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Ask Dr. Natasha Your Own Question

Dr. Natasha
Dr. Natasha, Doctor
Category: Medical
Satisfied Customers: 11630
Experience:  American Board Certified in Emergency Medicine and Ivy League trained. Medical Review Officer trained in Drug Testing
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Hello- My question involves hemorrhoids. A little less than

Resolved Question:

Hello-

My question involves hemorrhoids. A little less than two months ago my doctor diagnosed me with hemorrhoids and prescribed Proctosol cream. Using that, increasing my fiber and water intake and taking warm sitz baths I've had a bit of relief from the symptoms. But over the last week or so I've developed a number of small cuts around my anus and tonight I experienced a clear discharge from my anus. There is very little pain (mostly skin irritation) and only a tiny amount of blood spotting after a bowel movement. (I usually have one a day, 20-60 minutes after waking up.) Also for more than a week I've had somewhat severe low back pain. Can these things be related? Am I experiencing some kind of infection? Could the hemorrhoids developed into something more serious? My wife has looked at me and said nothing appears to look infected. Other than the above symptoms I feel fine. No constipation, no fever, no weight loss (I have put on about 15 pounds over the last year), no loss of appetite.

I have Crohn's disease and have had two surgeries in the rectal area in the last 7-8 years, one for a fistula and another for a perirectal abscess. My Crohns has been kept under control with diet and I've been largely free of symptoms for nearly a year.

Any advice is much appreciated.
Submitted: 8 months ago.
Category: Medical
Expert:  Dr. Natasha replied 8 months ago.

Dr. Natasha :

hello

Dr. Natasha :

welcome to the chat

Dr. Natasha :

are you still there? hang in the chat

Customer:

Hi.

Dr. Natasha :

did you develop the cuts after a BM/

Customer:

Probably. Some of my spotting has been from the hemorrhoids though.

Dr. Natasha :

when was your last crohns flare up

Customer:

They're in a somewhat odd spot, though. One on the left rim (I suppose) near the anus, the other near my perineum, I think.

Dr. Natasha :

any changes in diet

Customer:

last crohn's flare with constipation was about 3 months ago.

Customer:

More fiber and water. Kind of an uptick in coffee.

Dr. Natasha :

are you still using the cream and doing the sitz baths?

Dr. Natasha :

how about stool softeners

Customer:

Dairy is fairly high. Still doing the baths (about 30 mins ago), Using the cream periodically.

Customer:

Yes, stool softeners on occasion.

Dr. Natasha :

Does dairy cause any diarrhea or digestive issues?

Customer:

No, in fact it hasn't in a long time. I eat only specific types of dairy. No milk, rinsed cottage cheese and other cheeses.

Customer:

No diarrhea in months either.

Dr. Natasha :

Well, the tiny cuts around your anus imply that the anus was stretched a bit when you were having a bm

Dr. Natasha :

and so it caused some small rips in the skin

Dr. Natasha :

This is not life threatening, but it does mean you need to step up the fiber diet, stool softeners and baths on a regular basis- and using the cream

Customer:

Right. Those don't worry me too much. My biggest concerns are the fluid discharge and back pain. When I developed a serious fistula about 7 years ago it was preceded by low back pain.

Dr. Natasha :

The blood spotting is likely from hemorrhoids, because bleeding IBD is much worse

Dr. Natasha :

Now the fecal discharge and back pain may mean that your crohn's is flaring up again

Dr. Natasha :

because you are not digesting your food properly and transiting it through inflammed bowel

Customer:

I had a very bad infection and required emergency surgery that time and so any symptoms like those make me worry.

Dr. Natasha :

of course, I agree with you

Dr. Natasha :

you don't want to sit on this too late.

Customer:

Wouldn't that be accompanied by cramps or constipation?

Dr. Natasha :

The fact that you do not have a fever, weight loss or bloody stool is good, but it may mean that your bowel are acting up

Dr. Natasha :

They can be preceded by back pain and loose stools

Dr. Natasha :

or cramps and constipation

Customer:

But not all of the above all at once?

Dr. Natasha :

It can fluctuate between any of the symptoms

Dr. Natasha :

some people report alternating diarrhea and constipation

Dr. Natasha :

back pain and abdominal pain

Customer:

Right. Thats the frustrating part. Stool has been somewhat "loose".

Dr. Natasha :

clear mucus discharge and even blood discharge

Dr. Natasha :

are you seeing a GI doc?

Customer:

Could it mean an infection somewhere?

Dr. Natasha :

not necessarily an infection- but like inflammation

Dr. Natasha :

infection means bacteria and you need antibiotics

Customer:

Not in quite a while. Saw one back in March but it wasn't a good experience. Plus, I'm unisured

Dr. Natasha :

inflammation means you may need some medication to cool it of.

Dr. Natasha :

*off

Dr. Natasha :

Well, where do you live?

Customer:

What would be prescribed?

Customer:

Las Vegas.

Dr. Natasha :

Let me see if I can find a low cost clinic for you or a free one

Customer:

Wow. Thank you.

