What Causes Pain In Rectum During Bowel Movements?

Posted on Tue, 22 Jul 2014

Question: Severe cramping/spasms in rectum only during bowel movement lasting several hours. Bowels going from normal to watery to marble size pieces that float. The pain starts after the watery stage. Ending with red blood smears on toilet tissue. Last night 2nd time in 6 months & I went to the ER the first time. Had CT in ER & later my gastroenterologist did a colonoscopy & diagnosed ischemic colitis & also have internal hemorrhoids. I'm never constipated, just the opposite. Dr. started me on Fiber Con tablets for frequent loose bowels & that has helped tremendously. Along with stopping all artificial sweeteners. Guess my question is that I'm just wanting a 2nd opinion as I can't really match my symptoms to what has been diagnosed. Also, a little over a year ago I had a pancreatitis attack. Had CT & MRI & the scope into pancreas & gallbladder, all negative concerning the pancreatitis. MRI found a few diverticula in sigmoid colon & I've had no problem with that. I concluded the pancreatitis was brought on by the Gabapentin I was taking for nerve function & stopped taking it. I don't drink alcohol.

Answered by Dr. Dr. Klerida Shehu (5 hours later)

Brief Answer:
Get to know the causes of ischemic colitis first..

Detailed Answer:
Hi my dear,

I am sorry for the situation you are going through.

Now, you are reporting to have severe cramping/spasms in rectum during bowel movement lasting several hours associated with watery to marble size pieces of stool.

All these are indicative for possible bowel problems:
- internal hemorrhoids are one of the causes as you have noticed blood smears on toilet tissue. Luckily, colonoscopy did not diagnose any other serious problem.

What sounds strange to me is that when you had the MRI one year back, it reported diverticula in sigmoid colon. You are not reporting the existence of such diverticula in the colonoscopy you did this year.

At this point, I kindly suggest to send a copy of your colonoscopy report or the report of any other lab tests you did this year for further evaluation!

- bowel infection can also be the cause, therefore, I suggest to do :
1. fecal occult blood testing
2. examination of stool for ova/parasites
3. culture of stool for pathogenic bacteria/virus/fungus

Depending on the tests results, specific treatment might be prescribed.

- you are reporting ischemic colitis as diagnosed by your GI specialist. That explains your clinical symptoms. Here I need to stop and to advise for further evaluations by your GI specialist.

You need to discuss with him/her "WHY YOU ARE HAVING" it ? (the causes). Many other underlying diseases might cause ischemic colitis.

There might be severe complication of ischemic colitis; that's why you need regular treatment and follow up. As per treatment, apart Fiber con tablets, you need to start oral antibiotic for colitis (infection of colon).

Hope it was of help! Let me know if you need further clarifications!
Dr.Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar