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This Is A Proctological/Neurological Problem: In The Last 24 Hours
Question: This is a Proctological/Neurological Problem:
In the last 24 hours I have been experiencing intermittent, very brief, rectal (or pelvic) pain, seemingly deep inside my rectum (i.e. not at the anus). It occurs every few seconds, or every few minutes, or every few hours. The pain is brief (less than one second). On a scale of 1 to 10, it is a 5 or 6, but...when it happened last night, they woke me up, and continued to occur every few seconds or few minutes. The pain has occurred probably one hundred or more times since last night, and I could not sleep last night. If it continues as it has, I will not be able to sleep.
Relevant Medical History:
A. I received Radiation Treatment for Prostate Cancer, beginning in December 2018, and continuing until February 7, 2019. There were 42 Radiation Treatments in all. I also received two Lupron injections, each lasting three months. The last injection was March 7, 2019.
B. In 2018 (prior to the Radiation Treatment for Prostate Cancer) I experienced two bouts of a deep rectal (or pelvic) cramp, each lasting about 20 minutes. Once the pain events were over, they were over. No follow up pains occurred after the event. It was tentatively diagnosed as Levator Ani Syndrome. I have not had any such events since August 2018...until now. But, this time, it is different. It is not a rectal (or pelvic) cramp that lasts for 20 minutes (typical of Levator Ani Syndrome). It is a very quick, cramp-like feeling, deep in my rectum, that has continued, intermittently, over the last 24 hours.
C. I have had Polyneuropathy (electric-like) pains (Neuropathic Pains) that have occurred intermittently. I am taking Lyrica, 150mg, 2X/day for those pains, successfully.
I am distraught about these intermittent, recurrent, deep, brief (but painful) rectal (or pelvic) events. What is the diagnosis? What is the preferred treatment (if any)? What can be done? If I cannot sleep because of these pains, I will be less able to cope with them. Please help.
In the last 24 hours I have been experiencing intermittent, very brief, rectal (or pelvic) pain, seemingly deep inside my rectum (i.e. not at the anus). It occurs every few seconds, or every few minutes, or every few hours. The pain is brief (less than one second). On a scale of 1 to 10, it is a 5 or 6, but...when it happened last night, they woke me up, and continued to occur every few seconds or few minutes. The pain has occurred probably one hundred or more times since last night, and I could not sleep last night. If it continues as it has, I will not be able to sleep.
Relevant Medical History:
A. I received Radiation Treatment for Prostate Cancer, beginning in December 2018, and continuing until February 7, 2019. There were 42 Radiation Treatments in all. I also received two Lupron injections, each lasting three months. The last injection was March 7, 2019.
B. In 2018 (prior to the Radiation Treatment for Prostate Cancer) I experienced two bouts of a deep rectal (or pelvic) cramp, each lasting about 20 minutes. Once the pain events were over, they were over. No follow up pains occurred after the event. It was tentatively diagnosed as Levator Ani Syndrome. I have not had any such events since August 2018...until now. But, this time, it is different. It is not a rectal (or pelvic) cramp that lasts for 20 minutes (typical of Levator Ani Syndrome). It is a very quick, cramp-like feeling, deep in my rectum, that has continued, intermittently, over the last 24 hours.
C. I have had Polyneuropathy (electric-like) pains (Neuropathic Pains) that have occurred intermittently. I am taking Lyrica, 150mg, 2X/day for those pains, successfully.
I am distraught about these intermittent, recurrent, deep, brief (but painful) rectal (or pelvic) events. What is the diagnosis? What is the preferred treatment (if any)? What can be done? If I cannot sleep because of these pains, I will be less able to cope with them. Please help.
To my knowledge, I do not have any hemorrhoids, abscesses or fissures.
Brief Answer:
all possible causes explained below.
Detailed Answer:
Hello XXXXXXX
Welcome to Ask A Doctor services.
I have read your query and here is my advise.
* As per my surgical experience, the deep pelvic or rectal pain with varying
intensity in a person with previous history of prostate irradiation may
indicate possibility of
(1) early prostate inflammation
(2) bacterial infection
(3) re emergence of prostate nodule
(4) seeding of malignant cells to rectum or other pelvic organs
(5) constipation induced spasms
(6) post radiation fibrosis
* Treatment will depend upon the underlying diagnosis as if it turns out to
be inflammation or that type of issue, anti inflammatory medications with
or without antibiotics will solve the problem.
