Gastrointestinal Issues: What to Expect from Exams and Treatments

Poor gastrointestinal motility?

I often experience itching and pain in the anal area, and sometimes I have sharp pains.
Occasionally, there is blood and discharge when I wipe after a bowel movement.
I also have sharp pains that make me hesitant to defecate, and I frequently feel bloated and have abdominal pain.
Sometimes the pain is so severe that I have to go to the clinic for an injection of pain relief and also request an enema.
I regularly take stool softeners twice a day, but I still have difficulty with bowel movements.
My doctor has recommended that I undergo anal physiological examinations, a colonoscopy, and gastrointestinal motility tests.
However, I have heard that colonoscopies can be painful and involve enemas, which I am very afraid of.
Is it necessary to have a clean bowel for a colonoscopy? Will I need sedation for the colonoscopy? Do gastrointestinal motility tests require an enema, and will they be painful? How are these tests performed? I am very scared and worried about having to undress for these examinations, especially since they involve the anal area.
I fear the pain and feel embarrassed.

Mingjie, 30~39 year old female. Ask Date: 2003/12/26

Dr. Yang Peizhen reply Gastroenterology and Hepatology

Hello! Pain and itching around the anus are usually caused by anal fissures or inflammation of the anal area, which may result from hard stools or inadequate cleaning after bowel movements.
It is also possible that there are lesions in the rectum or colon, making a colonoscopy necessary.
Additionally, it is advisable to consume a diet high in fiber, including fruits, and to drink plenty of water to improve constipation habits.

The process of a colonoscopy is as follows: Two days before the procedure, patients should start taking laxatives and drink at least 2000 cc of fluids daily, while trying to maintain a low-residue diet.
On the day of the examination, fasting is required for breakfast (if the procedure is in the morning).
Patients should change into a gown and receive an intramuscular injection of an antispasmodic medication.
When lying on the examination table, patients should first lie on their left side and bring their knees up to their abdomen.
The colonoscope, coated with a pain-relieving lubricant, is then inserted through the anus and advanced through the rectum, sigmoid colon, descending colon, transverse colon, ascending colon, and into the cecum.
The colonoscope is approximately 1.6 meters long, but the length of the colon varies slightly among individuals due to differences in bowel curvature, averaging about one meter.
The most uncomfortable parts of the procedure occur at three bends in the colon, and a nurse will be present to assist throughout the process.

Sincerely, Dr.
Yang Pei-Chen, Chief of Gastroenterology, Taoyuan Hospital, Department of Health, Executive Yuan.

Reply Date: 2003/12/26

More Info

Understanding gastrointestinal issues can be quite daunting, especially when faced with multiple symptoms that can lead to confusion and anxiety. Your concerns about the examinations and treatments are valid, and it's important to address them comprehensively.

Firstly, the symptoms you describe—itching and pain around the anus, occasional bleeding during bowel movements, and abdominal discomfort—could be indicative of several conditions, including hemorrhoids, anal fissures, or even inflammatory bowel disease. The presence of blood and discharge, along with pain, suggests that a thorough evaluation is necessary to rule out any serious underlying issues.

Regarding the recommended tests, such as an anal physiology exam, colonoscopy, and gastrointestinal motility studies, it's understandable to feel apprehensive. Here's what you can expect from each procedure:
1. Colonoscopy: This procedure involves the insertion of a flexible tube with a camera into the rectum to examine the colon. It is typically performed under sedation, which means you will be relaxed and may not remember the procedure. Preparation for a colonoscopy usually involves a clear liquid diet for a day or two prior and taking a laxative to clear the bowel. While the preparation can be uncomfortable, the actual procedure is generally well-tolerated due to sedation. It's crucial to have a clean colon for accurate results, which is why the bowel prep is necessary.

2. Anal Physiology Testing: This test assesses the function of the anal sphincter and rectum. It may involve measuring the pressure of the anal sphincter and the sensation in the rectum. While it may sound uncomfortable, it is usually not painful. You may be asked to relax and cooperate with the technician during the procedure.

3. Gastrointestinal Motility Studies: These tests evaluate how well food moves through your digestive tract. Depending on the specific test, it may involve swallowing a small capsule or having a tube placed in your stomach. Again, sedation may be used to minimize discomfort.

It's important to communicate your fears and concerns with your healthcare provider. They can explain the procedures in detail, provide reassurance, and discuss pain management options. Many patients find that understanding the process helps alleviate anxiety.

As for the concern about modesty, healthcare professionals are trained to conduct examinations respectfully and discreetly. You will typically be provided with a gown to wear during the procedures, and staff will ensure your comfort and privacy.

In terms of treatment for your symptoms, it is essential to address the underlying causes. If hemorrhoids or fissures are diagnosed, treatments may include topical medications, dietary changes to increase fiber intake, and possibly procedures to remove or treat the affected area. If a more serious condition is identified, your doctor will discuss appropriate treatment options tailored to your specific needs.

In summary, while the prospect of undergoing these examinations can be intimidating, they are crucial for diagnosing and managing your gastrointestinal issues effectively. Open communication with your healthcare provider will help you navigate this process with greater ease and confidence. Remember, taking proactive steps towards understanding and treating your symptoms is a vital part of maintaining your overall health.

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