Persistent Anal Discomfort After Excessive Enema Use: What to Do?

There is a burning and aching sensation on the inside of the anus?

Hello, doctor.
I engage in anal intercourse, and two months ago, I overused an enema for an hour and strained a lot.
The next day, I experienced significant itching near the prostate area.
I consulted a doctor who diagnosed me with an anal fissure and advised me to rest.
I have stopped anal intercourse, but I still feel discomfort, and there is a dull sensation near the prostate.
I have seen several gastroenterologists, and during the digital examination, they suggested it might be an anal fissure.
However, over time, I have developed a burning sensation in the entire left side of my anal area, accompanied by a warm feeling.
Bowel movements have also become painful and burning.
One specialist said there were no signs of an anal fissure or other lesions.
I am at a loss about what to do next.
Should I seek another doctor for further examination, or should I give it time to heal? I am also concerned about other issues (I have been tested for STDs, and all results were normal).
Should I be reassured and ignore it, or should I actively seek medical attention? I am worried about the possibility of developing a fistula or needing a colostomy, which makes me anxious.
Thank you, doctor.

K, 20~29 year old female. Ask Date: 2023/07/08

Dr. Chen Shidian reply Gastroenterology and Hepatology

With limited experience in handling such situations, it is advisable to consult a colorectal surgeon for further guidance.

Reply Date: 2023/07/08

More Info

Persistent anal discomfort, especially after excessive enema use, can be a concerning issue that requires careful management. Based on your description, it seems that you have experienced a series of symptoms following a period of overuse of enemas, including itching, discomfort near the prostate, and burning sensations during bowel movements. Here’s a comprehensive approach to understanding and managing your situation.

Understanding Your Symptoms
1. Anal Fissures: It is possible that the excessive use of enemas and straining during bowel movements has led to the development of anal fissures. These are small tears in the lining of the anus that can cause significant pain and discomfort, especially during bowel movements. The itching you are experiencing may also be a result of irritation from the fissures.

2. Proctitis: Inflammation of the rectum, known as proctitis, can occur due to irritation from frequent enemas. This condition can lead to symptoms such as discomfort, a feeling of fullness, and burning sensations.

3. Nerve Irritation: The discomfort radiating to your left leg may indicate nerve irritation or referred pain from the pelvic region. This can happen if there is inflammation or pressure on the nerves in the area.

4. Psychological Factors: Anxiety about your symptoms can exacerbate the perception of pain and discomfort. It’s important to address both the physical and psychological aspects of your condition.

Recommendations for Management
1. Rest and Avoidance: Since you have already stopped anal intercourse and excessive enema use, continue to avoid these activities until your symptoms resolve. Allowing your body time to heal is crucial.

2. Dietary Adjustments: Incorporate a high-fiber diet to promote regular bowel movements and reduce straining. Staying hydrated is also essential. Consider using stool softeners if necessary to ease bowel movements.

3. Topical Treatments: Over-the-counter topical treatments, such as hydrocortisone cream or witch hazel pads, may help alleviate itching and inflammation. However, consult with a healthcare provider before starting any new treatment.

4. Warm Sitz Baths: Taking warm sitz baths can provide relief from anal discomfort and promote healing. Soaking the affected area for 10-15 minutes several times a day can help soothe irritation.

5. Follow-Up with Healthcare Providers: Since you have seen multiple specialists, it may be beneficial to consult with a colorectal surgeon or a gastroenterologist who specializes in pelvic floor disorders. They can perform a thorough examination and may suggest additional diagnostic tests, such as an anoscopy, to rule out other conditions.

6. Monitor Symptoms: Keep a journal of your symptoms, including their frequency and intensity. This information can be valuable for your healthcare provider in determining the best course of action.

7. Psychological Support: If anxiety about your symptoms is affecting your quality of life, consider speaking with a mental health professional. They can help you develop coping strategies and address any underlying concerns.

When to Seek Immediate Care
If you experience severe pain, significant bleeding, or any new symptoms such as fever or changes in bowel habits, seek medical attention promptly. These could be signs of a more serious condition that requires immediate intervention.

Conclusion
While it is understandable to feel anxious about your symptoms, many cases of anal discomfort can resolve with appropriate care and time. Focus on self-care, maintain open communication with your healthcare providers, and do not hesitate to seek further evaluation if your symptoms persist or worsen. Your health and comfort are paramount, and taking proactive steps can help you regain your well-being.

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