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Dr Uzair
Dr Uzair, Doctor
Category: Medical
Satisfied Customers: 8051
Experience:  MBBS, FCPS (R) General Surgery. Years of experience in Emergency Medicine.
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67 year old woman with anal paing that had been ongoing

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67 year old woman with anal paing that had been ongoing since June. I have faithfullly use Rectiv ( two tubes ) since June but I have pain and burning is the internal fisrt two inches of my rectum.
Hi. Welcome to JustAnswer. I shall try my best to assist you while you are corresponding with me.

Q. Is the pain associated with bowel movements?

Q. Do you have any constipation or diarrhea?

Q. Do you experience any bleeding per rectum before or after a bowel movement?

Q. Have you lost weight or have you lost appetite?

Q. Is the pain dull aching or sharp and stabbing?
Customer: replied 3 years ago.

No to all the questions except the last one . The pain is a burning sensation. I do not have hemmorides and if it is an anal fissure I have no symptoms of it. I have regular bowl movements and do not participate in anal sex. I use Reciv 2x per day. The pain is at it's mimimum upon rising in the AM and is at its worse just prior and after going to bed.

Q. Have you had an anal examintion by a physician?
Customer: replied 3 years ago.

In June when this started I went to a PA who put me on suppotories. When this did not help she referred me to a Gastrointerologist (sic) . He examined me digitally and although he did not see a fissure he thought that was what it was. He prescribed Rectiv. I have used two tubes of that and have not had relief. I will be returning to the Gastrointerologist next week.

This is interesting as will probably be the future of medicine with the intro of ACA and the fact that doctors will not be available. My family doctor has already retired at the age of 52 because he did not want to mess with all the rules.. He just wanted to treat patients.

I consider my health excellent other than the anoying burning.

Thanks for the reply.

I understand that you have been examined by a doctor digitally, but digital examinations are not sufficient to rule out conditions like haemorrhoids, they can only rule out fissures and masses located within the first 4 centimeters of the anal canal where the finger can effectively penetrate.
Burning sensations in the anal canal means that there is something below the dentate line - a demarcation between the lower 1/3rd of the anal canal which is sensate and feels pain and part above it which is not sensitive to pain and other sensations. Haemorrhoids are the most common cause, however other causes are polyps, local inflammatory conditions and infections and parasitic infestations especially with the enterobius vermicularis (pin worm), which comes out at night to lay eggs near the anal verge which cause an inflammatory reaction and burning especially in the AM (likely in your case).
Another cause is Proctalgia Fugax, which is anal pain caused by spasm of the pelvic muscles and anal sphincters.
Your Gastroenterologist can help you diagnose all these conditions but I urge that you get done a proctoscopy this time, which is a way of visualizing the anal canal and the rectum by putting a small scope inside.
Other than that you should also get done a stool routine examination and a stool culture test and a stool test for ova and cysts. A full blood count and ESR to rule out presence of an active inflammation or infection.
All the above mentioned conditions are benign and not serious and treatment can effectively boost your quality of life.
Hope this helps.
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