Dr. Ajeet Kumar
Medical Gastroenterology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am a 30-year-old male. I experience anxiety and depression and have had flare-ups of iritis. I have been having tight anal muscles and discomfort and had some bleeding in bowel movement, which I went to the doctor and said was a fissure. I have also had a colonoscopy two years ago, which came back normal, so the doctor was not overly concerned. The tightness in the anal region is discomforting and affecting my daily life and is adding to my anxiety and stress. I am afraid I have a severe disease that the doctors missed. Three years ago, I had seen another gastro which I had CT (computed tomography) scans and contrast scans which all came back normal.
I just want relief and not to worry anymore.
Thank you.
Hello,
Welcome to icliniq.com.
Is this just a tightness in the area or actual pain? Does the pain come in the episode for a brief period of time or a continuous pain? The pain basically suggests anal fissure. While feeling spasm and/or pressure in the anal canal is entirely different, symptoms and may or maybe not be related to anal fissure. There are certain conditions where there is an intermittent spasm of the muscles of the anal canal, namely chronic anal fissure that lasts for few months, proctalgia - a condition with unknown cause, leads to sudden spasm of the pain in the anal canal. The third is dyssynergia which is also called anismus levator ani syndrome.
To establish which of the above three conditions you have, you need to tell me.
How about your bowel movements? Do you strain while passing stools? Did you have any surgery in the abdomen or in this pelvic area? Do you have lower abdominal pain or spasm?
And did the doctor previously have to establish the diagnosis of anal fissure while examining the anal area, or was there just a possibility discussed?
Did you use any medications, particularly glyceryl trinitrate (GTN)? Xylocaine or similar painkillers for local applications in the anal canal?
Let me know the above things as I can able to address your concerns and can help you.
Regards.
Patient's Query
Hi doctor,
With the fissure, there was a lot of pain during bowel movements. Once the fissure was healed, the painful bowel movements left, but now I am experiencing tight anal muscles, and it seems like it will not relax no matter what I do. The doctor did a full exam. I had to take my pants down. I think it is a digital examination. He did not prescribe anything other than to take an Epson salts bath and keep the area clean with wet wipes. I am also having low back pain, and my lower abdomen feels weaker than normal. My bowel movement seems to be normal. I did not have any surgeries down there other than the colonoscopy a couple of years ago, which was for a fissure I had previously, but I do not recall having this much tightness and discomfort in the anal region before. It just feels like my anal cavity is constantly tightening and will not relax, which is making my anxiety really bad.
Thank you.
Hi,
Welcome back to icliniq.com.
Thanks for the information.
I think it is the anal canal that has developed a spasm. Spasm means the muscles in the anal can are excessively contracted, causing the lumen to be closed.
This can occur among some individuals whose acute anal fissure has caused significant injury to the lining of the anal canal and internal sphincter (a muscle layer), which has to lead to scar formation and narrowing of the opening.
Secondly, acute anal fissure converted into chronic anal fissure leading to the same sequelae as above.
The one way is to treat in with medical treatment. If no improvement, you can consider surgery.
The surgery is basically sphincterotomy, in which the internal sphincter (muscle layer) is divided into the part with a small incision.
For medical therapy, I suggest you take stool softeners like Ispagol husk two tablespoons full with water daily.
Polyethylene glycol sachet 17 gm with the brand name Movcol. Two sachets with water every night.
Plus, use Glyceryl trinitrate (GTN) cream at the anal area with the help of nozzle provided in the box twice to thrice daily.
Let me know in a week's time how you respond.
Patient's Query
Hi doctor,
Thank you doctor.
Can you continue your daily activities with this condition? My job requires me to lift heavy things, and I enjoy lifting weights in my free time. I am a hypochondriac, and I always worry I have something serious like cancer or something, and I am going to die. I know that sounds dumb, but I got scared when I saw the blood in the stool.
Hi,
Welcome back to icliniq.com.
Your concerns are absolutely reasonable. It is a common thing to have anxiety up to that level in the COVID era where everything seems so uncertain. I would have been so anxious, even more than you, if I had similar symptoms for so long. What you have to do is to understand your symptoms and discuss with experts to get answered for all your concerns.
I think it is a chronic anal fissure that has to led you to develop a spasm of the anal canal to the best of my knowledge. This thought is based upon few things -the one is you are too young to develop colon cancer. This what research says. The cancer prevalence in age less than 30 is in fractions out of 100 thousand individuals. Secondly, your one colonoscopy and one CT scan (attachments removed to protect the patient's identity) over a span of the last 2 to 3 years are normal. Again, they are against the possibility that you have cancer.
I think the best would be to take medical treatment, see if it improve your symptoms, and in case of no response, can consider sphincterotomy, which is mini surgery.
Lifting heavy weight would increase your abdominal pressure, and in return, increase the pressure over the bottom, which can worsen your chronic anal fissure issue. I suggest you avoid heavy lifting since it may be the actual reason for you developing anal fissure at such young age, without a history of constipation. So to conclude, you should avoid heavy lifting. At the same time, you can do some rest of exercises and just a routine gym.
Patient's Query
Hi doctor,
Thank you so much for your detailed response and reassurance. It makes me feel much more at ease. I will stop the heavy weight lifting and do other forms of exercise from now on. And yes, the COVID era in itself has made my anxiety at a much higher baseline rate with all attention on health and disease since that is what I worry about most often.
Thanks again doctor.
Hi,
Welcome back to icliniq.com.
I am glad you got your concerns answered.
It is my pleasure, after all.
Take care of yourself.
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