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Dr. Andrew Rynne

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34 year old male. i had a digital rectal exam

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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2041 Questions

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Posted on Mon, 21 Jan 2019 in Constipation
Question: 34 year old male. i had a digital rectal exam from a colorectal surgeon / specialist 3 months ago due to some pain, bleeding, and discharge that had recently gotten worse. i was diagnosed with an intersphintric fistula. he was able to find the internal opening and external opening with a fistula probe. he said there was no need to do an MRI or colonoscopy. i am having a lot of burning, uncomfortable feelings, pain, and general uncomfortableness that makes me feel like i have a mild need to have a bowel movement. the feeling appears to radiate from the tract. the symtpoms will subside breifly if i sit on the toilet, whether or not i have a bowel movement or not. i have a good bowel movement every morning, but generally struggle to go the rest of the day, even if i have this feeling (rectum does not feel full at these times). i have another appointment next month before fistula surgery. however i am very worried about these new symptoms and am terrified of cancer. i think the colorectal specialist would have found it, but struggle with health anxiety. having to go sit on the toilet every few hours is very frustrating. do you have any suggestions?
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Follow up: Dr. Ramesh Kumar 0 minute later
34 year old male. i had a digital rectal exam from a colorectal surgeon / specialist 3 months ago due to some pain, bleeding, and discharge that had recently gotten worse. i was diagnosed with an intersphintric fistula. he was able to find the internal opening and external opening with a fistula probe. he said there was no need to do an MRI or colonoscopy. i am having a lot of burning, uncomfortable feelings, pain, and general uncomfortableness that makes me feel like i have a mild need to have a bowel movement. the feeling appears to radiate from the tract. the symtpoms will subside breifly if i sit on the toilet, whether or not i have a bowel movement or not. i have a good bowel movement every morning, but generally struggle to go the rest of the day, even if i have this feeling (rectum does not feel full at these times). i have another appointment next month before fistula surgery. however i am very worried about these new symptoms and am terrified of cancer. i think the colorectal specialist would have found it, but struggle with health anxiety. having to go sit on the toilet every few hours is very frustrating. do you have any suggestions?
doctor
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
proctitis secondary to fistula.

Detailed Answer:
Hello and Welcome to 'Ask A Doctor' service.
I have reviewed your query and here is my advice.

The symptoms you are describing are mostly suggestive Proctitis and can cause rectal pain, diarrhea, bleeding and discharge, as well as the continuous feeling that you need to have a bowel movement.Proctitis is defined as inflammation of the anus and lining of the rectum (lower part of the intestine leading to the anus).Fistula is the cause of proctitis in your case.Open fistula acts as a site of infection which causes inflammation.Inflammation along anorectal canal results in symptoms.
Treatment-
Take an anti inflammatory like Ibuprofen 400 mg twice daily to settle down inflammation along anorectal tract.
Take a bulk forming agent like isabghul 10 mg thrice daily with XXXXXXX warm water for smooth passage of bulky stools.
You would feel better in few days.
Follow up are welcome,
Thanks!
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Ramesh Kumar 0 minute later
Brief Answer:
proctitis secondary to fistula.

Detailed Answer:
Hello and Welcome to 'Ask A Doctor' service.
I have reviewed your query and here is my advice.

The symptoms you are describing are mostly suggestive Proctitis and can cause rectal pain, diarrhea, bleeding and discharge, as well as the continuous feeling that you need to have a bowel movement.Proctitis is defined as inflammation of the anus and lining of the rectum (lower part of the intestine leading to the anus).Fistula is the cause of proctitis in your case.Open fistula acts as a site of infection which causes inflammation.Inflammation along anorectal canal results in symptoms.
Treatment-
Take an anti inflammatory like Ibuprofen 400 mg twice daily to settle down inflammation along anorectal tract.
Take a bulk forming agent like isabghul 10 mg thrice daily with XXXXXXX warm water for smooth passage of bulky stools.
You would feel better in few days.
Follow up are welcome,
Thanks!
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ramesh Kumar 8 hours later
Two follow up questions - 1) any idea why this would start now? I have had a fistula for many years, but never had these sensations until my diagnosis?
2) I am having fairly loose and easy to pass stools during my regular morning bowel movement. Is the bulking agent necessary if so?
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Follow up: Dr. Ramesh Kumar 0 minute later
Two follow up questions - 1) any idea why this would start now? I have had a fistula for many years, but never had these sensations until my diagnosis?
2) I am having fairly loose and easy to pass stools during my regular morning bowel movement. Is the bulking agent necessary if so?
doctor
Answered by Dr. Ramesh Kumar 16 minutes later
Brief Answer:
That's why modern tests are done to evaluate the complete detail of problem.
Not a good decision on part of your doctor not to do a MRI.

