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Dr. Brims
Dr. Brims, U.S. Licensed Physician
Category: Health
Satisfied Customers: 9616
Experience:  U.S. Licensed Physician, general surgery and internal medicine experience
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I have very sporadic pain that appears less than 8

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I have very sporadic pain that appears less than 8 times/year at distant intervals. It is intense pain (not sharp or stabbing) around the anus that weakens me to the point of near fainting. At its worsens, it radiates a dull aching pain across my entire bottom area, but not up into my whole colon. Colorectal surgeon examined me and ruled out fissures. He believes it is not protalgia fugax because they never occur at night and not levator ani syndrome because lying down and relaxing is the only way to get very quick pain relief. I am a frequent public speaker and this is debilating when they occur. Sphincter surgery risks leakage. Colonoscopy ruled out other causes. He recommends nifedipine ointment 2 times per day and perhaps a CT pelvic scan to rule out other causes. Do you have any suggestions?
Dr. Brims :

Hello, welcome to the site! My name is***** will try to assist you with your medical question and any medical information you seek.

Dr. Brims :

I am sorry to hear about this

Dr. Brims :

There is a possibility of a cyst compressing a nerve causing this pain, there is also a possibility it is due to compression of the nerve around the spine

Dr. Brims :

I agree with getting a CT scan, and possibly an MRI as well

Dr. Brims :

Nifedipne ointment twice a day is also a good option, if it is a variant of proctalgia fugax then it would help to use the ointment

Customer:

It would seem that a cyst would be consistent in pain and not something that only surfaces as infrequently as 4 months. I don't see where the constant ointment can be evaluated as a source of relief to something that only occurs so infrequently. There has to be a cause for this and I am confused as to why a surgeon can not diagnose. On the present course, all that he will do is a CT scan that will rule out certain serious diseases.

Dr. Brims :

A cyst may cause pain if it is inflamed and then compresses, it may also leak and cause irritation

Customer:

I am on a very high fiber diet, almost vegetarian. I have very large bowel movements that are like clockwork every day (same time) with no pain whatsoever. No blood, etc. Not runny or hard. The pain began when I adopted this diet, coupled with 1 and 1/2 hours of aerobic exercise per day/7 days/week. (I lost 75 pounds, now weigh 125/normal BMI, and have maintained for over 2 years). I believe that the high fiber diet has a correlation with this. I have excellent health (no diseases, but I have 98% heart calcium score, putting me at high risk for heart attack....hence the necessity to continue my diet/exercise routine and normal weight.

Dr. Brims :

There is a possibility that the pain has a correlation to the diet you are on, but the irritation of a nerve is still the most likely cause in my opinion, and I think that that cause is best determined by imaging, either a CT scan or MRI of you abdomen and pelvis

Customer:

Ok..the surgeon does not believe it is connected to the diet/exercise. I think I will get the CT scan. Do you believe it should be CT or MRI?

Dr. Brims :

I think a CT scan first, because it is cheaper, faster and easier to get

Dr. Brims :

If the CT scan shows nothing then an MRI would be next

Customer:

Ok...I will likely have to pay for these personally, in spite of the fact I have both primary and secondary PPO insurance coverages. At least this is what he mentioned. I am willing to pay if I think it can determine the cause. I fear there may be no treatment option. But, if a cyst, it can be treated. Thanks for your thoughts.

Dr. Brims :

You're quite welcome

Customer:

Goodbye

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