narrow stools, bulge in anal area, some discomfort

[mostlyhealthy]

I am a 46 yo female and I consider myself to be fairly healthy except for the issues I have had for about 2 years. I rarely have any tummy issues - only the occasional constipation (rare) or diarrhea or tummy ache that never lasts.

About 2 years ago, I started to have a tiny bit of bright red blood on my tissue and I was diagnosed with hemorrhoids. Then about a year maybe 15 months ago, I began to have narrow stools. About 6-9 months ago I noticed a bulging out in the area of my rectum. I was given a prescription for rectal suppositories and that sometimes helps - the bulging will go down for a while.

I had a colonoscopy in July 2008 under general anesthesia, resulting in a diagnosis of external hemorrhoids (they didn't look big to me, I was told because of the air pressure) and 3 small polyps were found to be benign. Three providers (a PA & 2 MDs) looked at the photos and found nothing alarming.

For about the past 3 months, I've noticed a pain to the left and near the bone I sit on that comes and goes and it doesn't seem to be associated with anything other than perhaps I notice it more after I've been sitting for longer than an hour. Also for about 3 months, I notice that sometimes my bowels don't empty completely the first time - sometimes I have to go to the bathroom a second or third time, although the third time is less common.

In September 2008, I had a pelvic ultrasound to rule out the cause as coming from the history of uterine fibroids I've had for over 4 years and the fibroids are no different than they were a year or two ago - same number (4) and same size (forgot the size) and much smaller than 4 years ago. I have a history of heavy bleeding but not since last year in April and only in April. Prior to that, my heavy bleeding period started in February 2003 through March 2005.

In the past month, I've noticed that the rectal pain is sometimes more than just a mild discomfort - the pain is progressing beyond mild discomfort.

One of my first cousins had a "tipped" uterus and had surgery (I think a hysterectomy) and I asked my doctor if that could be my problem but I was told that the condition is not hereditary. She also had a history of hemorrhoids - she's a cousin on my father's side of the family.

Although I don't eat as much salad and fresh fruits as I used to, my diet is balanced and good, I try to drink 8-10 glasses of water every day, rarely drink soda (history of diabetes in the family but not in me), get some amount of exercise going up and down stairs both at home and at work many times every day, have a desk job but I have to go up and down stairs frequently every day, I take a multivitamin almost every day, rarely drink alcohol, no drug use, although I started smoking again 6 weeks ago after not smoking for 17 months (smoked for 4 years before that and didn't smoke for 6 years before that).

In the past 5 weeks I have lost 10-15 pounds but that is because I'm eating smaller portions and occasionally skip breakfast. I thought losing some weight would relieve pressure in my abdomen - if that's the cause of the bulging. I'm about 5'2" and 145-150 pounds but I don't appear "chunky" (maybe my bones are heavy - lots of dairy in my diet).

My maternal grandaunt died of colon cancer but that's the only colon cancer in the family I'm aware of. My father had hemorrhoids many years ago and had to have them excised and he hasn't had a problem since. I'm concerned - should I be seen by a specialist?

[John Kenyon, CNA]

Hi there -

If you weren't seen by a gastroenterologist before or during the colonoscopy then yes, you should be seen by a specialist in the area of concern. However, the colonoscopy should have been signed off by a GI specialist, and was fairly recent. The fact that you had external hemorrhoids should have been apparent on visual exam and those wouldn't be affected by the air pressure from the procedure -- but internal ones would. Internal or external ones will sometimes bleed, so might account for the frank blood on the tissue. Still, if you haven't had an actual sit-down consult with a gastroenterologist you should have one. I suspect the pain you describe (near the tail bone) may be a condition called proctolagia fugax, and if so it can be quite painful. It is a poorly understood phenomenon commonly believed to only occur during sleep (and often waking the patient because of the sharp pain) but it can often take place during waking hours as well or even instead. There's no specific treatment for this that I know of, but it's of no consequence, either. However, it may be triggered by the presence of hemorrhoids. Since you've had the colonoscopy (and so been given a "passing" grade by some gastroenterologist) you might want to try being seen by a proctologist instead (one who deals mainly with the last part of the GI tract). Either specialist would probably be appropriate, and I do think you should be seen by one or the other, if only to put your mind at ease. It sounds like a fairly simple problem, but chronic discomfort is plenty reason enough to be seen and treated or at the least reassured. The matter of the narrow stools is often considered a red flag for lower GI disease, although it can also be caused by internal hemorrhoids. I think this alone warrants a further examination of the area to rule out anything untoward.

I hope this is helfpul to you. Best of luck and please don't hesitate to follow up with us here as needed.