Patient: So for about 6 days I’ve been dealing with itching and burning on my butt. It mainly occurs after a bowel movement. I feel fine pooping and don’t have any blood in stool. I went to my dr this morning. He stuck his finger up there and couldn’t feel anything wrong. I’ve tried hemorrhoid creams (recently using proctozone cream). Didn’t work. Do it doesn’t seem like hemorrhoid. My dr said it may be tensemus. He prescribed B&O suppositories for spasms and rectal pain. Three different pharmacies say they don’t carry these and look perplexed about them. Not sure what to think. For 4-5 days I’ve been waking up with some pressure/cramping in lower back/pelvic area but then it all goes away when I’m up and about. Could this be possibly an anal fissure or proctitis? I did have a colonoscopy a few years back not for this problem and everything on that looked good. I’m not sure what to do here or how to proceed. I guess it’s good he didn’t feel anything. But to explain the itching and burning which is worse when I’m up and walking or after having a bowel movement could it be this tenesmus? Or anal fissure or possible proctits? I think if it was Colon cancer he would have felt something. Please I need advice. I don’t like the idea of taking suppositories especially since most pharmacies aren’t really using them.
Symptoms: Itching and burning on butt
Doctor: Hi.Read and re-read and understood your problem.This looks to be dermatitis of the anal and perianal area secondary to occult intestinal infection not showing so much of intestinal symptoms along with multivitamin deficiency.The fissure is painful and does not allow the per-rectal examination.Tenesmus is pain before passing motion with or without actual passage of stool.Hemorrhoids are not palpable, they are seen on Proctoscopy examination.I would advise you the following:You will have to discuss this with your Doctor and get appropriate prescription.- You need a course of an antibiotic like Cefixime or Ofloxacin and Metronidazole.- Add on treatment is Therapeutic dosages of Vitamin A and D.- To be continued with Multivitamins, Probiotics.- Sitz bath at least twice a day and clean the area with plain warm water- no soaps or any chemicals at all except povidone iodine liquid in the morning before bath and in the evening if you can dry it up with a hair dryer.- No ointments at all.- Oral mild steroids like Deflazacort or Omnacortil for a few dosages only to take care of the dermatitis part.This helps all my patients and may help you too.In the meantime go for the tests of stool, blood, urine, colonoscopy and USG or CT abdomen if need be.
Comments / Follow Ups
Patient: So today I ended up having to go to ER because I was having pain in my pelvic area when I bend over or move around excessively. In my right groin area the ER doctor disovered I have an inguinal hernia. He said it’s not really bad or emergent and that I should follow up with my family doctor in a week, which I already have a set appointment for Monday morning. He advised me that there really is no way to treat these and if they get too bad often people have surgery done. Is there anything that I can do that will help decrease the pain? Will the pain cease over time as long as the hernia doesn’t worsen? Finally if I did end up getting surgery on it one day are the procedures usually outpatient? I didn’t know if this was something someone stayed long in the hospital for if they did get surgery. From my ER visit though it didn’t seem like the doctor was concerned with me having to get surgery. Could this be related to any of the rectal itching/burning I’ve been having? They checked for signs of infections and nothing showed up in the lab work.
Doctor: The pain in the pelvic area can be due to many reasons:
Please explain/ give details about the pain:
Where exactly was the pain?
How are your stools (BM/Poop)?
Incidental finding of the right inguinal is in no way concerned with the anal itching /burning you have.
Small hernia is a surgery for which you have to be in the hospital for a day only.
ER Doctor would be worried about your ”acute” problem, the one for which you have attended the ER for. What was his opinion on clinical evaluation and examination?
Did he suggest for Colonoscopy or CT scan ?
Patient: I can have a bowel movement ok. Stool appears to look ok. No blood or anything like that and I’m going daily. It just seems that everytime I go then my butt gets itchy and starts to burn. I’m wondering if there is something in the stool that’s causing this (ie mucus or something)? After I wipe the toilet paper is a little yellow. Is there any kind of ointment or any kind of medication I can take to cease the itching and burning sensation? It doesn’t hurt inside my butt, just in my butt crack. The pelvic pain was all in my lower back today. It only hurt when I bent over or repositioned myself. Not sure if this could be due to the hernia or something else. I wasn’t seeming to have a lot lot of pelvic pain until the doctor I went to see on Monday (not the one in the ER) did a rectal exam where he shoved his fingers up there. Could this have caused the hernia as he was really rough when he did it or the pain? Thoughts on this whole thing?
Doctor: Thanks for your feedback.
Read and understood the sequence of symptoms. The pelvic pain got enhanced after the Doctor you went to see on Monday did a rectal examination, where he shoved his finger up This can not cause hernia at all. But if this examination increases your pelvic pain means you have Procto-colitis and need further investigation of colonoscopy and further treatment under the care of a Gastroenterologist.
This in turn can cause the pain in the low back as you have explained.
The pain is in the butt crack- as per your history. Get the treatment as advised and you will be fine. Take Multivitamins for a long time as the pain in the butt crack is due to vitamin deficiency in some patients.
I hope you are under the correct medications now. Please follow the advise of the Doctors and prescription medicines properly and be fine.