I have rectal discomfort since two weeks and there is no sign of healing. Are these symptoms of cancer?

Hello,

Welcome to icliniq.com.

I understand your concern.

The discomfort or pain can be due to a small anal breach or an acute anal fissure. I do not think that it is a previous anal fissure that has re-opened because that would have caused excruciating pain and usually causes bleeding. An acute anal fissure is common with diarrhea, repetitive washing, and using a water jet while washing.

Skin tags, however, are a common finding in the perianal (around the anus) area. And they can be single or multiple. Multiple skin tags can be due to an infection like human papillomavirus (HPV) or can simply be due to skin overgrowth. But generally, these skin tags are harmless.

I do not think Ciprofloxacin and Flagyl (Metronidazole) are actually required. You can use the following regimen:

1. Xylocaine 2 % gel for local application with a finger or a nozzle provided with the package, thrice daily.
2. Diltiazem gel (Diltiazem Hydrochloride) or Glyceryl Trinitrate (GTN) with finger thrice daily.
3. Fill a water tub with semi-warm water up to half, add Savlon or Dettol, and sit in it for five minutes (two to three times) daily.
4. Use Isabgol husk to keep stools formed and soft; take it with water and a little bit of sugar. This will improve your diarrhea.
5. You can use an oral rehydration solution (ORS) in 1 liter of water twice daily for one to two days till your diarrhea settles.
6. If you still have diarrhea or repetitive loose bowel movements, you can use Tab Mebever 200 mg (Mebeverine Hydrochloride) only as needed before meals.

I hope this will help you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

No, it is not. With this short history of your symptoms and no blood in stools, it is less likely to be cancer. This seems to be an acute anal fissure, and I believe you would be alright with the above regimen.

I hope this helps you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Yes absolutely. These are the symptoms of an acute anal fissure. Blood may or may not come, but it is a pain that comes and goes every time you open your bowel or examine it. I suggest you not examine it again and again, since a slight stretching of the anal canal with a finger or otherwise would delay its healing, can bring pain, and can even worsen it. For ointment application, gently insert the cream into the anal canal without rubbing, or use a nozzle instead.

I hope this helps you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

The healing time varies from one to six weeks. Usually, it takes two to three weeks. I can understand your concern, but I do not think by any means that this is cancer. So please do not be worried about this. It is normal for feces to separate when they drop into the water, and there is no abnormality related to this. It is normal. I suggest you start using the treatment as advised above and let me know in a week's time to update on how you respond.

I hope this helps you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

But I do not think that Metronidazole and Ciprofloxacin would improve your diarrhea. This acute diarrhea is usually self-limiting and goes away by itself. You have not been taking Isabgol husk (dietary fibers) and ORS in the required amount; otherwise, your diarrhea would have settled by now.

SCC (squamous cell carcinoma) does not develop in a week, and according to classical teaching, cancers always appear as a painless nodule or cause painless bleeding. In your case, it is of short duration and extremely painful, which are both against the diagnosis.

But to further ease your concern, a digital rectal examination of this area, after your diarrhea and pain settle, is the next best approach. A gastroenterologist would do a digital rectal exam and use a proctoscope to see inside your rectum. We would be in a better position to address your concern. But as of my experience is concerned, it is improbable to be an SCC.

Yes, that cream could have caused this burning. Kindly do not use it again. See if Glyceryl trinitrate GTN cream, Xylocaine (lignocaine) 2% gel, and Diltiazem (calcium channel blocker) gel are available.

Yes, the rectum and anus both contain muscles, and these muscles often go into spasm whenever there is injury or inflammation in this area. The pain produced is the product of skin breach and muscle spasms. That is why Diltiazem or a GTN-like cream relieves the spasm, and Xylocaine desensitizes the nerves to reduce pain.

I hope this helps you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

The levator ani syndrome, pelvic floor dyssynergia, and anismus are all the same condition. It does not develop over a few weeks, and usually, the main symptom of anismus is constipation. I feel this is proctitis, i.e., inflammation of the rectum, which can cause a feeling of urgency to defecate repetitively.

This inflammation can be infection-related. A five-day antibiotic course would resolve this inflammation or infection. I suggest you take, tablet Ciprofloxacin 500 mg twice daily and tablet Metronidazole 400 mg thrice daily. Both for five days. You can continue the fiber and ointments for now. Consult your specialist doctor, discuss with them, and take the medicines with their consent.

I hope this helps you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

It is very unlikely to be cancer given the short duration of symptoms, absence of pain, and no bleeding in stools. Infections of the rectum can cause diarrhea, a repetitive urge to pass stools, painful feelings in the rectum, and mucus formation. Both symptoms of increased bowel movements and experiencing urgency, fullness, or discomfort, and mucus in stools seem to be due to proctitis, i.e., inflammation of the rectum.

Infections are a common cause of proctitis. However, less common causes such as ulcerative proctitis, which is a condition called ulcerative colitis (UC) when it affects only the rectum, should be considered if symptoms do not resolve after four to six weeks from the onset of initial symptoms. Ulcerative colitis is an autoimmune condition that causes ulceration of the entire colon.