Dr. Natasha :

Medications used to treat minor flares are 5-aminosalicylic (5-ASA) drugs, corticosteroids, and for more severe flares- immunosuppressive agents

Customer:

I know stress and lack of sleep also factor into Crohns flares and both have been very present the last few months. So perhaps those are possible causes?

Dr. Natasha :

absolutely

Dr. Natasha :

here are some clinics:

Dr. Natasha :

Clark County Social Services
1600 Pinto Ln.
Las Vegas, NV 89106
(702)(NNN) NNN-NNNN
http://www.clarkcountynv.gov/Depts/social_service/Pages/default.aspx external link
Services: Provides care to low-income individuals not eligible for other public or private programs. Client services include outpatient clinic care, inpatient hospital care, emergency room service, institutional care, adult day care, medical transportation and pharmacy services. Eligibility determination is based upon an assessment of need according to established agency guidelines.

Dr. Natasha :

Community Care Clinic
Open the first & third Friday of each month from 2 p.m. until 4:30 p.m.
1015 S. Cimarron Road
Las Vegas, NV 89145
(702)(NNN) NNN-NNNNbr/>Services: The clinic offers free primary health care treatments for adults only. It is open the first and third Friday of each month and offers a variety of medical services for those who can’t afford it. People can get free referrals to specialty care, free laboratory tests and free prescription drug assistance. The clinic also works with Wal-Mart and CVS Pharmacies for prescription vouchers. The clinic does not require people to prove they can't afford care but would like only the truly needy to use the services. The Southern Nevada Community Foundation sponsors the Community Care Clinic.

Dr. Natasha :

Nevada Health Centers, Inc.
Multiple locations and services available at each clinic. Patients may be able to qualify for a sliding scale fee with proof of income and residence [such as a utility bill, birth certificate and picture ID]. Medicaid, Medicare and NV check-up are accepted.
http://nevadahealthcenters.org/ external link

Customer:

Thank you so much!

Customer:

Thank you so much!

Dr. Natasha :

University Medical Center Lied Ambulatory Care Center
1524 Pinto Lane
Las Vegas, NV 89106
(702)(NNN) NNN-NNNNAdult patients
(702)(NNN) NNN-NNNNChild Patient
www.umcsn.com external link
Services: Primary care including annual exams and treatment for ongoing illness. Appointments are necessary. Most insurance is accepted including Medicaid and pending slips

Dr. Natasha :

Volunteers in Medicine of Southern Nevada
4770 Harrison Dr., #105
Las Vegas, NV 89121
(702)(NNN) NNN-NNNNbr/>www.vmsn.org external link
Services: Volunteers in Medicine of Southern Nevada (VMSN) is a nonprofit, primarily volunteer staffed medical clinic that fosters a “culture of caring” by providing free health care and wellness services to the working uninsured and unemployed residents of Southern Nevada. The following services are provided: adult and pediatric primary care, preventive and acute care, woman’s care, well newborn checkups and immunizations, basic diagnostic tests, medications

Dr. Natasha :

Anyway, these people will be able to get you hooked into the system and on the road to better GI health

Dr. Natasha :

You don't want to wait too long on unusual symptoms- I don't think you need to rush to the ER tonight- I would tell you if I did, but seeing someone sooner than later would be best

Customer:

I really appreciate that.

Customer:

That was my next question.

Customer:

What can I do in the meantime re. the clear discharge and such?

Dr. Natasha :

keep up with what you are doing. Hopefully it will cool down on its own. I would also avoid milk products all together- they tend to worsen diarrhea

Customer:

Been taking Aleve for the back pain but it's not doing much.

Dr. Natasha :

at least for now

Customer:

Coffee as well, I imagine?

Dr. Natasha :

yes.

Customer:

Its my only remaining vice.

Dr. Natasha :

Tea is good :-)

Customer:

Will give that stuff a try ;-)

Dr. Natasha :

and then when you are better you can have a beer :-)

Customer:

Is there anything else I should know until I can see a Dr.?

Customer:

Ha! If I still drank I would!

Dr. Natasha :

If you have black or bloody stool, fever, vomiting or severe pain, then see a doctor...

Customer:

Will keep an eye out. Lately the bm's have been more... bulky(?) in consistency. Just FYI.

Dr. Natasha :

that is probably a good thing, but make sure they are not too hard

Customer:

This is all so embarrassing to discuss. Got to love the internet

Dr. Natasha :

:-)

Customer:

Thanks for your help. You put my mind at ease.

Dr. Natasha :

you are welcome

Dr. Natasha :

I hope that I provided you with excellent service? :-)?

Customer:

Yes. The referrals alone are a great help.

Dr. Natasha :

perfect. I will check in with you in 2 weeks to see how you are... you will get a note from me from the site

Customer:

That's great. Thanks again.

Dr. Natasha :

have a good night

Customer:

I will now. :-)

Dr. Natasha, Doctor
Category: Medical
Satisfied Customers: 11630
Experience: American Board Certified in Emergency Medicine and Ivy League trained. Medical Review Officer trained in Drug Testing
Dr. Natasha and 3 other Medical Specialists are ready to help you
Expert:  Dr. Natasha replied 7 months ago.
Hey Jon- I was checking in to see how you are doing :-)

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