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Q. I have constant pain with a bump in my rectal area and burning sensation. Please suggest.

Answered by
Dr. Mian Shah Yousaf
and medically reviewed by Dr. Preetha J
This is a premium question & answer published on Nov 04, 2020 and last reviewed on: Nov 09, 2020

Hello doctor,

First of all, I would like to describe my symptoms. For the past five months, I am suffering from constant pain in my rectal area. Earlier, it felt like a sharp knife-like pain tearing apart the perianal region. Still, as of now, it is turned into an intense burning discomfort severe during the bowel movement. And mild in the daytime. I use Anovate cream, and when I apply it, I feel a painful wound like a bump in the outer anus region and 3/4 cuts in the outer rectum, which I could think through gloved fingers and very painful to touch. Also, there is an occasional discharge of mucus (no blood).

History: I had a colonoscopy three months back, and it was done because, for almost two years, I have been bleeding from the rectum. (I have attached the report along with the biopsy). After the colonoscopy, I have prescribed Mesacol (Mesalamine) suppositories for one month, which I took as advised. I did not have any symptoms before five months.

Treatment:

I have been making rounds to my gastro doctor several times. In the first visit, I have prescribed Oxerute tablets, Cremafix, and painkillers. I took that, but no relief. Started Mesacol suppositories, which made all symptoms worst. This all went till four months back end.

Then, three months back, the pelvis and abdomen's MRI was advised as I started experiencing nausea and stomach fullness (reports are attached). After the MRI doctor earlier told me he would do sigmoidoscopy, but he did not do that.

After the MRI, I was given fiber powder and sent home for the next appointment two months later. I started using Anovate cream, which gave relief for some days.

Right now, I am very confused as to what to do. My main questions are,

1) What did my MRI report show, and does it correlate with the colonoscopy findings? I was not explained about it and just told it is all normal. But if everything is normal, then why I am my experiencing all these symptoms.

2) I have a family history of cancer as my grandfather died from esophagus cancer, so I am always worried that I may have cancer in my colorectal area. I read that MRI can detect cancer, but some protocol has to be mentioned in the prescription. In my case, the prescription did not say anything except for perianal pain. Would the radiologist miss out on ulcers or cancer if it is not mentioned why the MRI has been taken?

3) Is it necessary for me to undergo sigmoidoscopy? My city is reporting a hundred COVID-19 cases every day. And most hospitals are not willing to do that unless the COVID-19 test is done. My doctor told me that he would have done if MRI showed something but now no need and to stay at home and avoid exposure.

Shall I go to a bigger city and get it done? I do not want to live in this fear of having something sinister growing in my rectum.

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Hello,

Welcome to icliniq.com.

I reviewed all your history and the attached three reports (attachment removed to protect patient identity).

There is nothing sinister in it. And to me, you are suffering from an anal fissure at the moment. Now I am going to answer your queries one by one and will advise treatment as well.

1. Your MRI (magnetic resonance imaging) is entirely normal, and it does not show any abnormality in the pelvis.

Yes, colonoscopy was also not showing any significant disease last time, and that may be healed with treatment.

2. Yes, MRI can pick tumors and no need for any specific protocol in the pelvic area. Your colonoscopy also does anything suggestive of cancer.

3. I will recommend using treatment as advised, and if no improvement, it can undergo sigmoidoscopy, but it is not urgent, nor is it mandatory.

It would help if you did not have any fear of cancer.


Treatment plan:

1. Lignocaine gel and GTN (Glyceryl trinitrate) cream. Mix both on fingers and apply four times in perianal area.

2. Syrup Cremaffin (Liquid paraffin and milk of Magnesia) two tablespoon two times daily.

Preventive measures:

Avoid hard stools and try to have two soft stools per day.


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