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Dr. K.
Dr. K., Board Certified MD
Category: Medical
Satisfied Customers: 3958
Experience:  Board certified with experience in primary care.
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Can internal rectal proplapse cause IBS like symptoms?

Customer Question

Can internal rectal proplapse or internal haemoroids cause IBS like symptoms? Chronic constipation/Diarrhea and severe abdominal pain during an attack when passing stool which is watery or like mousse. Attacks like that have been the norm for 8 years however recently I had a particularly bad attack which ended with me having rectal bleeding with every bowel movement for 6 days. Now with all the tests I have and a very brisk rectal examination at a & e, is it possible or probably that internal haemoroids/internal prolapse could be missed?

Submitted: 2 years ago.
Category: Medical
Expert:  Dr. K. replied 2 years ago.

Dr. K. :

Hello, this is Dr K.. Answers are not medical advice and do not constitute a doctor/patient relationship. I look forward to helping you today.

Dr. K. :

These sound like severe symptoms for a hemorrhoid. Young people do not just develop prolapse

Dr. K. :

Hemorrhoids cause bleeding and pain with bowel movements

Dr. K. :

Your symptoms sound like inflammatory bowel disease,either ulcerative colitis or crohns disease.

Dr. K. :

You should have a colonoscopy, see your GP to schedule this.

Customer:

I have previously had a colonoscopy and had 4 biopsies taken and there was no evidence of IBD. My more recent symptoms appear to suggest IBD and I am due to have a sigmoidoscopy soon as the blood was fresh. I don't like to follow the idea's that certain conditions are age related, there are known cases of younger people having developed proplapse. Please don't take age into account when you consider my question. What I need to know is if a prolapse CAN cause those types of symptoms. My sister was deemed too young to need to be screened for cervical cancer, by the time they DID it was too late. It has even been in the news recently. Too many dr's consider age over symptoms.

Customer:

I had a colonscopy 2 years ago and had 4 biopsies and everything was fine, however as the bleeding is new I am having a sigmoidoscopy soon. What I want to know is, regardless of age, is it possible that an internal prolapse could cause similar symptoms to IBS? As this is probably the only thing that after all the tests i've had could miss, baring IBD in my Small intestine however I am sure that my blood tests would've shown something up, or I would've had darker stools during flare ups or the barium meal and x-ray would've shown narrowing... This has been plaguing me for 8 years and the NHS moves so damn slow I am just now having to come up with my own ideas to try and help the Gastroenterology department. My own thoughts are that something is causing my prostate or something near it to become irritated during looser bowel movements (The consistency of mousse and usually quite light in colour) because in the constipation I have between attacks, passing harder larger round lumps of stool the only pain I get really is sometimes a small tearing of my anus which obviously leaves a small smear of blood on the tissue and stings like mad, it's only the looser movements that give me abdominal pain. I am so confused with everything because my symptoms could be typical to many conditions but aren't close enough to IBS (and typical IBS treatments don't work, fodmaps diet, peppermint capsules, laxatives, fibre supplements, vit b, colestyramine, low fibre and high fibre diets) Nothing makes me regular and I just swing between the two extremes constantly. I guess what I am getting at is can a prolapse cause this and if not, what are your thoughts on what conditions it could be if Prostate cancer, colon cancer, IBD in the colon and IBS are all excluded? Would IBD show up on a barium meal? What other tests could be done?


 

Dr. K. :

Yes rectal prolapse is possibility but its not one of the most common causes of these symptoms even in an older age groupl

Dr. K. :

I am still concerned about ulcerative colitis and crohns. It can be missed and your colonoscopy was 8 years ago. Its good you are at least having a sigmoidoscopy.

Dr. K. :

One consideration that is quite common to crop up in your age range is gluten insensitivity. You can be tested for this.

Dr. K. :

You can also go on a very strict gluten free diet for 4 weeks.

Dr. K. :

This is a test in and of itself

Dr. K. :

Milk allergy is also a possibility, though less likely. Again, you can be tested but the self test is 2 weeks of a lactose free diet.

Dr. K. :

I hope this helps

Customer:

Thank you for your advice but as I previously said I have tried the fodmaps diet which is an extreme exclusion diet testing a whole range of foods. Also for gluten sesitivity I had a biopsy and was tested for celiacs when I had the endoscopy. The Colonoscopy was only 2 years ago... This new stronger pain and bleeding though, could it be that whatever problem I have been having for 8 years has now caused IBD to appear? There are so many potential issues with bowels and Gastro's only like to think of one problem at a time. I want to have a colostomy and have my colon removed as I am almost certain that this is where the pain is being caused and the diarrhea seems to be a bi-product of the pain, but this isn't seen as wise at this stage but I really am trying to exhaust as many possibilities as quick as i can. Is there anything else you can think of ? Again I really appreciate your advice and I apologise if I am really trying to pick your brain for any and every possibility that could be explored. I know that prolapse is unlikely, but considering one of the symptoms of my attacks is that my stomach muscles involutarily tense and strain to push stool out even when there is none left, it is a possibilty in my mind that prolapse could be caused by this? Do you agree? - I know I am pushing my luck now and this is my last bout of questions before Ill rate and finish up, I only decided to use this site to try and find new ideas ontop of what I am already considering.. Also to what I said about something irritating my prostate and the pain I am getting is coming from my prostate, could this also cause diarrhea? then could constipation follow BECAUSE of the diarrhea? I put that idea to my gastro and while he said the idea is interesting, he would like me to visit the incontinence/incomplete bowel movement specialist first. Thank you again

