Get your Health question answered in 3 easy steps
A Doctor will be with you shortly
Ask a Doctor Now
141 Doctors are Online

Rectal itching and burning with frequent urination - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Very Good Posted in: Urinary and Bladder Problems
Answered by

General & Family Physician
Practicing since : 2009
Answered : 638 Questions
Doctor :   hi
Doctor :  
how can i help you?
User :   hi Dr
Doctor :  
please proceed with your health query
User :   I have been suffering from rectal itching and burning, frequent urination and urethral pain for 2+ years now
Doctor :  
ok
User :   and have had many, many tests, dozens if not over 100 dr visits, but the good news is I now have a diagnosis
User :   I think
Doctor :  
ok
User :   most tests came back normal but I did a test call MRI Defecography
User :   and they said I have spastic pelvic floor muscles
Doctor :  
ok
User :   so I was reffered for physical therapy that specializes in treating this and they also said I have pudendal neurolgia
Doctor :  
ok
User :   this condition was also causing outlet constipation
Doctor :  
ok
User :   so I have been going twice a week and doing the excersizes they have recommended for a few weeks now
User :   and still feel only a little better
Doctor :  
pudendal neuralgia can be a source of chronic pain, in which the pudendal nerve (that is located in the pelvis) is entrapped or compressed
Doctor :   the pain could be worsened by sitting, and can include prickling, stabbing, burning, numbness, and the sense of a foreign object in the urethra, vagina, or rectum
Doctor :   the physiotherapy helps
Doctor :  
but it should be taken more frequently initially untill the symptoms are under control.
User :   ok, yes I have had all these symptoms except maybe numblness
Doctor :   so i would suggest you to go for physiotherapy every alternate day
Doctor :  
to get maximum benefit out of the therapy
User :   well I do the excersizes at home twice a day and the therapy costs $200 USD / session not covered by insurance
User :   I also have to miss work for therapy
Doctor :  
this pain can also be managed with corticosteroid injections, that are used to block the pain sensation in the nerve
Doctor :   which can be tried if physical therapy is not helping
User :   is that magnesium?
Doctor :  
and the permanent cure can be achieved by doing a surgical decompression of the nerve in case it is due to entrapped or compressed pudendal nerve
Doctor :  
no, it is not magnesium
Doctor :  
it is a corticosteroid injection (in common terms steroid injection)
Doctor :   that is used for blocking the nerve sensation and signals which in turn relieves the pain
User :   does this have negative side effects?
User :   is it a cure or only temporary?
Doctor :  
the surgical cure is permanent cure, rest all other measures give temporary benefit of pain relief
User :   my dr said 80% of patients are cured 100% with physical therapy after 6-8 weeks
User :   but I'm not sure now
User :   I was hoping I'd be feeling much better by now
User :   and I have a whole list of other health conditions I am waiting to treat
User :   what kind of dr. would do an injection or surgery?
Doctor :  
what your doc said is correct that 80% of patients are cured 100% with physical therapy after 6-8 weeks but the therapy has to be taken in short gaps initially to control symptoms
User :   ok
Doctor :  
that is to take physical therapy every alternate days for say 2-3 weeks
Doctor :  
and then continue it at 2 times a week for the rest 4-5 weeks
Doctor :  
injection or surgery is done by urologists.
User :   ok, not a colorectal surgeon?
User :   that's who diagnosed me
Doctor :  
even a colorectal surgeon could do the injection or surgery procedure
Doctor :  
you can discuss teh possibilities of both with him
User :   ok
Doctor :  
and see if he can do it for you
User :   hopefully I won't need these procedures
User :   so physical therapy more often is your recomendation first?
Doctor :  
yes, if the physical therapy itself helps you then you will not need them
Doctor :  
as injection or surgery is recommended in cases where the physical therapy is failed to relive
Doctor :  
*relieve
User :   ok
Doctor :  
yes, my immediate recommendation would be to have physical therapy more often that is every alternate day foe atleast 2 weeks
Doctor :  
and once the symptoms are controlled, then you can increase the gap
Doctor :  
to once in every 2 days for a week and then to twicea week
Doctor :  
for the next 4 weeks
Doctor :  
and see if the symptoms get totally relieved.
Doctor :   and in that case to prevent further relapse of symptoms, you should continue doing the exercises and few maneuvers at home daily
User :   now earlier on the surgeon mentioned I have a lot of hair near the anal area that may have been contributing to irritation, do you agree this could be the case? I keep the area very clean but if this is the case, is there is a way to remove it from this area without stubble or rapid regrowth?
User :   I want to treat all possible causes not just one
Doctor :   the irritation due to hairs could be a possibility as teh nerve when compressed can give altered signals instead of normal touch signals
Doctor :   so the idea of removing hairs
Doctor :  
is to treat the irritation symptoms
Doctor :  
this can be permanently done by doing laser removal of the hairs in that area.
Doctor :   without repeat growth as the laser will remove the hair follicle itself.
Doctor :   so the hair cannot grow back
Doctor :  
have you folowed what i have said?
User :   yes, I have heard a little bit about this treatment, but didn't know it can be use near the anal area
User :   it is safe to use there? if so this sounds like maybe a good idea
Doctor :  
ok, it can be used to remove hair in any part of the body, the intensity of the laser used might vary
Doctor :  
you can discuss the possibility of removing hairs in the area since it is medically indicated for your case
Doctor :  
you can discuss with a cosmetologist or a dermatologist
Doctor :  
and get them removed
User :   will my insurance cover this or consider it cosmetic?
Doctor :  
if cosmetic, then may be th einsurance wil not cover it, if medical then it may cover
User :   I suspect I would be better off with a dematologist than a cosmetologist
Doctor :  
it is medically indicated and if your doctor writes a prescription for it, they may consider it
Doctor :   especially if dermatologist is involved
Doctor :  
Is there any thing else I can help you with?
User :   ok
Doctor :  
are you there?
User :   yes
User :   sorry
Doctor :   Is there any thing else I can help you with?