Detailed Answer:
Hello and thanks for follow up my dear patient,
As said by you earlier neither a colonoscopy nor an MRI had been done on you.
The role of MRI in your case is to find out the route followed by fistula.
In easy language all these things rectum anal canal colon etc are packed compactly inside your small abdomen.Now first priority of us should be to know that what is the path followed by fistula in your case.Using a fistula probe these days is done initially for screening,We have such modern and sophisticated tests like MRI available these days that we can track complete path of fistula.
From what i can assume
Answer 1-Initially the fistula was either small or was not directly in contact with debris or fecal matter containing area.You must be knowing that fecal matter contains a number of toxic bacteria,yeast and other waste products.Supposing that terminal part of colon comes in contact with it then it may result in severe infection...This is just one case scenario.Therefore sophisticated tests like MRI are done sir.Probe test was done in an era when these highly advanced tests are not available or there is non availability of machines as in second and third world sir.
2)In that case you can just take anti inflammatory analgesic.As inflammation would settle down your false sensation may be lessened or may be relieved temporarily.However isaphghul husk is a natural product so there are no side effects of it instead it has many other beneficial effects too.

Hope i was helpful,
Please feel free to follow up,
It would be a pleasure to answer you.
Get well soon and happy new year.
Do rate the answer!
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Ramesh Kumar 0 minute later
Brief Answer:
That's why modern tests are done to evaluate the complete detail of problem.
Not a good decision on part of your doctor not to do a MRI.

Detailed Answer:
Hello and thanks for follow up my dear patient,
As said by you earlier neither a colonoscopy nor an MRI had been done on you.
The role of MRI in your case is to find out the route followed by fistula.
In easy language all these things rectum anal canal colon etc are packed compactly inside your small abdomen.Now first priority of us should be to know that what is the path followed by fistula in your case.Using a fistula probe these days is done initially for screening,We have such modern and sophisticated tests like MRI available these days that we can track complete path of fistula.
From what i can assume
Answer 1-Initially the fistula was either small or was not directly in contact with debris or fecal matter containing area.You must be knowing that fecal matter contains a number of toxic bacteria,yeast and other waste products.Supposing that terminal part of colon comes in contact with it then it may result in severe infection...This is just one case scenario.Therefore sophisticated tests like MRI are done sir.Probe test was done in an era when these highly advanced tests are not available or there is non availability of machines as in second and third world sir.
2)In that case you can just take anti inflammatory analgesic.As inflammation would settle down your false sensation may be lessened or may be relieved temporarily.However isaphghul husk is a natural product so there are no side effects of it instead it has many other beneficial effects too.

Hope i was helpful,
Please feel free to follow up,
It would be a pleasure to answer you.
Get well soon and happy new year.
Do rate the answer!
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ramesh Kumar 24 minutes later
You are fairly confident that these symptoms are fistula related and not something really bad?
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Follow up: Dr. Ramesh Kumar 0 minute later
You are fairly confident that these symptoms are fistula related and not something really bad?
doctor
Answered by Dr. Ramesh Kumar 14 minutes later
Brief Answer:
if you were my patient a MRI would have been done.
If a patient is not relieved and is having symptoms then there is no sense in not doing tests or making assumptions.

Detailed Answer:
Hello again my dear patient,
Golden rule of medical science is that first observe your patient then auscultate percuss palpate do physical examination required tests and then make a differencial diagnosis.Unfortunately this can't be done online and just by going through a history of few lines we need to answer you.So answers here are most probable and not 100% sure.

Secondly you have not mentioned you age.
If its above 40 i would suggest you to go for colonoscopy as well.As per protocol every person should go for a colonoscopy once every five years.

Now lets frankly move to your answer.It can be of two types-

Book protocol answer-
"i am having a lot of burning, uncomfortable feelings, pain, and general uncomfortableness that makes me feel like i have a mild need to have a bowel movement. the feeling appears to radiate from the tract."-Dear patient the main problem with gastroenterology is that clinically more or less the same set of symptoms are there in every patient.For e.g this could also be a presentation of patient with colon polyp,internal hemorrhoids irritable bowel or even a carcinoma.
Therefore i told you earlier that not doing basic tests like MRI and colonoscopy was not a good decision on part of your doctor specially when you are symptomatic also.

Now lets come to clinical answer-Clinically i feel its related to fistula.

It also depends on approach of doctor how casual or serious is he/she about a patient.Just as there are good excellent and average in every field we have it in medical science too.Therefore as a aware patient you should insist to go for 2 basic tests.Some times things don't clicks in doctors brain(they are also humans) so a patient being aware can insist or at least suggest(and that's the use of healthcaremagic).

So better to go for two tests and make things clear.
Hope i was helpful,
Feel free to ask for any confusion.
I would be happy to provide you with answer.
Hope you would get what i tried to explain above.
Can reach me any time at my direct link,
http://doctor.healthcaremagic.com/doctors/dr-ramesh-kumar/72660
Thank you!
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Ramesh Kumar 0 minute later
Brief Answer:
if you were my patient a MRI would have been done.
If a patient is not relieved and is having symptoms then there is no sense in not doing tests or making assumptions.

