How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Dr. SH Your Own Question

Dr. SH
Dr. SH, Board Certified Physician
Category: Medical
Satisfied Customers: 8702
Experience:  Doctor of Medicine
28323552
Type Your Medical Question Here...
Dr. SH is online now

Hi. I'm hoping this service is entirely confidential, because

Customer Question

Hi. I'm hoping this service is entirely confidential, because I have a difficult situation on my hands.
My girlfriend of three months is a former victim of domestic violence. She was seeing a man for around 1 to 1.5 years, when she was aged 17-18. She is now just turning 20 so has been free from him for about 1 year.
I've been slowly discovering things that have happened to her, as she is going through what seems to be a common stage in survivors - having flashbacks, nightmares etc.
Amongst the things he did (that she's told me about) included anal and vaginal rape (violent and repeated over a year). He also hit her very hard and repeatedly in the belly; either daily or at least frequently.
She got pregnant and miscarried during that time (he never used protection). She believes the miscarriage was due to the beatings to the stomach, although it may of course have been as a result of the intense stress.
It turns out he is a former intravenous drugs user and had frequent sex with other women during the time they were together.
I've taken the following actions:
1. Get her to a confidential GUM clinic for tests, where she told the nurse/doctor what happened in terms of their sexual intercourse and the drug habit - she's being tested for all the possible diseases including HIV and HepB (and so am I, now I know this all) and we're waiting for the results, which will come in 3-10 days.
2. Help her to make the choice of signing up for counselling with the service offered by rapecrisis.org (or a regional branch of it). The counselling will begin in ~2 weeks, although she is presently at university and it will presumably cease over the Christmas break - she's likely to get 1-2 sessions before a pause until early next year.
So, the issues of STIs and her mental health are going to start to be taken care of, as soon as they can.
However, we have a problem with her physical health too, and this is what I need direct advice on. Symptoms:
Since her abuse, there has periodically (recurring every few months for a few days at a time) been blood in her stool. Earlier in the week she felt quite faint from it, so I guess at times it it might be fairly heavy but she won't tell me how much because she's embarrassed.
It has also been painful for her to have sex - I found this out the other day (wednesday night) when we had to stop because of a very sharp stabbing pain. It slowly resided over the course of an hour. However, she hadn't told me the full story and it now seems that it hadn't resided entirely - she's still feeling an aching after almost 48 hours which she describes as being in a band just above and below the belly button, like a lower stomach ache. Her stool is still bloody and after half an hour's walk today she felt quite faint.
She's had these stomach aches since her abuse; they're of a day or two duration, a month or two apart. They sometimes get clustered (e.g. one day, then a few days fine, then one day, then a month off).
The fainting could also be due to lack of sleep - she's been sleep deprived due to nightmares for quite some time now.
Her mother has access to her medical records; and the family physician at home is a friend of her mother's.
She is no longer in any direct danger, but her parents know the abuser (as acquaintance, not close family friend) and she doesn't want to deal with telling her mother and father at the same time as going through counselling - saying it's too much to deal with.
My options as I see them are as follows:
1. I hang on and wait - if she's not at risk of her physical condition getting *worse*, we could get over the current bit, get her safely into counselling, get the STI results checks back, and maybe move toward telling her family. Then we could deal with the stomach aches.
- or -
2. Should I persuade her (I wouldn't be forceful but would have to be really really persuasive) to go immediately to a doctor's or A&E? This would effectively involve telling her mother, since her mother has access to her medical history.
- or -
3. Is there somewhere we can go for safe, professional medical treatment (or at least the right scans) which won't show up on a record?
Emotionally, she's at the end of her tether and I'm really, really worried. I don't want to load her up with anything more, especially the trauma of her family finding out.
She's only just felt ready to go into counselling which I feel would be a longer term solution. I'm concerned this trauma could set that back a long time (especially since her parents are likely to be unsupportive of counselling).
MY QUESTION:
I'd like any advice on those options - or others that I haven't thought of.
I'd also like to know the possibilities of what could be wrong with her causing the bleeding and stomach pains; and, especially, whether the problem could get *worse* in a permanently damaging way.
Thanks,
Tom
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. SH replied 2 years ago.
Dr. Shahzad MD :

Hi there. Thank you for your question. I will be helping you out with your queries

Dr. Shahzad MD :

She is having what is called as post-traumatic stress disorder or PTSD.

Dr. Shahzad MD :

Has she been to a psychiatrist yet?>

JACUSTOMER-s2jvf8zq- :

Hi doctor, yes, I'm familiar with it having been through PTSD myself. She's not gone yet, but will be seen by a specialist centre starting next week.

Dr. Shahzad MD :

Yes I personally think that is the best thing to do i.e. professional help from a psychiatrist and psychologist.