User :   yes, I have a non cardiovascular chest pain
User :   that has progressed over the past 2 years
Doctor :  
ok.
User :   and I ended up in the emergency room once it was so bad I couldn't move
Doctor :  
could you please explain the non cardiovascular chest pain in detail?
User :   it occurs in the costrochondridal part of the chest I think the center where the ribs join
User :   but when I have pain there, I also have pain in the back of my neck towards the right
Doctor :  
ok
Doctor :  
ok
User :   it happens a lot when I roll over in bed
Doctor :  
ok
User :   my chest seems to be caved in a bit physically
User :   and sometimes I hear and feel a popping sound
User :   in my chest when changing positions
Doctor :  
the non cardiovascular chest pain causes can be grouped under these headings: Gastrointestinal, pulmonary, chest wall causes, and others
User :   we can probably rule out the first two
Doctor :   ok
Doctor :  
so you do not have any GI or pulmonary symptoms?
User :   Not related to this no
User :   although I feel resistance in the chest wall when I try to take a deep breath
Doctor :   among the chest wall symptoms, the most common cause is costochondritis or Tietze's syndrome
Doctor :  
which causes pain that is easily mistaken for heart disease and heart attack
User :   the ER mentioned it may be costochondritis, but I thought that was only an acute condition? This has happened many times over the past 2 years
Doctor :  
and the symptoms of pain appear with deep breathing, coughing, any sudden movement.
Doctor :  
it can be a chronic condition as well.
Doctor :  
with symptoms appearing once in a while in few people.
Doctor :  
other chest wall causes include fibromyalgia, radiculopathy, spinal nerve involvement etc.
User :   sneezing can be extremely painfull
User :   my chest seems to be physically shaped wrong
Doctor :   among the 'other' causes, panic attack, anxiety, depression, hypochondria, hyperventilation syndrome, pre-cordial catch syndromes can be thought of
Doctor :   ok
User :   like mile pectus excavatum
User :   *mild
Doctor :  
ok
Doctor :  
so then in that case the cause can be attributed to the chest wall causes
User :   but that has been since birth but only in the past year or so have I experienced pain
User :   I have tried pushups to try and move the chest outward but not sure if that helped at all
Doctor :  
and a CT of chest would be helpful to determine it along with other tests like ECG, complete blood count, creatine kinase, and liver enzymes
Doctor :  
pectus excavatum cannot be treated with doing exercises
Doctor :  
it wil only cause inflammation of the costochondral joints leading to pain
User :   so by excersizing I could be making my pain worse?
Doctor :   so avoid doing excessive exercises
User :   so I cannot lead an active lifestile again?
Doctor :  
yes, you could be making the pain worse since the inflammed joints will get intense pain on slight movement itself.
Doctor :   you can lead a active lifestyle but without the push ups and other chest exercises or anything that can increase the pain
Doctor :   have you followed what i have said?
User :   yes
User :   but not happy about the limitations
Doctor :  
Is there any thing else you would like to ask me?
User :   avoiding chest excersizes, do you mean for the rest of my life? or can I improve this condition?
Doctor :  
once the condition is improved you can do mild exercises as long as you dont get pain again.
User :   yes, but this pain has been progressing for 2 years and not improving
User :   there are no other treatment options?
User :   like physical therapy?
Doctor :   no, physical therapy will help only minimally
Doctor :  
for treatment of costochondritis
Doctor :  
you will again need corticosteroid and other medical treatments
User :   ok, thank you
Doctor :   Is there any thing else you would like to ask me?
User :   I think that is all for today, thank you very much
Doctor :   Please fill the feedback form say done when done.
User :   ok
User :   done
Doctor :   Thanks for consulting HealthcareMagic. Bye for now. Please chat with our doctors 24/7 for medical queries. Please refer your friends to our service.
Question is related to
Medical Topics
© Ebix, Inc. All Rights Reserved.
All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. You should always speak with your doctor before you follow anything that you read on this website. Any health question asked on this site will be visible to the people who browse this site. Hence, the user assumes the responsibility not to divulge any personally identifiable information in the question. Use of this site is subject to our Terms & Conditions
Already Rated.
Your rating:

Ask a Doctor