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What Does This MRI Report Indicate?
Question: Hello Doctor,
Recently I saw a proctologist at Sir XXXXXXX XXXXXXX hospital. He told me to get my MRI reviewed at their MRI Department. Their report says : There is evidence of subtle oedema seen in the internal sphincter between 5 to 7'o clock position approximately 2.1 cm from the anal verge a suggestive of residual inflammatory changes however no evidence of any well defined internal opening or perianal fistula/collection seen.
The doctor then prescribed me Chymoral Forte DS thrice a day for 10 days.
For the first 4-5 days I felt improvement in pain and hardness/swelling but then again the pain came back.
After 10 days I again went to the doctor who did a DRE and pinpointed the exact location of the pain. After DRE he suggested that there might be a fissure or a residual fistula left. He is also suggesting that maybe the internal opening of my fistula was not treated at the time of my surgery or might be a new internal opening has now formed. He has now prescribed Anobliss gel and Metrogyl gel and also told me to get anal manometry done. He has told me that if my problem does not improves I might require another surgery to treat the residual fistula.
I would again like to share my symptoms with you so that u can correlate.
I feel pain at the area where the wound got closed after the surgery. I can also feel a cord like hardness/ swelling near the same area. I also feel a throbbing spas sometimes.
I would like to know your opinion as to if my problem persists should I consider another surgery. Also I strongly believe that it is the scar tissue that is giving me problems. Also can u please suggest if another surgery will also not cause these kind of troubles because when I decided to get the surgery done at the first place I thought that my problem will be resolved but it has only worsened.
Regards
Recently I saw a proctologist at Sir XXXXXXX XXXXXXX hospital. He told me to get my MRI reviewed at their MRI Department. Their report says : There is evidence of subtle oedema seen in the internal sphincter between 5 to 7'o clock position approximately 2.1 cm from the anal verge a suggestive of residual inflammatory changes however no evidence of any well defined internal opening or perianal fistula/collection seen.
The doctor then prescribed me Chymoral Forte DS thrice a day for 10 days.
For the first 4-5 days I felt improvement in pain and hardness/swelling but then again the pain came back.
After 10 days I again went to the doctor who did a DRE and pinpointed the exact location of the pain. After DRE he suggested that there might be a fissure or a residual fistula left. He is also suggesting that maybe the internal opening of my fistula was not treated at the time of my surgery or might be a new internal opening has now formed. He has now prescribed Anobliss gel and Metrogyl gel and also told me to get anal manometry done. He has told me that if my problem does not improves I might require another surgery to treat the residual fistula.
I would again like to share my symptoms with you so that u can correlate.
I feel pain at the area where the wound got closed after the surgery. I can also feel a cord like hardness/ swelling near the same area. I also feel a throbbing spas sometimes.
I would like to know your opinion as to if my problem persists should I consider another surgery. Also I strongly believe that it is the scar tissue that is giving me problems. Also can u please suggest if another surgery will also not cause these kind of troubles because when I decided to get the surgery done at the first place I thought that my problem will be resolved but it has only worsened.
Regards
Brief Answer:
Please post the actual report.
Detailed Answer:
Hi.
Thanks for the feedback and the query.
MRI of the affected area done was the best thing, as I suggested many a times in the initial discussions as it clears many a doubts and helps in planning the management.
Since the MRI shows subtle edema - internal sphincter - 5-7 O'clock - 2.1 cm away from anal verge - s/o residual inflammatory changes - but NO evidence of internal opening/ perianal fistula or collection - DRE confirms the area - understood the opinion of the Surgeon at Sir Gangaram Hospital - the prescrition of oral and local medications -
As per the report you have mentioned, there looks to be scar tissue with the edema but it is 2.1 cm away from the anal verge. This can cause the irritation, reflex spasms, instigated by the peristaltic movement of the distal colon and rectum while passing stool as you do not have any pain the movement you get up, starts only during/after passing stool.
The medications may help you, please complete the course of stipulate period.
Since there is no definite collection, surgery may not be required at the moment.
