menstrual-time pain from the phantom anus
Big Sister Asks:
This is a serious question. My youngest sister has Crohn's disease and has had an ileostomy. Her rectum has been removed and all is stitched closed down there. Every month at her menstrual ovulation time, she is miserable. She only has one remaining overy, but her remaining GI tract is in chaos.
The symptom I am writing about, however, has the MDs stymied. She gets a pain in the area where her rectum used to reside and feels the need to bear down continuously. She has to sit up, on a stool or hard chair, and push for days on end. She can't sleep. She has tried nerve pain pills, narcotics, muscle relaxers... nothing helps much.
We are trying to get her menstrual cycle stopped to see if the pain will go away. It is proving to be a stubborn task -- depo-provera shot and provera pills are not completely stopping her cycle. She wants a hysterectomy. Any suggestions?
Please, any help would be appreciated.
Dear Big Sister,
Phantom pains from a missing anus are not uncommon among ileostomates, but I would be more inclined to believe that your sister is suffering from proctitis. The National Digestive Diseases Information Clearinghouse (NDDIC) has this to say about proctitis:
"Proctitis is inflammation of the lining of the rectum, called the rectal mucosa. Proctitis can be short term (acute) or long term (chronic). Proctitis has many causes. It may be a side effect of medical treatments like radiation therapy or antibiotics. Sexually transmitted diseases like gonorrhea, herpes, and chlamydia may also cause proctitis. Inflammation of the rectal mucosa may be related to ulcerative colitis or Crohn's disease, autoimmune conditions that cause inflammation in the colon or small intestine. Other causes include rectal injury, bacterial infection, allergies, and malfunction of the nerves in the rectum.
The most common symptom is a frequent or continuous sensation or urge to have a bowel movement. Other symptoms include constipation, a feeling of rectal fullness, left-sided abdominal pain, passage of mucus through the rectum, rectal bleeding, and anorectal pain.
Physicians diagnose proctitis by looking inside the rectum with a proctoscope or a sigmoidoscope. A biopsy (a tiny piece of tissue from the rectum) may be removed and tested for diseases or infections. A stool sample may also reveal infecting bacteria. If the physician suspects Crohn's disease or ulcerative colitis, colonoscopy or barium enema x rays may be used to examine areas of the intestine.
Treatment depends on the cause of proctitis. For example, the physician may prescribe antibiotics for proctitis caused by bacterial infection. If the inflammation is caused by Crohn's disease or ulcerative colitis, the physician may recommend the drug 5-aminosalicyclic acid (5ASA) or corticosteroids applied directly to the area in enema or suppository form, or taken orally in pill form. Enema and suppository applications are usually more effective, but some patients may require a combination of oral and rectal applications."
After reading several forums on the topic, it seems to be quite common for people to have this complication even when the rectum has been surgically closed. Your sister may just be more prone to the symptoms during her ovulation time just as most women do experience increased activity and sensitivity of the lower digestive system each month.
Thanks for asking Motherload!
Motherload is a Certified Nurse Assistant as well as an IBS sufferer, which means she knows a lot about poop. Got a question for her? Ask it here.