I suggest you check for some stool tests and let me know. There is no urgent need to visit a doctor at the moment. You can wait. You should continue taking fiber in water daily. You can start tablet Mebeverine 200 mg half an hour before meals twice daily. The main side effect of this medication is constipation. So, you can decrease the dose to once daily if constipation occurs.

I hope this helps you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Yes, it will surely go away if we handle things properly. First, we need some testing to confirm what it is. Your symptoms suggest proctitis, but whether it is secondary to infection or due to inflammatory bowel disease, we do not know. The testing I recommended in my last response would answer that question. I will list the investigations below.

Secondly, I suggest you start a course of Ciprofloxacin and Metronidazole antibiotics for at least five days. If you have completed the course, then proceed with the testing, and we will decide further. If you have not taken these medications for five days before, I recommend you start them right away. Additionally, take Isabgol husk two tablespoons daily. You can continue Mebeverine for now.

Naringenin (NGN) cream would not improve tenesmus. It basically improves the spasm of the muscles of the anal canal and would alleviate the pain associated with anal fissures. An anal fissure causes a sore anal area and burning/pain while or after defecation.

Tenesmus, on the other hand, is a symptom of rectum inflammation, which means a repetitive, painful urge to pass stools that often fails to pass stools. This is a symptom of rectal inflammation, and the only thing that can improve this is proper treatment of rectum inflammation. If you do not have pain in the anal area and only experience urgency and tenesmus, you can stop using NGN and any other local treatments. Since the nozzle or finger used for application would irritate the rectum more.

I hope this helps you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Please add Metronidazole 400 mg thrice daily to your existing regimen. I do not think sitting on a bad chair or hard surfaces has led you to develop tenesmus. The cause of tenesmus is within the rectum. Since you have recently experienced this problem, the possibility of acute inflammation in the form of infection is highly likely.

The chances of a condition like solitary rectal ulcer syndrome (SRUS), which is a condition of ulcer formation within the rectum due to chronic constipation and straining during bowel movements (dyssynergia), are less likely. SRUS can also cause tenesmus.

So, to simplify, it is basically rectal inflammation that is the reason behind tenesmus, and I believe it is acute and not chronic. Doing pelvic exercises is otherwise good. It is excellent for those who have chronic constipation secondary to dyssynergia.

However, since we have not yet made the diagnosis of dyssynergia, I think it is premature to recommend it to you at the moment. Dyssynergia is diagnosed via anal rectal manometry. Regarding ejaculation, since I am not an expert in this problem, I suggest that you seek help from a urologist if you think it is necessary.

If you want, you can consult me via a video consultation, as we can discuss in more detail and address your concerns more easily.

I hope this helps you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Well, that pressure is not tenesmus, actually. By definition, tenesmus is a failed, painful urge to defecate. The pressure you feel while lying supine on the bed could be coming from the coccyx - the tailbone. Since I recall you have had problems with your tailbone due to sitting on hard surfaces and a bad chair before, this seems to be the reason for your current symptom. If you feel a repetitive urge to pass stools with mucus, then, as suggested before, take a repeat course of Ciprofloxacin and Metronidazole for five days.

For the tailbone problem, I suggest getting a physical exam by a general practitioner and applying a pain-relieving cream, such as a pain-relieving gel, three times daily until the pain subsides. Also, use soft surfaces for sitting and sleeping. Since it all started with some changes in bowel habits and with pain in the anus, this could be due to inflammation in the rectum. However, it is wise to have a physical exam to check for coccyx (tailbone) tenderness. You can also apply some gentle pressure over the tailbone yourself and see if it causes tenderness.

I hope this helps you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

This voluntary squeezing of the anal canal can be either painful or not painful. If it is painful, it is called proctalgia. Regardless of whether voluntary or involuntary, this movement can be minimized by behavioral changes. Try to ignore it and remove any anxiety that may be contributing to the belief that you are physically ill. How is your sleep?

Do you experience obvious anxiety or panic episodes that you feel need to be treated? Because some level of anxiety is common in individuals our age, and it can often be without reason. This anxiety is usually not sustained and can spontaneously go away within days. However, if you are interested, I can suggest some anxiolytic medications.

Regarding the lump, it could be a chronic anal fissure, as we discussed earlier. They may cause pain initially, but with medications and good fiber intake, the pain usually subsides, leaving behind a small scar. Alternatively, it could be a simple anal tag, which appears as a dark brown to black fleshy outgrowth, movable, and almost always not painful. The sigmoidoscopy would help us establish these possibilities with more confidence. I look forward to seeing your report.

I hope this helps you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

That thing will be well observed during sigmoidoscopy. I do not think it is wise to make assumptions or give straightforward diagnoses based on feeling a vague lump. Both the anal canal and rectum are lined by a surface epithelial layer. Since it is inside the lumen, which you cannot see with the eye but can only feel, it might just be the epithelial lining (mucosa) and not a serious issue.

I mean, this could be a completely normal occurrence and not cancerous at all. Anal tags can arise within the anal canal epithelial lining and may only be palpable outside the anal canal. In fact, we often see these anal tags deep-seated in the anal canal lumen during digital rectal examinations.

At the moment, since it is not bleeding or causing pain, it suggests that things have probably healed from before. The best course of action I can suggest is to wait for the sigmoidoscopy, which will provide clearer information to help decide on future treatment, if required.

I hope this helps you.

Thank you.