Rectal Issues: Seeking Solutions for Chronic Discomfort

Q: Rectal Issues: Seeking Solutions for Chronic Discomfort

Hello： 1. <br>Based on your description, it could be hemorrhoids, but it is important to see a physician for an accurate diagnosis. <br>It is difficult to make a correct diagnosis based solely on a description of symptoms, so please seek medical attention as soon as possible. <br

Please consult about rectal issues?

Your question: Hello Doctor: Two years ago, I started experiencing bowel movements that resembled flat chewing gum and were difficult to pass.
Six months ago, I was unable to have a bowel movement for about 15 days and had to undergo a temporary colostomy.
To this day, whether standing or sitting, I still feel a pulling sensation between my anus and coccyx, along with a feeling of heaviness, which is extremely uncomfortable.
Additionally, the intestine at the stoma protrudes about 5 centimeters, and I wonder if this is related to the tension on the anus.
Is it possible that the anal sphincter around the rectum is damaged? Or could it be a nerve issue? How should I be examined? Which specialty should I consult? Are there any other possible causes? I would appreciate any solutions you can provide.
Thank you!
Response from the physician: Surgery, Dr.
Hou Yong-ji suggests: Hello:
1.
May I ask where your colostomy surgery was performed?
2.
If your surgeon is a colorectal specialist, they should understand your condition and arrange appropriate examinations to formulate a treatment plan.

3.
If your surgeon is not a colorectal specialist, please obtain a copy of your surgical records and consult a nearby colorectal specialist for evaluation.

4.
Your condition is quite complex, and without detailed medical history and examinations, I cannot provide a complete response.
Thank you for your patience, Dr.
Hou.
Response:
1.
Two years ago, when the symptoms first appeared, I was hospitalized at National Taiwan University Hospital, where I underwent lower gastrointestinal X-rays and a colonoscopy.
The conclusion was that I had an elongated sigmoid colon, which was surgically resected, but my condition did not improve.

2.
Later, I visited Cathay General Hospital, where I underwent dynamic defecation testing.
The doctor indicated that there was an issue with the puborectalis muscle, and biofeedback therapy was ineffective.

3.
Since no tumors were found, the doctors were hesitant to perform a colostomy.
Living with this condition has been very painful, and I eventually sought help from Chang Gung Memorial Hospital, where I requested a colostomy, which alleviated my immediate distress (inability to pass stool).
As for treatment, it seems there is little that can be done.

4.
I have been treated by a colorectal specialist who has prescribed mostly medications to aid digestion or stool softeners.
Now, I am wondering if I should consult a neurologist or orthopedic specialist to explore other potential causes.
I feel quite lost and would appreciate any advice you can provide.

shih, 50~59 year old female. Ask Date: 2004/07/16

Dr. Hou Yongji reply Surgery

Hello: 1.
Based on your description, it could be hemorrhoids, but it is important to see a physician for an accurate diagnosis.
It is difficult to make a correct diagnosis based solely on a description of symptoms, so please seek medical attention as soon as possible.
2.
Constipation itself is a complex issue, but you can work on developing good lifestyle and bowel habits.
Additionally, diet is very important, so please put in some effort in that area, and do not forget to seek medical attention promptly.
3.
Please do not self-medicate with laxatives; it is better to follow your physician's guidance.
4.
You need to consult a colorectal surgeon for treatment, so please seek medical attention as soon as possible.

Reply Date: 2004/07/16

More Info

It sounds like you are experiencing a very challenging and distressing situation with your rectal issues, which have significantly impacted your quality of life. Chronic discomfort, especially in such a sensitive area, can lead to a multitude of physical and emotional challenges. Let's break down your concerns and explore potential avenues for relief and treatment.

Understanding Your Symptoms
From your description, it appears that you have been dealing with several interconnected issues, including:
1. Altered Stool Consistency: The fact that your stools resemble flat gum suggests a possible obstruction or narrowing in the bowel, which could be due to anatomical changes or muscle dysfunction.

2. Difficulty in Bowel Movements: The inability to pass stool for an extended period, leading to the need for a temporary colostomy, indicates a significant functional problem in your lower gastrointestinal tract.

3. Discomfort and Pressure: The sensation of pulling between the anus and the tailbone, along with a feeling of heaviness, could be related to muscle tension, nerve involvement, or complications from the colostomy.

Potential Causes
Several factors could contribute to your symptoms:
- Anatomical Issues: You mentioned that a previous surgery to remove a segment of the colon did not alleviate your symptoms. This suggests that there may be other anatomical issues at play, such as an excessively long sigmoid colon or strictures.

- Muscle Dysfunction: The dynamic defecation study indicating issues with the pelvic floor muscles (like the puborectalis muscle) could explain the difficulty in bowel movements. Dysfunction in these muscles can lead to obstructed defecation syndrome.

- Neurological Factors: If there is nerve damage or dysfunction affecting the anal sphincter or pelvic floor muscles, this could lead to the symptoms you are experiencing. Conditions like pelvic floor dysfunction or nerve entrapment could be contributing factors.

Recommended Steps
1. Consult a Colorectal Specialist: Since you are already under the care of a colorectal surgeon, it is crucial to continue working with them. They can provide specialized assessments and interventions tailored to your condition.

2. Consider a Multidisciplinary Approach: Given the complexity of your symptoms, it may be beneficial to involve other specialists:
- Neurologist: To assess any potential nerve-related issues that could be affecting bowel function.

- Physical Therapist: A pelvic floor physical therapist can help with muscle retraining and may provide biofeedback therapy to improve muscle coordination and function.

3. Diagnostic Imaging and Tests: Further imaging studies, such as MRI or specialized motility studies, may be necessary to evaluate the function of the rectum and anal sphincter. These tests can help identify any underlying issues that may not have been previously detected.

4. Medication Review: Since you are currently on medications for digestion and stool softening, it may be worth discussing with your doctor whether these are the most effective options for your specific situation. There may be other medications or treatments that could provide better symptom relief.

5. Psychological Support: Chronic pain and discomfort can lead to significant emotional distress. Engaging with a mental health professional who specializes in chronic illness can provide coping strategies and emotional support.

Conclusion
Navigating chronic rectal issues can be incredibly frustrating and painful, but it is essential to remain proactive in seeking solutions. Collaborating with a team of healthcare providers, including colorectal specialists, neurologists, and physical therapists, can help you find a comprehensive treatment plan tailored to your needs. Remember, you are not alone in this journey, and there are professionals who can assist you in finding relief and improving your quality of life.

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