Anal stenosis (narrowing of the opening of the anus) - Help!

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minnietoty
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Date Joined Dec 2010
Total Posts : 1754
   Posted 11/24/2011 7:49 AM (GMT -7)   
More than two weeks ago, I developed constipation despite suffering from D. I did have D but I could not pass stool easily and used to use stool softeners. I did post then at this forum asking for help and a lot of fellow Crohnies answered thankfully that it is normal to have D. My main problem is chronic proctitis and I need to use steroid enemas. However, I could not insert it. So, I saw my doc and he decided that I should stop taking any kind of enemas to relieve the rectum.

Two days ago, the proctitis pain returned and I know very well that if I leave it untreated, a flare up begins. I took the steroid enema and it was a torture. So, I saw my rectal surgeon, he examined me and told me that I have narrowing of the opening of the anus because of scarring of fissures, prescribed gtn (glycerine trinitrate) 4 times/day for 4 days, stop any enemas and call him after these 4 days. I browsed the net and found that this narrowing is called anal stenosis and it requires a lot of times surgery.

My proctitis started to be more painful. So, I have two questions:
1. I'm afraid of leaving the proctitis untreated as proctitis flare up take a long of time to be treated and require a lot of meds which irritate my stomach. Is there anything I can do to prevent proctitis relapse?
2. Has anybody been through this before? How was it treated?

Your replies are highly appreciated.
Thank you.
Minnie
_______________________
Current meds: Pred (5 mg tapering), Entocort 3mg, Methotrexate 25 mg im inj/week, Pentasa tablets 3g, Nexium 80, an anti-ulcer med 1x3, folic acid, weekly B shot and mulivitamins.

firecracker1
Regular Member


Date Joined Apr 2007
Total Posts : 208
   Posted 11/24/2011 8:32 AM (GMT -7)   
So sorry you're going through this. I don't have any tips or advice because I have never had to deal with such an issue. Hopefully someone will be able to reply with some advice. Hang in there!
Meds: Methotrexate injections 1x a week, zoloft, gabapenten.

Crohn's Disease with a failed seton placement for fistula, 2 perforations, 1 small bowel resection. Technically in remission, but still feel sick. Have joint pain, muscle pain, fatigue, nausea, D, and abdominal pain & cramping; recently diagnosed with Crohn's arthritis and gastritis.

Roni
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Date Joined May 2003
Total Posts : 2480
   Posted 11/24/2011 9:00 AM (GMT -7)   
minnietoty, I have issues with my rectum/anal area too, but mine *usually* resolve fairly quickly if I keep applying Cortate, take sitz baths, chamomile, probiotics, and make diet changes, especially when flaring horribly. Eating very plain easy to digest food or homemade soups makes things easier too.
It is so painful having issues in that area, and I'll have to remember to ask my GI for a suppository again. I also have colon and rectum spasms and roids which are quite painful too. Do you have those as well?
Co-Moderator for Crohn's Disease and Epilepsy forums.
Crohn's Disease since the 1990s.
Close family member has had epilepsy for more than 45 years.

minnietoty
Veteran Member


Date Joined Dec 2010
Total Posts : 1754
   Posted 11/24/2011 9:34 AM (GMT -7)   
Firecracker, thank you for the get well wishes.
Roni, thank you very much. Yes, I do have colon and rectal spasms. But this pain is different from that of anal fissures and proctitis. It's something in between. I still have a problem in having a bowel movement and can't sit. It feels as if there is something hard in the beginning of my rectum. I'll wait for the 4 days of treatment and then call the surgeon.
Take care!

Roni
Veteran Member


Date Joined May 2003
Total Posts : 2480
   Posted 11/24/2011 9:45 AM (GMT -7)   
That might be the same feeling I get in my rectum. Honestly, it feels like something big is in there, but there is no stool or anything (Sorry, all, I know that's graphic and gross). Does it sound the same as what you get?
For me, I'm pretty sure it's related to flaring roids, spasms, inflammation, etc. I had it so horribly just last week that I could hardly walk and lying down didn't even help, so I got into the tub ASAP and loaded it with epsom salts.
Tylenol didn't help much that time, so if that happens again, I'm going to take something a little stronger like tylenol 1.
Co-Moderator for Crohn's Disease and Epilepsy forums.
Crohn's Disease since the 1990s.
Close family member has had epilepsy for more than 45 years.

minnietoty
Veteran Member


Date Joined Dec 2010
Total Posts : 1754
   Posted 11/24/2011 3:04 PM (GMT -7)   
Roni, I always feel that I have a stabbing pain in the rectum that makes me unable to stand. Yesterday, I woke up with severe rectal pain and i had important work and couldn't call absent. So, I thought that it might be proctitis and took my steroid enema. It was painful so that's why I saw the surgeon. Whenever I have this feeling I take an enema: either steroid or pentasa and the pain is relived. But now I can't.
Does tylenol help you? No painkiller whatsoever relieves the pain.
Take care!

keepingfaith
Regular Member


Date Joined Nov 2011
Total Posts : 360
   Posted 11/24/2011 7:44 PM (GMT -7)   
Is the pain like tenesmus, also, minnietoty? I find that taking warm baths, using hydrocortisone cream/suppositories help with the spasms and inflammation! On those days where I just can't take it and I feel like I have to 'D' but it wont come out I use the hydrocortisone cream and use a 'butt paste' after appling that and I usually have a BM fairly soon. I take the cortisone suppository 2 times a day because the Canasa ones haven't been cutting it. My GI suggests when the inflammation is bad an I'm 'constipated' (tenesmus) to just take a half dose of miralax and go on with the usual med routine and that helps a lot!
 
