Brief Answer:
To relax anal sphincter calcium channel blockers can be used with nitroglycerine.

Detailed Answer:
Hi,
Thanks for choosing HealthcareMagic for your query.

I've gone through your details and I appreciate your concerns.

As per your query, answers are-

To relax anal sphicter, calcium channel blocker class of drugs can be used. Calcium channel blocking drugs with nitroglycerin, ointments (for example, Nifedipine [Adalat] or Diltiazem [Cardizem]) relax the muscles of the internal sphincter. They also expand the blood vessels of the anal muscular layer and increase the flow of blood.Hence relaxes the anal sphincter(you need a prescription for them).

Though not asked, I feel that the problem is not with your sphincter rather you are having severe constipation which is responsible for your straining excessively while passing stools.

For treatment of constipation, a complete life style modification is required along with medications.

Please start taking Syp. Lactulose 10-15 ml once daily at night time(laxative).
Take two table spoon ispaghula husk with XXXXXXX warm water at night.

Try to increase your daily fiber intake gradually. maintain it at 25-30 grams/day.
Take probiotic supplements they are good bacteria and will improve digestion.

Drink one glass of lemon water after getting up in morning.
Use olive oils on salad.
Try to avoid too much of dairy products and red meat.
Prefer green leafy vegetarian diet instead.
Eat lots of bananas, grapes, and oranges.

Keep yourself well hydrated.
Avoid fatty and spicy food.
For symptomatic relief from gas/burping, you can take PPI/antacid like Omeprazole 20 mg once daily.

However, a digital and proctoscopy examination of anal canal and sphincter should be done in person by a proctologist afterward.

Follow this for the next 14 days and let me know how you feel.

Follow ups are welcome
Kind regards.

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Brief Answer:
Follow up answer.

Detailed Answer:
Hi dear,
As you have already tried the above-mentioned things the only way out is an extensive investigation of the anal and rectal region.

I would suggest you few test to check the patency of muscles in the sphincter.

1) MRI- Noninvasive and easy investigation will give us a clear picture of the condition of sphincteric muscles.
2) Anorectal manometry- This test measures the pressures of the anal sphincter muscles, the sensation in the rectum, and the neural reflexes that are needed for normal bowel movements.
3) Anorectal electromyography (EMG)- This will help us understand whether anal muscles are contracting normally or not.
4) Digital examination of anal reflexes by a surgeon in person.

Though you have been investigated extensively, yet those tests were not meant specifically to measure anal rectal and sphincteric tone.

Constipation is the most common cause of this problem however as the treatment didn't help you further investigation should be done to find the cause of the problem.

Hope I answered your query.
In case you want any other details, feel free to ask.

Warm regards.

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Brief Answer:
Disturbed intestinal microflora resulting in indigestion.

Detailed Answer:
Hi there.

Answer to question 1,2,3,4 and 7--
Our intestine consists of trillions of good bacteria's termed specifically as gut flora. Gut Bacteria help digest and absorb Foods. The most plentiful and important bacteria in the small intestine are the Lactobacillus species.

Lactobacillus helps ferment indigestible carbohydrates. Gut bacteria helps in the production of mucous and digests food properly hence prevent constipation.Toxins produced by food, age poor diet etc are among various factors causing dysbiosis in which the good bacterial colonies get deplete while bad bacteria's over number them. This causes a problem with digestion like unformed stools, bloating belching pain in abdomen etc.

Follow the suggestions for 4 weeks and observe how you stay.

-Psyllium husk(natural fiber) should be taken 2 tsf once daily soak in half a cup of lukewarm water.It increases the bulk of stool, lubricates stool and helps in the formation of well-formed stools.

TakeProbiotic containing Lactobacillus species twice daily with food.This will help to replenish the depleted gut flora. As the good gut flora is restored overall digestion will improve

To provide symptomatic relief in bloating, belching gas take Omeprazole 40 mg once daily...
Try to increase fibers intake gradually(maximum 30 gram per day).

Avoid overeating take small meals at frequent interval.
Take lots of curd in food it's rich in probiotic.

Avoid juices for few days.They are rich in citric acid and can increase your problem.
Take fruits like Banana, Grapes, and Oranges.
Sprinkle olive oil over green salad and have it.
Avoid red meat, egg, and heavy food for few days,

Pain in lower back and numbness can be due to vitamin B12 deficiency along with calcium and vitamin D deficiency, So kindly get it checked.

Do follow-up after 2 weeks.

Regards

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