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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35454
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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This question is for doctor with diabetes familiarity. Had

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Hello, this question is for doctor with diabetes familiarity. Had fissure twelve months although last four months healed. Despite this pain remains and decided to have lateral int sphincterotomy five weeks ago. Again pain remains. Only possibility now I understand is nerve damage. I am type 1 diabetic. How likely is it that this could be diabetic neuropathy caused by initial scar from fissure? Now getting worried that lis has weekened sphinc muscle and read that neuropathy in rectum usually leads to incontinence. Help gratefully welcome. Thks

Hello Chris,

I am back again and we have discussed your pain earlier also. An isolated diabetic neuropathy is though known but is exceedingly rare. Pelvic floor electromyography and nerve conduction velocity study are good investigation to confirm or rule out neuropathy. So you may contemplate this work up. Meanwhile your doctor can consider Pregabalin or Gabapentin for the treatment. I would also recommend anal manometry to see the sphincter spasm and if there is increased spasm, one may consider Biofeedback which help in decreasing the anal sphincter tone.

Please feel free for your follow up questions.

Dr. Arun

Customer: replied 6 years ago.
Dr arun , forgive my regular questions on same issue but when you are in pain day after day after day you get rather desperate. Your proct fugulax suggestion I cannot accept because the symptoms don't match mine at all. My pain is there constantly ranging from bad pain to unbearable pain. Tonight I am at my wits end. I am a rational positive thinking man but i have nothing left to deal with this mentally. I am beginning to have dark thoughts because I see no hope. I have had sphincterotomy that I didn't need which may have longer term implications. The pain gies on hour after journey despite nothing being visible. The diabetic neuropathy came from a suggestion from friend who is a doctor. She I'd Jo expert on colorectal issues and I want to rule out. I am feeling tonight more desperate than I have felt in my life. It's unfair for me to ask you for some hopeful advice but pls give options in what are the only things it can be. Vissibly things look ok. MRI also ok. Is this pain for the rest of my life.

Hello Chris,

I can understand about the continuous nagging painful sensation and since this is going on for so long, understandably this is very annoying. One of reason of this kind of pain is pelvic floor problems and weakness. One of the cause to be considered for your pain is levator ani syndrome. Ask your physician to consider this entity. Following investigations are done to confirm the diagnosis;

1) defecography,

2) pelvic MRI (already done for you)

3) nerve-conducting velocities and needle-electromyographic studies are used to help evaluate compression or entrapment neuropathy and pelvic floor function.

The treatment is following;

1) electrogalvanic stimulation,

2) biofeedback training,

3) digital massage of the levator ani muscles

4) sacral nerve stimulation

5) physical therapy for the pelvic floor muscles

Pelvic congestion syndrome, Pelvic floor relaxation disorders, Pelvic floor dysfunction too need to be considered for the pain. Though treatment is essentially same. Another entity to consider for your pain would be chronic regional pain syndrome. Apart from the above treatment we had discussed; medications like Gabapentin and Pregabalin are helpful.

It is privilege assisting you.

Dr. Arun

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