Please post the scanned copy of the MRI report in full so that I too can understand the problem better.
Please post the actual report.
Detailed Answer:
Hi.
Thanks for the feedback and the query.
MRI of the affected area done was the best thing, as I suggested many a times in the initial discussions as it clears many a doubts and helps in planning the management.
Since the MRI shows subtle edema - internal sphincter - 5-7 O'clock - 2.1 cm away from anal verge - s/o residual inflammatory changes - but NO evidence of internal opening/ perianal fistula or collection - DRE confirms the area - understood the opinion of the Surgeon at Sir Gangaram Hospital - the prescrition of oral and local medications -
As per the report you have mentioned, there looks to be scar tissue with the edema but it is 2.1 cm away from the anal verge. This can cause the irritation, reflex spasms, instigated by the peristaltic movement of the distal colon and rectum while passing stool as you do not have any pain the movement you get up, starts only during/after passing stool.
The medications may help you, please complete the course of stipulate period.
Since there is no definite collection, surgery may not be required at the moment.
Please post the scanned copy of the MRI report in full so that I too can understand the problem better.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Thanks for the report
Detailed Answer:
Thanks for the original report, says the same as you have mentioned and as we are discussing.
Since there is no collection the chances of recurrence at the moment are nil.
Anobliss should reach the area of inflammation. Use the applicator judiciously so that the ointment reaches the affected area.
Continue Chymoral Forte DS and other medicines as you have noted.
Let us see the results.
Thanks for the report
Detailed Answer:
Thanks for the original report, says the same as you have mentioned and as we are discussing.
Since there is no collection the chances of recurrence at the moment are nil.
Anobliss should reach the area of inflammation. Use the applicator judiciously so that the ointment reaches the affected area.
Continue Chymoral Forte DS and other medicines as you have noted.
Let us see the results.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
One more thing i want to tell you that whenever i get a DRE done the whol day is really painful for me.
Should i use metrogyl gel in the day and anobliss in the night or should i only use Anobliss twice .e
Should i use metrogyl gel in the day and anobliss in the night or should i only use Anobliss twice .e
Brief Answer:
Anobliss early in the morning
Detailed Answer:
It would be better to apply Anobliss early in the morning, preferably before passing the stool so that it becomes most effective.
Apply Metrogyl gel at night.
Anobliss early in the morning
Detailed Answer:
It would be better to apply Anobliss early in the morning, preferably before passing the stool so that it becomes most effective.
Apply Metrogyl gel at night.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Can i use finger to apply anobliss or using the applicator will be most effective.
I tried using applicator and it was a little painful.
Any tips you can give to use applicator
Regards
I tried using applicator and it was a little painful.
Any tips you can give to use applicator
Regards
Brief Answer:
As discussed in details below.
Detailed Answer:
If the anal applicator is available with the tube smear the anal area with small amount of ointment to make insertion of the well lubricated end to be inserted into the anus, the direction should be towards umbilicus as this is the natural course of anal canal.
Insert about one and half cm inside slowly and carefully and press a bit on the tube while gradually withdrawing with tube out so that the quantity is well smeared inside the anal canal where the lesion is found on MRI.
Try this and let me know whether this suited you.
The ideal direction towards the umbilicus is not painful at all.
Application or pushing in with finger may not allow the ointment to reach the targeted area.
Putting in finger will be painful and not yet as effective.
As discussed in details below.
Detailed Answer:
If the anal applicator is available with the tube smear the anal area with small amount of ointment to make insertion of the well lubricated end to be inserted into the anus, the direction should be towards umbilicus as this is the natural course of anal canal.
Insert about one and half cm inside slowly and carefully and press a bit on the tube while gradually withdrawing with tube out so that the quantity is well smeared inside the anal canal where the lesion is found on MRI.
Try this and let me know whether this suited you.
The ideal direction towards the umbilicus is not painful at all.
Application or pushing in with finger may not allow the ointment to reach the targeted area.
Putting in finger will be painful and not yet as effective.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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