Rectal Discomfort: Risks and Surgical Options

Bowel movement issues

Hello Doctor: Recently, I have been experiencing discomfort in my anus after having a bowel movement (it doesn't hurt, but it feels like there's something at the anal opening).
I later realized that I had pulled my anal sphincter out, and I managed to push it back in myself.
Will this pose a long-term risk of infection? Is surgery the only solution? Should I see a general surgeon for suturing or a colorectal specialist?

Fen, 20~29 year old female. Ask Date: 2022/09/28

Dr. Zhang Shuhao reply Surgery

The tissue that protrudes after bowel movements is a prolapsed internal hemorrhoid, which can be manually pushed back into place.
Sometimes, taking warm sitz baths can help reduce swelling and improve the condition.
If this occurs frequently and causes distress, it is advisable to consult a colorectal specialist, as there are both surgical and non-surgical treatment options available.

Reply Date: 2022/09/28

More Info

When it comes to rectal discomfort, particularly the sensation of something protruding from the anus, it is essential to understand the underlying causes, potential risks, and available surgical options. The condition you described may suggest a rectal prolapse or a related issue involving the anal sphincter.

Understanding the Condition
1. Rectal Prolapse: This occurs when the rectum protrudes through the anus. It can happen due to various factors, including chronic constipation, straining during bowel movements, or weakening of the pelvic floor muscles. Symptoms may include a feeling of fullness, discomfort, or the sensation of a mass at the anal opening.

2. Sphincter Dysfunction: If you are experiencing a sensation of the anal sphincter being pulled out, it may indicate a dysfunction or weakness in the sphincter muscles. This can lead to difficulties in controlling bowel movements and may increase the risk of fecal incontinence.

Risks of Long-term Symptoms
If left untreated, the condition can lead to several complications:
- Infection: Prolapsed tissue can become irritated, leading to inflammation or infection. If the tissue becomes necrotic (dead), it can result in serious complications requiring urgent medical intervention.

- Fecal Incontinence: Over time, the weakening of the sphincter muscles can lead to difficulties in controlling bowel movements, resulting in fecal incontinence.

- Strangulation: In severe cases, the prolapsed tissue can become trapped, leading to strangulation, which is a surgical emergency.

Treatment Options
1. Conservative Management: In some cases, lifestyle modifications such as dietary changes to prevent constipation, pelvic floor exercises, and avoiding straining during bowel movements may help alleviate symptoms.

2. Surgical Options: If conservative measures fail or if the prolapse is significant, surgical intervention may be necessary. The type of surgery will depend on the severity of the prolapse and the condition of the sphincter muscles.

- Rectopexy: This procedure involves securing the rectum to the surrounding tissue to prevent it from prolapsing.

- Sphincteroplasty: If there is significant damage to the anal sphincter, a sphincteroplasty may be performed to repair and strengthen the sphincter muscles.

3. Specialist Consultation: It is advisable to consult with a colorectal surgeon or a specialist in rectal disorders. They can provide a thorough evaluation and recommend the most appropriate treatment based on your specific condition.

Conclusion
In summary, while your self-reduction of the protruding tissue may provide temporary relief, it is crucial to seek professional medical advice to prevent potential complications. A colorectal surgeon would be the most appropriate specialist to evaluate your condition and discuss surgical options if necessary. Early intervention can help mitigate risks and improve your quality of life. If you notice any signs of infection, such as increased pain, swelling, or discharge, seek medical attention promptly.

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