   When all else fails I take tylenol and maybe a lortab...I'm not big on pain medication but ya gotta do what ya gotta do sometimes. Tylenol does nothing  for me though when everything is swollen shut..
 
 
  Hope the pain/inflammation subsides and you can get in touch with your GI asap! Happy holidays :-)
Current medicine:-Flagyl, amoxicillin(sp?), Apriso, Remicade(Hoping this will be a miracle drug!), Hydrocortisone suppository, Prednisone (Tapering due to being steroid refractory), Zantac, Prilosec, Pain medication as needed, Zofran as needed & a few more that I can't remember.
Tried:
- Asacol

In current flare since February 2011

Roni
Veteran Member


Date Joined May 2003
Total Posts : 2480
   Posted 11/24/2011 9:23 PM (GMT -7)   
minnie, tylenol is pretty much all I take because the other pain killers are too strong for me. And no, it doesn't help enough, but it's better than nothing.
Co-Moderator for Crohn's Disease and Epilepsy forums.
Crohn's Disease since the 1990s.
Close family member has had epilepsy for more than 45 years.

minnietoty
Veteran Member


Date Joined Dec 2010
Total Posts : 1754
   Posted 11/25/2011 6:18 AM (GMT -7)   
Keepingfaith and Roni, Happy Holidays.

Keepingfaith, thank you very much. I always thought that anal problems are the responsibility of a surgeon but yes I think that i have to contact my GI. They both tell me that they have to cooperate together in treating me but when I consult the GI alone, the surgeon gets upset. I like the idea of hydrocortisone suppositories very much and hope he will prescribe it. I'm just worried would this narrowing get wider by medication or does it require any kind of surgery? I remember that my GI warned me against any anal surgeries as this might cause incontinence. This gtn causes me severe headache and I skip taking it every 6 hrs. I just take it twice per day instead of 4. Also, I can't take any painkillers for the headache because of my stomach problems.

Roni, mild painkillers stopped working for me altogether and my GI has difficulty in finding me stronger ones as I got used to all types of painkillers.

Take care!

ep49
Regular Member


Date Joined Apr 2010
Total Posts : 171
   Posted 11/25/2011 1:02 PM (GMT -7)   
I also have stenosis in my rectum.  It's been a nightmare for me because I have to constantly watch what I eat and take laxatives everyday.  I strained so much one day to move my bowels that I must have torn something and began vomiting and almost passed out from the pain. Afterwards, I had a lot of bleeding.  I have been told that there is no surgery for me other than a proctocolectomy with an ileostomy.  I'm not ready for that, so in the meantime, I have been going to the OR and getting dilated.  I am due in a few weeks for another dilation and the doctor will also inject steroids into the tissue to see if it helps. I also get a lot of rectal and abdominal pain from the pressure and the straining and cortisone suppositories do help relieve a lot of that discomfort for me, and they are easier to insert than Canasa suppositories. I lubricate the opening and also run the suppository under hot water to soften it a little before insertion. 

minnietoty
Veteran Member


Date Joined Dec 2010
Total Posts : 1754
   Posted 11/25/2011 1:57 PM (GMT -7)   
Ep 49,
Thank you very much. Things are not going on well. Normally, I have 4 or 5 bowel movements a day or even more but now I can't. I keep straining without any effect. I don't know how to act. To top it off, I have severe cramps and need to defecate. That's really horrible.
You mentioned the dilation issue, is this going to be regular? Is it painful? I'm ready to bear any pain but don't have this awful feeling. I want my normal D again.
Take care!

ep49
Regular Member


Date Joined Apr 2010
Total Posts : 171
   Posted 11/25/2011 4:52 PM (GMT -7)   
Minnie,
The dilations are being done regularly, and so far I have had one done in June by a colorectal surgeon, in the OR under general anesthesia. Then my GI told me he stretched it again during a sigmoidoscopy in September, but that was under conscious sedation and I remember waking up from the pain. So now I am scheduled again with my GI doctor in a few weeks, in the OR, for a balloon dilation under general anesthesia so that I feel nothing. He will inject steroids this time too, so I'm praying and keeping my fingers crossed that I can get some longer lasting relief. Maybe I'm praying for a miracle but I don't know. All I do know is that I'm not ready for major surgery and an ileostomy and am just taking it one day at a time. Good luck.
Diagnosed 8/2009 with proctitis and left sided UC
Diagnosis now changed to Crohn's disease
Lialda, 3 pills once a day but switching to biologics soon
Suffer from rectal stricture which was dilated 6/11

minnietoty
Veteran Member


Date Joined Dec 2010
Total Posts : 1754
   Posted 11/26/2011 4:08 AM (GMT -7)   
Ep49,
Thank you. Now, I started to get anxious about this dilation issue. I had a bowel movement without trying to strain but the pain was horrible afterwards. I wake up out of pain and take this gtn ointment. I have to wait for more than 2 days and then call the surgeon and see what he thinks.
Hope things get better for you and the steroid effect lasts long:)
Take care!

ep49
Regular Member


Date Joined Apr 2010
Total Posts : 171
   Posted 11/26/2011 12:14 PM (GMT -7)   
Please keep us all posted, minnie. I would definitely like to know how you're doing seeing we're kind of in the same boat.  Again, good luck, and try not to worry too much. 
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