Pain During Rectal Exams: Causes and Next Steps

Pain at a specific point during a digital rectal examination?

Hello, doctor.
I was originally being treated for prostatitis at a small urology clinic, where the physician would perform prostate massage therapy during follow-up visits.
After several visits, I began to notice a specific point (on the far right side) that was noticeably painful when pressed.
This corresponds to an area near my right groin and the junction with my thigh.
Therefore, I switched to a larger hospital's urology department for further examination.
After a digital rectal exam, the doctor mentioned that the location of that point is quite peripheral and feels irregular, like a blister.
He advised me to see a gastroenterologist for an endoscopy.
The endoscopy report indicated only inflammation.
I can feel that point (on the right side) is slightly painful, but I cannot press it from the groin area.
However, pressing during the digital rectal exam causes significant pain, and there is also discomfort in the surrounding areas, such as pain in the inner right thigh and pain near the pubic bone close to the base of the penis.
The pain radiates to the groin and varies in intensity from strong to weak.

I have a few questions for you:
1.
Could that painful point be related to the rectum, prostate, or possibly other issues (such as lymph nodes or other tumors)?
2.
Which specialty should I consult for further examinations?
3.
Are there any additional tests I should consider? (I have already undergone abdominal ultrasound and rectal endoscopy.) Thank you!

yo, 30~39 year old female. Ask Date: 2011/11/23

Dr. Ke Fangxu reply Surgery

If the area of pain is not the prostate, then it is likely the rectum or the surrounding tissues.
Essentially, the areas that can be palpated during a digital rectal examination in males are limited to these regions.
Without a personal examination, it is difficult to determine the exact issue, as factors such as the duration of pain, bowel habits, and the presence of fever can all influence the diagnosis.
In the context of limited information, making blind guesses may suggest a lower rectal injury as a more probable cause, which could include medical procedures, foreign bodies in the rectum, or accidental ingestion of foreign objects.

Reply Date: 2011/11/23

More Info

Understanding pain during rectal exams can be a complex issue, especially when it involves multiple symptoms and potential underlying conditions. Based on your description, it seems you have been experiencing localized pain in the right side of your body, particularly around the groin and inner thigh area, which has been exacerbated during rectal examinations. This situation can be distressing, and it's important to address your concerns thoroughly.

1. Possible Causes of Pain: The pain you are experiencing could be related to several anatomical structures in the pelvic region. Given that you have a history of prostatitis and have undergone prostate massage, it is possible that the pain could be originating from the prostate itself, especially if there is inflammation or irritation present. The fact that the pain is localized and worsens with pressure during a rectal exam suggests that it may indeed be related to the prostate or surrounding tissues.

Additionally, the presence of a "bump" that feels uncharacteristic and is painful upon palpation could indicate a few things:
- Prostatitis: Inflammation of the prostate can lead to localized pain and discomfort.

- Pelvic Floor Dysfunction: Tension or dysfunction in the pelvic floor muscles can cause referred pain to the groin and inner thigh.

- Lymphadenopathy: Swollen lymph nodes in the groin area could also cause discomfort and may need further evaluation.

- Other Conditions: While less common, conditions such as abscesses or tumors (benign or malignant) could also present with similar symptoms.

2. Recommended Specialist: Since you have already seen a urologist and a gastroenterologist for rectal issues, it may be beneficial to consult a pelvic pain specialist or a urologist with a focus on chronic pelvic pain syndromes. These specialists can provide a more comprehensive evaluation of your symptoms and may consider conditions that are often overlooked in standard examinations.

3. Further Diagnostic Tests: Since you have already undergone abdominal ultrasound and rectal endoscopy, additional tests that may be helpful include:
- MRI of the Pelvis: This imaging can provide a detailed view of the pelvic organs and surrounding structures, helping to identify any abnormalities that may not be visible on ultrasound.

- CT Scan: A CT scan can also help in evaluating any potential masses or lymphadenopathy in the pelvic region.

- Urodynamic Studies: If urinary symptoms are present, these tests can assess bladder function and help determine if there are any underlying issues contributing to your pain.

- Referral to a Pain Management Specialist: If the pain persists, a pain management specialist can offer interventions such as nerve blocks or physical therapy focused on pelvic floor rehabilitation.

In conclusion, while the pain you are experiencing during rectal exams could be related to several factors, it is essential to pursue further evaluation with the appropriate specialists. Keeping a detailed record of your symptoms, including their intensity, duration, and any associated factors, can be very helpful in guiding your healthcare provider in making an accurate diagnosis and developing an effective treatment plan. Remember, it is crucial to communicate openly with your healthcare team about your symptoms and concerns to ensure you receive the best possible care.

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