormal connection between the rectum and the skin, can lead to persistent discharge. This condition often results from previous abscesses or infections.

4. Dietary Factors: Sometimes, dietary choices can lead to changes in bowel habits and discharge. Foods high in certain dyes or those that affect gut flora could potentially alter the color and consistency of rectal discharge.

5. Poor Hygiene or Skin Conditions: Skin conditions around the anal area, such as dermatitis or fungal infections, can also lead to irritation and discharge.

Recommended Steps
Given the complexity of your symptoms and the lack of definitive findings from previous examinations, here are some recommendations:
1. Consult a Gastroenterologist: Since you have already seen proctologists, it may be beneficial to consult a gastroenterologist who specializes in gastrointestinal disorders. They can provide a more comprehensive evaluation of your digestive system.

2. Infectious Disease Specialist: If there is a concern about infections, particularly STIs, seeing an infectious disease specialist may be warranted. They can perform specific tests to rule out infections that may not have been considered previously.

3. Further Testing: Depending on the findings of the specialists, further testing may be necessary. This could include stool tests, cultures, or imaging studies to assess for any underlying issues that may not have been detected in the colonoscopy.

4. Symptom Management: In the meantime, managing your symptoms is important. Over-the-counter medications for itching and discomfort may provide temporary relief. Maintaining good hygiene and avoiding irritants can also help.

5. Lifestyle Modifications: Consider dietary changes that may alleviate symptoms. Keeping a food diary to track any correlations between what you eat and your symptoms may provide insights.


Conclusion
Your symptoms of green rectal discharge, itching, and discomfort are not typical and should be taken seriously. While you have already sought help from specialists, it may be time to explore further with a gastroenterologist or an infectious disease expert. They can help identify the underlying cause and recommend appropriate treatment. Remember, persistent symptoms should never be ignored, and seeking a second opinion is always a valid option.