Dr. Shahzad MD :

Cognitive behavioral therapy and eye movement desensitization and reprocessing (EMDR) are cornerstones or therapy.

JACUSTOMER-s2jvf8zq- :

Yes, I know that. Please can you read my full question? I'm concerned more immediately about her physical state.

Dr. Shahzad MD :

But she will also most likely require medications as well.

Dr. Shahzad MD :

Her physical state certainly is fragile at the moment.

JACUSTOMER-s2jvf8zq- :

Do you have a perspective on the possible causes of the pain?

Dr. Shahzad MD :

She most important first step is to get her into counselling and medication therapy as soon as you can.

Dr. Shahzad MD :

Blood in her stool is most likely unrelated. I am coming to the pain as well.

Dr. Shahzad MD :

So this certainly does require further evaluation i.e. anoscopy and possibly further tests.

Dr. Shahzad MD :

But seems unrelated to what she has experienced.

JACUSTOMER-s2jvf8zq- :

Even though it started at the same time?

Dr. Shahzad MD :

The most common cause of blood in stools would be piles or hemorrhoids which is usually due to constipation.

JACUSTOMER-s2jvf8zq- :

OK

Dr. Shahzad MD :

People who have been through a lot of stress can have irritable bowel syndrome that can cause constipation and inturn that can cause piles which can cause such bleeding.

Dr. Shahzad MD :

Pain during sex should also be investigated further

JACUSTOMER-s2jvf8zq- :

OK well that would make sense. Is it possible that leaving it (*temporarily*) untreated would cause lasting damage?

Dr. Shahzad MD :

Infections in the vagina or trauma during sex are the most common causes.

Dr. Shahzad MD :

So basically the main thing is her psychological issues

JACUSTOMER-s2jvf8zq- :

Yes, I understand that is of primary concern. My view is that it would be best for her psychological health if we didn't seek immediate medical attention for the blood and pain.
What I'm asking is whether taking this decision could cause lasting permanent damage, which would mean we would ultimately regret this course of action?

Dr. Shahzad MD :

Actually the bleeding in the stool at her age is something that is very unlikely to be anything serious.

Dr. Shahzad MD :

Plus, you mentioned that the pain is settled now.

Dr. Shahzad MD :

So the main concern is the psychological issue and it should be dealt with as soon as you can.

Dr. Shahzad MD :

The more prompt you are in dealing with it the better.

Dr. Shahzad MD :

obviously the treatment would in itself be a long process.

Dr. Shahzad MD :

It would not only require good support at your end but also good counselling and medications from her professionals.

Dr. Shahzad MD :

A good family support system is essential.

Dr. Shahzad MD :

So taking an immediate decision regarding her state of mind or PTSD would actuallybereallygoodfor her.

Dr. Shahzad MD :

actually be really good for her**

Dr. Shahzad MD :

Are you with me?

Dr. Shahzad MD :

Are you there?

JACUSTOMER-s2jvf8zq- :

So it couldn't be something like a tear in the colon (which I understand to be very serious) caused by her abuse?

Dr. Shahzad MD :

If it had been a tear in the colon you would have certainly known it

Dr. Shahzad MD :

She would be require emergency surgery.

Dr. Shahzad MD :

But blood in the stool is something that should certainly be evaluated as well.

Dr. Shahzad MD :

So you can do that before her psychological treatment or along with it.

Dr. Shahzad MD :

Tear in the colon would be HIGHLY unlikely in her case

JACUSTOMER-s2jvf8zq- :

Sorry, some messages have got corrupted in the chat, and I think my last was lost. It was:
"So it's very unlikely that there's anything like a tear in her colon caused by her abuse?"

Dr. Shahzad MD :

That is very unlikely

Dr. Shahzad MD :

Is her bleeding painful or painless?

JACUSTOMER-s2jvf8zq- :

OK just caught up with your last

Dr. Shahzad MD :

yes

Dr. Shahzad MD :

Is the bleeding in her stool painful or painless?

Dr. Shahzad MD :

I mean does she experience pain when passing stool?

JACUSTOMER-s2jvf8zq- :

It's painless - the way she knows about it is from fainting or looking down the toilet bowl

Dr. Shahzad MD :

If she is fainting then she would definitely need to go to the emergency to get the 'fainting' part evaluated.

Dr. Shahzad MD :

I am pretty certain that the fainting is most likely also nothing serious.

Dr. Shahzad MD :

But it certainly does require emergency evaluation to rule out important causes.

Dr. Shahzad MD :

So fainting is a symptom that requires emergency evaluation even if we think it is not serious in this particular chat session just to be on the ultra safe side.

Dr. Shahzad MD :

Always good to err on the side of caution.

JACUSTOMER-s2jvf8zq- :

So above, you said that it wasn't emergent and that we could proceed with medical treatment alongside her counselling; now you tell me that it is an emergency and I need to take her to A&E?

