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Swelling, perineum pain, hemorrhoids, bloating, blood in stools, negative FOB, colonoscopy showed diverticulitis. Want educated feedback

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Gastroenterologist, Surgical
Practicing since : 1989
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Hi, I am a 45 year old male who is experiencing some swelling and pain in the perineum. I have both XXXXXXX and external hemorrhoids. In April of this year I experienced severe gas and bloating with blood in my stool, using the bathroom was very painful. For about 4-5 days I could only pass gas when having a bowel movement. I went to the doctor and had urine, blood, and FOB run and they came back negative. I had a one day FOB test done that was positive, but the doctor said it did not count because of diarrhea. So, I did a 3 day FOB home test that came back negative. However, I still had pains in my guts so I went and had a colonoscopy done which came up negative for cancer, but I do have 2 small sacks in the colon (diverticulitis) of which the doctor who performed the colonoscopy said were of no great concern, and to eat more fiber. I have made these changes which helps keep me more regular. I also quit drinking alcohol ( I had started drinking less beer since the new year) and play hockey 2-3 times a week until recently which has helped me lose weight ( from 190 to 170 since Christmas). Now, getting to the problem at hand, I still have pain in the perineum that recently started radiating to the end of my penis; the pain in my penis is not severe, but I know it is there. In addition, I seem to have pain developing in the bottom of my buttocks into my hamstring area, it is not severe but once again I know it is there. My right hip is sore along with the top part of my right buttock. I also have pain in the lower front part of my pelvis that I can follow up to the front part of my hip. I do not feel weak or sick at the moment and still do yard work etc., but there is definitely something wrong, I notice the pain when walking now. (Also I hurt my hips and knees in the early 90's, they were overworked in a WCB program-swimming with flippers in a pool and biking-resulting hip pain on and off for years) I first noticed a little pain in the perineum around 3 yrs ago and the gp said it was nothing. I have recently seen 3 more gp doctors without success; they just give me cream for hemorrhoids and send me home. The last gp I saw is seeing me again today on short request which is good because this condition is getting worse and is starting to affect my daily life. When I saw him last he gave me a quick digital exam that was painful and prescribed Sandoz-Proctomyxin HC Rectal Ointment, 5 days of suppository at night and the cream portion to be used at morning, after bowel movements and at night. I am hoping that I can get some educated feedback so that I can better prepare my personal answers to my gp's questions and possibly give him more detailed information that he can act on for a proper diagnoses and hopefully a referral resulting in a ct scan etc.Thank-you.
Posted Thu, 5 Jul 2012 in Abdominal Pain
Answered by Dr. Ketan Vagholkar 9 hours later

Thanks for providing a detailed account of your complaints.

I have gone through the details and from your description it appears that you might be having not one but two issues namely:
1. The perineal problem.
2. The hip pain radiating to the lower extremity.

1. Perineal problem: There is high likelihood of this pain being related to hemorrhoids / fissure in ano. That is why you are continuously experiencing pain. Discuss with your doctor about the severity of this problem. Accordingly you will need to undergo a course of conservative management to start with comprising of the following.
a. Stop application of all creams to that area.
b. Apply a local anaesthetic jelly to the lower opening before going to the toilet for passing stools.
c. Do not strain.
d. After passing stools, clean the area with soap water and mob it dry.
e. Have a sietz bath for at least 30 minutes. This comprises of hot water fomentation to that part by sitting in a tub of warm water. The agents to be added to the water are 4-5 teaspoon of magnesium sulphate powder and 4-5 teaspoon of dettol solution. This will give you great relief.
f. A short 5 day course of pain killers.
g. A 5 day course of antibiotics (ciplox with metronidazole)
h. High fiber diet.
i. Stool softeners at bed time like cremaffin to ensure smooth passage of stools.

A 5 day course of the above regimen should be followed by clinical evaluation by the surgeon. If there is no pain or spasm then that cures the issue. But if the response to treatment is suboptimal then a small surgical intervention may be necessary.

2. Hip pain: As you have been involved with a lot of sporting activities there is high likelihood of it being related to degenerative disease of the bones and joints. I would insist that your doctor also look at this possibility. You will need to undergo investigation at your age such as.
a. X-ray of the both hips.
b. Blood PSA levels (prostate specific antigen to look for prostatic cancers)
c. Digital rectal examination will be done during the course of the above treatment will reveal abnormalities of the prostate.
d. CT/MRI scans of lower back and hips
e. In addition arterial Doppler of both lower extremities to rule out a vascular cause will complete the investigations.

I hope my explanation answers all your doubts. Discuss about these when you go to XXXXXXX your doctor. I will be available for follow ups.

With regards
Above answer was peer-reviewed by
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