But if there is emergence of previous pathology in terms of nodule or say
post radiation fibrosis then treatment plan differs accordingly.
* It is most appreciable to consult your oncologist or surgeon for per rectal
examination at primary evaluation point which will help to possible need of
further work up and treatment plan accordingly.
* Presently maintain hydration with more intake of liquids to prevent
secondary bacterial infection and can take tablet paracetamol for primary
pain relief.
* Kindly provide me following necessary information when you proceed for
the follow up.
1. Any recent changes in bowel or urination habits ?
2. Is there back pain, weight alteration if any ?
Wish you best health and recovery.
Do feel free to discuss further regarding the same.
Regards.
Dr Bhagyesh ( MS consultant surgeon )
all possible causes explained below.
Detailed Answer:
Hello XXXXXXX
Welcome to Ask A Doctor services.
I have read your query and here is my advise.
* As per my surgical experience, the deep pelvic or rectal pain with varying
intensity in a person with previous history of prostate irradiation may
indicate possibility of
(1) early prostate inflammation
(2) bacterial infection
(3) re emergence of prostate nodule
(4) seeding of malignant cells to rectum or other pelvic organs
(5) constipation induced spasms
(6) post radiation fibrosis
* Treatment will depend upon the underlying diagnosis as if it turns out to
be inflammation or that type of issue, anti inflammatory medications with
or without antibiotics will solve the problem.
But if there is emergence of previous pathology in terms of nodule or say
post radiation fibrosis then treatment plan differs accordingly.
* It is most appreciable to consult your oncologist or surgeon for per rectal
examination at primary evaluation point which will help to possible need of
further work up and treatment plan accordingly.
* Presently maintain hydration with more intake of liquids to prevent
secondary bacterial infection and can take tablet paracetamol for primary
pain relief.
* Kindly provide me following necessary information when you proceed for
the follow up.
1. Any recent changes in bowel or urination habits ?
2. Is there back pain, weight alteration if any ?
Wish you best health and recovery.
Do feel free to discuss further regarding the same.
Regards.
Dr Bhagyesh ( MS consultant surgeon )
Above answer was peer-reviewed by :
Dr. Kampana
Dr. Bhagyesh:
Thank you for your prompt response to my query. In response to your questions:
1. I do not have any back pain.
2. I have gained seven pounds in the last several months, possibly caused by the Lupron injections that I have received.
3. I have had diarrhea in the last week, which has occurred from time to time since the Radiation treatments. I have taken Imodium from time to time to stop the diarrhea.
In doing some "research" on the Internet, the two possible causes of my rectal pain appear to be Levator Ani Syndrome, or Prostalgic Fugax, with the latter being the more likely cause. Do you agree with this possibility?
Thank you for your prompt response to my query. In response to your questions:
1. I do not have any back pain.
2. I have gained seven pounds in the last several months, possibly caused by the Lupron injections that I have received.
3. I have had diarrhea in the last week, which has occurred from time to time since the Radiation treatments. I have taken Imodium from time to time to stop the diarrhea.
In doing some "research" on the Internet, the two possible causes of my rectal pain appear to be Levator Ani Syndrome, or Prostalgic Fugax, with the latter being the more likely cause. Do you agree with this possibility?
Brief Answer:
Follow up.
Detailed Answer:
Hi
Thanks for the details.
* As per my surgical experience, cause is more likely related to possible irritation of rectum or anal canal mucosa by previous effects of radiation , recurrent diarrhea support this theory strongly. * I do not support Prostalgia fugax possibility which is of unknown reason.
* You must discuss need of further work up in this direction with MRI pelvis or else with your surgeon.
Thanks dear.
Follow up.
Detailed Answer:
Hi
Thanks for the details.
* As per my surgical experience, cause is more likely related to possible irritation of rectum or anal canal mucosa by previous effects of radiation , recurrent diarrhea support this theory strongly. * I do not support Prostalgia fugax possibility which is of unknown reason.
* You must discuss need of further work up in this direction with MRI pelvis or else with your surgeon.
Thanks dear.
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Kampana
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