Detailed Answer:
Hello again my dear patient,
Golden rule of medical science is that first observe your patient then auscultate percuss palpate do physical examination required tests and then make a differencial diagnosis.Unfortunately this can't be done online and just by going through a history of few lines we need to answer you.So answers here are most probable and not 100% sure.

Secondly you have not mentioned you age.
If its above 40 i would suggest you to go for colonoscopy as well.As per protocol every person should go for a colonoscopy once every five years.

Now lets frankly move to your answer.It can be of two types-

Book protocol answer-
"i am having a lot of burning, uncomfortable feelings, pain, and general uncomfortableness that makes me feel like i have a mild need to have a bowel movement. the feeling appears to radiate from the tract."-Dear patient the main problem with gastroenterology is that clinically more or less the same set of symptoms are there in every patient.For e.g this could also be a presentation of patient with colon polyp,internal hemorrhoids irritable bowel or even a carcinoma.
Therefore i told you earlier that not doing basic tests like MRI and colonoscopy was not a good decision on part of your doctor specially when you are symptomatic also.

Now lets come to clinical answer-Clinically i feel its related to fistula.

It also depends on approach of doctor how casual or serious is he/she about a patient.Just as there are good excellent and average in every field we have it in medical science too.Therefore as a aware patient you should insist to go for 2 basic tests.Some times things don't clicks in doctors brain(they are also humans) so a patient being aware can insist or at least suggest(and that's the use of healthcaremagic).

So better to go for two tests and make things clear.
Hope i was helpful,
Feel free to ask for any confusion.
I would be happy to provide you with answer.
Hope you would get what i tried to explain above.
Can reach me any time at my direct link,
http://doctor.healthcaremagic.com/doctors/dr-ramesh-kumar/72660
Thank you!
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ramesh Kumar 1 hour later
I am 34. I have had the fistula for many years.
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Follow up: Dr. Ramesh Kumar 0 minute later
I am 34. I have had the fistula for many years.
doctor
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
Follow up.

Detailed Answer:
Hi again,
What are the medications are you on?
Have you taken any anti spasmodic?
Any anti inflammatory?
Have you ever noticed pus around the area?
What did your primary gastroenterologist suggested you?
If any medications were tried then what were the doses?
Your food habit?
If fistula is there for many years why was it not treated?
I need few answers.
Please provide details.

Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Ramesh Kumar 0 minute later
Brief Answer:
Follow up.

Detailed Answer:
Hi again,
What are the medications are you on?
Have you taken any anti spasmodic?
Any anti inflammatory?
Have you ever noticed pus around the area?
What did your primary gastroenterologist suggested you?
If any medications were tried then what were the doses?
Your food habit?
If fistula is there for many years why was it not treated?
I need few answers.
Please provide details.

Above answer was peer-reviewed by : Dr. Prasad
doctor
default
Follow up: Dr. Ramesh Kumar 51 minutes later
I am on 50mcg of levothyroxine. I take Advil sinus fairly regularly for sinus problems. I have not taken an antispasmodic. There is some pus - not a lot and not regularly. My colorectal surgeon said he recommends getting the fistula repaired, but it is not essential. I did not get it repaired before because it did not cause me pain or discomfort. I am getting it surgically repaired in 4 weeks.
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Follow up: Dr. Ramesh Kumar 0 minute later
I am on 50mcg of levothyroxine. I take Advil sinus fairly regularly for sinus problems. I have not taken an antispasmodic. There is some pus - not a lot and not regularly. My colorectal surgeon said he recommends getting the fistula repaired, but it is not essential. I did not get it repaired before because it did not cause me pain or discomfort. I am getting it surgically repaired in 4 weeks.
doctor
Answered by Dr. Ramesh Kumar 15 hours later
Brief Answer:
follow up.

Detailed Answer:
Hello again my dear patient,
Firstly a very happy new year,
Pus any where is suggestive of infection.When defence cells of our body fails to fight against bacteria's they die and form pus.
Get it surgically repaired and start taking an antibiotic to kill bacteria and analgesic anti inflammatory to settle down inflammation for 5 days minimum.
Open wound may lead to sepsis which can be a life threatening condition.
Wash fistula properly by betadine and take medicines.
Thanks you.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Ramesh Kumar 0 minute later
Brief Answer:
follow up.

Detailed Answer:
Hello again my dear patient,
Firstly a very happy new year,
Pus any where is suggestive of infection.When defence cells of our body fails to fight against bacteria's they die and form pus.
Get it surgically repaired and start taking an antibiotic to kill bacteria and analgesic anti inflammatory to settle down inflammation for 5 days minimum.
Open wound may lead to sepsis which can be a life threatening condition.
Wash fistula properly by betadine and take medicines.
Thanks you.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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