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Just over a month ago, I began having severely sharp

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Posted on Sat, 23 Mar 2019
Question: Just over a month ago, I began having severely sharp pain when having a bowel movement, at the rectum. I can definitely feel as though it's on the left side, not at the top of bottom.

For weeks it was quite painful when I'd have a BM, once or twice a day. It started to get a little better at one point but I had a hard stool and it was back to square one.

In the beginning, the pain lasted for 4-5 hours AFTER the BM. It's usually much shorter now, but the intense pain still happens with the act. It can hurt less intensely for an hour or so after, but sometimes won't hurt after just a few minutes now.

I went to the ER a week ago when I was bleeding not even during the BM. I bled for a few hours, and then it stopped. The doctor examined and said he didn't feel a hemorrhoid. I'm not sure if he was looking for a fissure or not, but he made it sound as though he didn't know the cause and I have an appointment to see a GI in two months. Given how far that is, and that I'm still in pain, I'm trying to get an idea of what this could be.

I have access to doctors on a personal level, so if I feel it's urgent I could see a specialist right away, but I don't want to bother them if it's not potentially serious. Does this sound like a fissure, or could it be more?

I think what has me more concerned is that the pain is most certainly on the left side, and fissures (from what I understand) almost always occur at the top or bottom. The pain is frustrating but I can deal with it if it's temporary.
doctor
Answered by Dr. Ramesh Kumar (4 hours later)
Brief Answer:
Very likely diverticular pain.

Detailed Answer:
Hello dear and welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice.
Very likely your pain seems to be related to diverticulitis. Diverticula are small, bulging pouches that can form in the lining of your digestive system. They are found most often in the lower part of the large intestine (colon).Sometimes, however, one or more of the pouches become inflamed or infected. That condition is known as diverticulitis. As pain is mostly on left side the first diagnosis to be ruled out is diverticulitis. Patient with constipation are more prone to it as constipated food acts as a culture medium for various bacteria's and may act as a source of infection. These bacteria's cause rottening of food causing severe inflammation in pouches and pain. Pain is usually associated with bowel moment as that is the time when stool passes through these inflamed pouches. Some times the soft surface of the mucosa is breeched causing bleeding.

Test suggested
CT scan of abdomen

Treatment
Stool culture test should be done and treatment should be started as per the results of the test.
Usually Ciiprofloxacin 500mg thrice daily with metronidazole 400 mg thrice daily is given in combination with anti inflammatory like ibuprofen.
Take large amount of bulk forming agent called isabghul along with it for prompt relief.
I don't think it's fissure or hemorrhoid.
Take a print out and consult your doctor and get the tests done.
Hope i was helpful.
Thanks.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ramesh Kumar (15 hours later)
I'll bring what you've said to my doctor but in reading on the issue the symptoms described aren't what I experience.

The pain I feel is very sharp and intense. It can be so bad that I do breathing exercises with some BMs. The pain is also very near the rectum. It's hard to say if it's right at the rectum or an inch or so inside though.
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Follow up: Dr. Ramesh Kumar (8 minutes later)
One other thing of note. When I did experience the bleeding after, instead of the usual during, it went for hours then stopped at the hospital. The following day, there was little but constant liquid feces leak too. That went for most of one day then stopped.
doctor
Answered by Dr. Ramesh Kumar (19 minutes later)
Brief Answer:
Follow up.

Detailed Answer:
Hello again my dear,

In that case, it's suggested is to get the colonoscopy done- where with the help of camera attached to a small tube the doctor would examine the complete anal canal rectum etc. Any fissure fistula etc would be ruled out in the 30-minute test.

Some times even the rectum get inflammed called proctitis. Even it sounds like fecal incontinence too. So the test should be done to rule it out.

CT abdomen-If colonoscopy is normal please do get a CT scan done to rule out diverticulitis.
You would get your diagnosis in less than 8 hours and would be treated accordingly.

Hope I was helpful.

Frankly speaking, almost all problems of intestine present with the same set of symptoms hence going for specific tests is a much better option in the first place...

Please feel free to follow up.
Regards!

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Ramesh Kumar (19 hours later)
Thank you. I'm already booked for a colonoscopy, but in Canada it takes a very long time to see a specialist. It's in another two months (booked a month ago). I hate the idea of enduring this discomfort and pain for months more.

I do have a doctor in the family who could get me in with a specialist friend right away.

Would you recommend I request to see one immediately, or am I fine waiting a couple months? Really my question is do you think it could potentially be something serious where it should be found right away?
doctor
Answered by Dr. Ramesh Kumar (44 minutes later)
Brief Answer:
follow up.

Detailed Answer:
Hello again,
I can very well understand your plight as in canada getting an appointment is too tough and takes a lot of time so instead of giving you a theoretical response my answer this time would be practical.
As per me you are having attacks of diverticulitis(left sided pain first differential is diverticular pain) in which colonoscopy as such has no role,Colonoscopy would be performed to rule out carcinoma or polyp or inflammatory bowel disease.
As per you;
I do have a doctor in the family who could get me in with a specialist friend right away-Get a precription for
Tablet Ciprofloxacin 500 mg thrice daily
Tablet Metronidazole 400mg thrice daily
Tablet Dicyclomine 10mg thrice daily
Take this for 10 days very likely(99%) you would be cured.

Take a probiotic along with it preferably econorm thrice daily and add isabghul husk 10 mg thrice.

You would be fine in 10 days.
Hope i was helpful,
Do feel free to follow up,
Do rate answer!
I have given you a very practical answer you just need to get a prescription from your friend doctor.
Above answer was peer-reviewed by : Dr. Yogesh D
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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2467 Questions

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Just over a month ago, I began having severely sharp

Brief Answer: Very likely diverticular pain. Detailed Answer: Hello dear and welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice. Very likely your pain seems to be related to diverticulitis. Diverticula are small, bulging pouches that can form in the lining of your digestive system. They are found most often in the lower part of the large intestine (colon).Sometimes, however, one or more of the pouches become inflamed or infected. That condition is known as diverticulitis. As pain is mostly on left side the first diagnosis to be ruled out is diverticulitis. Patient with constipation are more prone to it as constipated food acts as a culture medium for various bacteria's and may act as a source of infection. These bacteria's cause rottening of food causing severe inflammation in pouches and pain. Pain is usually associated with bowel moment as that is the time when stool passes through these inflamed pouches. Some times the soft surface of the mucosa is breeched causing bleeding. Test suggested CT scan of abdomen Treatment Stool culture test should be done and treatment should be started as per the results of the test. Usually Ciiprofloxacin 500mg thrice daily with metronidazole 400 mg thrice daily is given in combination with anti inflammatory like ibuprofen. Take large amount of bulk forming agent called isabghul along with it for prompt relief. I don't think it's fissure or hemorrhoid. Take a print out and consult your doctor and get the tests done. Hope i was helpful. Thanks.