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Hi there. Thank you for your question. I will be helping you out with your queries
She is having what is called as post-traumatic stress disorder or PTSD.
Has she been to a psychiatrist yet?>
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.
Yes I personally think that is the best thing to do i.e. professional help from a psychiatrist and psychologist.
Cognitive behavioral therapy and eye movement desensitization and reprocessing (EMDR) are cornerstones or therapy.
Yes, I know that. Please can you read my full question? I'm concerned more immediately about her physical state.
But she will also most likely require medications as well.
Her physical state certainly is fragile at the moment.
Do you have a perspective on the possible causes of the pain?
She most important first step is to get her into counselling and medication therapy as soon as you can.
Blood in her stool is most likely unrelated. I am coming to the pain as well.
So this certainly does require further evaluation i.e. anoscopy and possibly further tests.
But seems unrelated to what she has experienced.
Even though it started at the same time?
The most common cause of blood in stools would be piles or hemorrhoids which is usually due to constipation.
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.
Pain during sex should also be investigated further
OK well that would make sense. Is it possible that leaving it (*temporarily*) untreated would cause lasting damage?
Infections in the vagina or trauma during sex are the most common causes.
So basically the main thing is her psychological issues
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?
Actually the bleeding in the stool at her age is something that is very unlikely to be anything serious.
Plus, you mentioned that the pain is settled now.
So the main concern is the psychological issue and it should be dealt with as soon as you can.
The more prompt you are in dealing with it the better.
obviously the treatment would in itself be a long process.
It would not only require good support at your end but also good counselling and medications from her professionals.
A good family support system is essential.
So taking an immediate decision regarding her state of mind or PTSD would actuallybereallygoodfor her.
actually be really good for her**
Are you with me?
Are you there?
So it couldn't be something like a tear in the colon (which I understand to be very serious) caused by her abuse?
If it had been a tear in the colon you would have certainly known it
She would be require emergency surgery.
But blood in the stool is something that should certainly be evaluated as well.
So you can do that before her psychological treatment or along with it.
Tear in the colon would be HIGHLY unlikely in her case
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?"
That is very unlikely
Is her bleeding painful or painless?
OK just caught up with your last
Is the bleeding in her stool painful or painless?
I mean does she experience pain when passing stool?
It's painless - the way she knows about it is from fainting or looking down the toilet bowl
If she is fainting then she would definitely need to go to the emergency to get the 'fainting' part evaluated.
I am pretty certain that the fainting is most likely also nothing serious.
But it certainly does require emergency evaluation to rule out important causes.
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.
Always good to err on the side of caution.
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?
To be honest doctor, I'm very rapidly losing confidence in this conversation
I am just talking about the fainting part.
Well the fainting is because of the bleeding; I fail to see how it's separate?
Your post actually was really long so the fainting part slipped out of my mind
Fainting is something that 'DOES' require emergency evaluation.
That is something 'FOR SURE'
If the bleeding is really heavy then yes fainting could be due to it.
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?
I would have also lost confidence if I were you
Sorry about that
You can clarify things again if you wish.
This session is open until you are satisfied
I am sorry that I missed the fainting part in your chat
Fainting is most likely not related to bleeding unless it is really heavy.
If the bleeding is heavy then it certainly also requires emergency evaluation.
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.
Let me know if you have more questions.