Dr. K. :

I really dont think this is rectal prolapse as this is a surgical condition and would not go away on its own

Dr. K. :

1. Anal fissure

Dr. K. :

2. AVM of the colon (arteriovenous malformation)

Dr. K. :

3. Meckels diverticulum

Dr. K. :

4. Dieulafoys lesion of the bowel

Dr. K. :

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3229341/ heres the link

Dr. K. :

I still believe the more likely cause is crohns or UC that is undiagnosed/missed. You need another colonoscopy.

Dr. K. :

Also the possibility of Crohns in the small bowel that was missed by colonoscopy. Hope this helps

Customer:

Thank you so much for your help! I will look into these, see if they are relevant enough to bring to my gastro next time I see him. Goodnight

Dr. K., Board Certified MD
Category: Medical
Satisfied Customers: 3958
Experience: Board certified with experience in primary care.
Dr. K. and 3 other Medical Specialists are ready to help you
Customer: replied 2 years ago.

I have been documenting all my known symptoms whether related to the bowel or not in a bid to try and help the gastro in any way I can, and I just had a thought. Occasionally I get acne (or small lumps without any head that contain a similar sort of white pus that acne has) but only when I am going through a particularily bad week/month of attacks when they are happening more frequently... Could this be a stress response or a sign of something else going on? The spots usually occur mostly on my forehead and behind my ears but lately since my attacks have worsened I have started getting the odd spot here and there all over my body? Just a thought.. Also Ill post the list of symtpoms i've made, which also include the duration of my history i've had those symptoms.

Customer: replied 2 years ago.

apthous ulcers every month/2months (last year or two) - irregualar bowels (8 years) -
chronic diarrhea/constipation (8 years) -
acute abdominal pain during loose bowel movements pain not in anus but above it inside, leads to a painful ache and extreme tiredness after an attack (8 years) -
Always become very suceptible to cold during an attack (8 years) -
fatigue/lack of energy (2 years) -
insomnia (4 years) -
strong headaches, GP diagnosed cluster headaches (10 years) -
patches of dry red skin that comes and goes over the course of weeks, gets worse when wet (new to the last 3 months) -
Mucus with bowel movements not all though (2-3 years) - rectal bleeding (new to the last 3 months) -
small lumps of calcification found on testicles (once a fortnight or so (2-3 years) -
Can't put weight on (did put on weight for a few months about 2 years ago however it stopped. Was between 8 1/2 & 9 1/2 st, how is 10 1/2 st - 9 years) -

Expert:  Dr. K. replied 2 years ago.
Aphous ulcers, decreased immune function, fatigue, skin problems, mucous and blood in stool, lack of weight. All point to inflammatory bowel disease, Crohns or ulcerative colitis.
Customer: replied 2 years ago.

Thank you, if you know much about IBD is it possible that it can heal between flare-ups or is it a permanent reddening/ulceration? Because if it's periodic then it could be missed, if it isn't then it's unlikely to be in my colon. Also I got my blood results which were taken 2 days before the rectal bleeding. I'll copy what I can. when I get paid I would like to give you a bonus for all your added help. The only significant changes are my white cell count were at 15.5 3 months ago and the Heamoglobin etc were lower 3 months ago but still considered above normal. Here are those results:


Sodium 140 mmol/L


Potassium 4.4 mmol/L


Urea 3.4 mmol/L


CRP 0.2 mg/L


eGFR >90 ml/min/1.73m*2


Creatinine 73 umol/L


Bilirubin 7 umol/L


ALT 38 IU/L


ALK.Phosphatase 151 IU/L


Albumin 48 g/L


GGT 42 IU/L


 


Haemoglobin 17.1 g/dl


White cells 11.13 x10*9/L


Platelets 217 x10*9/L


Haematocrit 0.474 L/L


Red Cell Count 5.20 x10*12/L


Mean Cell Vol 91.2 fl


Mean Cell HGB 32.9 pg


Mean Cell HGB Conc 36.1 g/dl


Neutrophils 7.79 x10*9/L


Lymphocytes 2.45 x10*9/L


Monocytes 0.67 x10*9/L


Eosinophils 0.22 x10*9/L


Basophils 0.00 6 x10*9/L

Expert:  Dr. K. replied 2 years ago.
Your lab work is normal. Even your c reactive protein is normal. Does not mean much. Your symptoms again, are suggestive of inflammatory bowel disease.
Customer: replied 2 years ago.

Okay thank you, I just needed to throw the idea around. Having a 10 minute appointment every 3-6 months is hard to get all relative information. For example the Hiatus hernia. In my report it is described as significant but the gastro said the endoscopy was normal so I feel the need to get as many opinions as possible.

Expert:  Dr. K. replied 2 years ago.
sure, come back any time you need more help. and good luck getting a diagnosis.

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