JACUSTOMER-s2jvf8zq- :

To be honest doctor, I'm very rapidly losing confidence in this conversation

Dr. Shahzad MD :

I am just talking about the fainting part.

JACUSTOMER-s2jvf8zq- :

Well the fainting is because of the bleeding; I fail to see how it's separate?

Dr. Shahzad MD :

Your post actually was really long so the fainting part slipped out of my mind

Dr. Shahzad MD :

Fainting is something that 'DOES' require emergency evaluation.

Dr. Shahzad MD :

That is something 'FOR SURE'

Dr. Shahzad MD :

If the bleeding is really heavy then yes fainting could be due to it.

JACUSTOMER-s2jvf8zq- :

OK never mind. Sorry I've totally lost confidence. How much of that post have you forgotten? Perhaps I should have given you less information to work with instead of a detailed description?

Dr. Shahzad MD :

I understand

Dr. Shahzad MD :

I would have also lost confidence if I were you

Dr. Shahzad MD :

Sorry about that

Dr. Shahzad MD :

You can clarify things again if you wish.

Dr. Shahzad MD :

This session is open until you are satisfied

Dr. Shahzad MD :

I am sorry that I missed the fainting part in your chat

Dr. Shahzad MD :

Fainting is most likely not related to bleeding unless it is really heavy.

Dr. Shahzad MD :

If the bleeding is heavy then it certainly also requires emergency evaluation.

Dr. Shahzad MD :

If the bleeding is mild and only happens with stools then you can book an appointment with the doctor. But any person who faints must be taken to the emergency, in that there is no doubt.

Dr. Shahzad MD :

Let me know if you have more questions.

What Customers are Saying:

 
 
 
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me FROM a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O.
< Previous | Next >
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me FROM a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O.
  • Wonderful service, prompt, efficient, and accurate. Couldn't have asked for more. I cannot thank you enough for your help. Mary C.
  • This expert is wonderful. They truly know what they are talking about, and they actually care about you. They really helped put my nerves at ease. Thank you so much!!!! Alex
  • Thank you for all your help. It is nice to know that this service is here for people like myself, who need answers fast and are not sure who to consult. GP
  • I couldn't be more satisfied! This is the site I will always come to when I need a second opinion. Justin
  • Just let me say that this encounter has been entirely professional and most helpful. I liked that I could ask additional questions and get answered in a very short turn around. Esther
  • Wonderful service, prompt, efficient, and accurate. Couldn't have asked for more. I cannot thank you enough for your help. Mary C.
 
 
 

Meet The Experts:

 
 
 
  • Family Physician

    Family Physician

    Doctor

    Satisfied Customers:

    2418
    GP with over 27 years experience including emergency medicine
< Last | Next >
  • http://ww2.justanswer.com/uploads/FA/FamilyPhysician/2013-8-31_191624_JA550x500Photo.64x64.jpg Family Physician's Avatar

    Family Physician

    Doctor

    Satisfied Customers:

    2418
    GP with over 27 years experience including emergency medicine
  • http://ww2.justanswer.com/uploads/DO/DoctorRich/2012-9-12_72454_Doctorweb.64x64.jpg Dr. Natasha's Avatar

    Dr. Natasha

    Doctor

    Satisfied Customers:

    7887
    American Board Certified in Emergency Medicine, Ivy League trained
  • http://ww2.justanswer.com/uploads/DR/DrK99/newpic2.64x64.jpg Dr. K.'s Avatar

    Dr. K.

    Board Certified MD

    Satisfied Customers:

    255
    Board certified with experience in primary care.
  • http://ww2.justanswer.com/uploads/agketch/2008-7-14_184046_drketchresized.jpg Dr. Ketch's Avatar

    Dr. Ketch

    Board Certified Physician

    Satisfied Customers:

    76
    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • http://ww2.justanswer.com/uploads/JA/JACUSTOMERjtu60wne/2011-2-14_183449_passportphoto2.64x64.jpg docwithheart's Avatar

    docwithheart

    Board Certified Physician

    Satisfied Customers:

    0
    Board certified pediatrician, with special experience in general pediatrics, hospital pediatrics, and pediatric cardiology
  • http://ww2.justanswer.com/uploads/DR/drappapo/2013-8-16_22576_drdavid.64x64.jpg Dr. David's Avatar

    Dr. David

    Board Certified Physician

    Satisfied Customers:

    224
    Treat children/young adults, former chief resident, multiple publications
  • http://ww2.justanswer.com/uploads/TA/tazechip/2012-6-7_135230_drpic.64x64.png Dr. Chip's Avatar

    Dr. Chip

    Board Certified Physician

    Satisfied Customers:

    12373
    20 yrs. in practice, includinge surgery, general medicine, addiction medicine and pain.
 
 
 

Related Medical Questions