Brief Answer:
Likely to be anal fissure

Detailed Answer:
Hi
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Greetings of the day

Dear Ms XXXXXXX

Going by description of hard stools , pain while passing stools and bleeding possibility of anal fissure needs to be considered. Anal fissure is a small tear at anal opening which occurs due to stretching of skin associated with passage of hard stools. Exact diagnosis will depend on clinical examination of anal region.

Following are predisposing factors

1. Decreased intake of water

2. Low fiber diet

3. Consuming more of refined wheat flour ( Maida ) in the form of biscuits, bread , rusk

4. Lack of physical activity and exercise

5. Consuming spicy and oily food


It would be very helpful if you could provide me clinical photograph of anal region. In the meantime I would suggest you the following

1. Ensure good intake of water : 2 to 3 liter a day

2. High fiber diet : 2 servings of vegetable salad and 2 servings of fruits especially citrus fruit will ensure adequate intake of fiber

2. Hot Seitz bath : To a tub of lukewarm water add 2 spoons of antiseptic solution. Sit in it for 15 to 20 minutes each session twice a day. . The warmthnes will help relax the perineal muscle and relieve pain

3. Xylocaine ointment for local application : Apply Xylocaine ointment 15 minutes before going to washroom. Clean the anal region thoroughly after passing stools, dry it and apply Xylocaine ointment

4. Laxatives like Lactulose will help maintain soft stools a and help in reducing pain and constipation


Awaiting your response


Take care

Best regards
Dr Deepak Kaltari
Consultant Surgeon

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Brief Answer:
Additional information required

Detailed Answer:
Dear M XXXXXXX

Non Specific Psoas Muscle spasm can lead to such pain. Normal CT and MRI would have definitely ruled out disc prolapse as cause of symptoms. Local application of hot water fomentation and muscle relaxant along with analgesic will be helpful in relieving pain.

Also do consume plenty of oral fluids and also ensure adequate intake of electrolye, as electrolyte deficiency can predispose to spasm.

It would be very helpful if you could provide me following additional information

1. Is there any precipitating factor for pain?

2. Does the pain in groin ocuurs following pain while passing stools?

3. Are the movements of hip joint restricted at time of pain?

4. Is there any redness in anal region?

Awaiting your response

Take Care

Regards
Deepak

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Brief Answer:
Likely to be non specific Psoas Spasm

Detailed Answer:
Dear Ms

The cause is likely to be Non specific Psoas muscle spasm. I would suggest you the following

1. Avoid exposure to extremes of temperature

2. Prolonged exposure to air conditioning can induce spasm. Wearing appropriate clothing will be helpful

3. Ensure adequate intake of water: 2-3 liter a day

4. Hot water fomentation and anlagesic like Ibuprofen along with muscle relaxant will help relieve pain during spasm.

5. Hot Seitz bath as mentioned previously will help reduce redness in anal region. Healing of associated anal fissure will also reduce groin and thigh pain.


Wishing you a very happy and healthy life


Take Care

Regards
Dr Deepak

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