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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18527
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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My husband has had problems for the last 6 years which no doctor

Customer Question

My husband has had problems for the last 6 years which no doctor seems to have helped with. He had a sigmoidoscopy (?) 2 years ago and a polyp was removed. However the problem still persists in that he following defecation he is in severe pain, in fact hardly able to walk. This can last anything from hours to all day. It is relieved somewhat after several visits to pass urine
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. D. Love replied 3 years ago.
It will help if you could provide some further information:
Has he had any evaluation beyond the sigmoidoscopy?
What is his stool consistency and pattern with the dietary changes?

Customer: replied 3 years ago.

Only that a polyp was removed by laser. stool consistency is quite constant with occasionally loose ones.

Expert:  Dr. D. Love replied 3 years ago.
Thank you for the additional information.

There ar several issues to consider in this situation.

When there is rectal pain that persists for hours after a bowel movement, there would be concern that there is a separate condition affect the anus or rectum. Some of these conditions would typically be detected by a sigmoidoscopy, such as inflammation of the lower rectum or an internal hemorrhoid. However, there are certain conditions that may not be detected by a sigmoidoscopy.

An anal fissure can cause such pain. An anal fissure is a tear of the lining of the anal canal, but it typically is present at the depths of an infolding of a tightened anus, so may not be readily detected without an instrument that stretches the anal canal, such as an anoscope.

It is also possible to have anal spasm, which is prolonged tightening of the muscles of the anal sphincter. An anal spasm can be associated with an anal fissure, so these problems are not mutually exclusive, and some of the treatment for an anal fissure are actually treatments for anal spasm.

I ask about stool consistency because management should achieve stool that is neither too firm nor too soft. Either exxtreme can make the problem worse.

There are a couple of options at this point. It may detect an anal fissure to perform anoscopy. It may be difficult to detect anal spasm if symptoms are not present when seen by his doctor, so some doctors will simply try a medicine to relieve anal spasm to see if it helps ease symptoms. The most commonly used is nitroglycerin ointment applied to the rectum, but another option that is getting increasing evidence is nifedipine ointment. Another option for long term management would be Botox injections.

If I can provide any further information, please let me know.

Customer: replied 3 years ago.

Thank you, XXXXX XXXXX been helpful but I would appreciate knowing why urination relieves the pain gradually. Would that be just because a full bladder presses against the fissure, adding to the pain. I have had an anal fissure myself but only found the pain lasted whilst defecating rather than lasting hours and affecting walking and sitting

Expert:  Dr. D. Love replied 3 years ago.
There is some reflex contraction of certain muscles of the pelvic floor that occurs when there is a full bladder or rectum, and emptying the bladder will ease this reflex contractions that may be exacerbating the symptoms.

The severity and duration of symptoms from an anal fissure will depend upon the severity of the fissure. Some people have no symptoms; some people have symptoms only during a bowel movement; and some people have symptoms all day. The symptoms can be quite variable. When the symptoms are more severe and prolonged, it is more likely that there is anal spasm present, but an anal fissure by itself can cause symptoms all day long.

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Customer: replied 3 years ago.

Thanks for your advice, it was helpful

Expert:  Dr. D. Love replied 3 years ago.
You're welcome. I'm glad I could be of assistance.