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Forum Name: Gastroenterology Topics

Question: urinary hesitancy/painful defecation/distended abdomen


 aircrew1982 - Mon Jun 28, 2010 5:37 pm

I have had the following symptoms for 1 1/2 weeks now. Urinary hesitency, Painful defecation, and distended abdomen. originally thought was hemmorroids and treated as such but no relief found. Now a new symptom of numb/tingling feeling in my scrotum. When present to ED they say no infections based on labs and nothing noticable on CT. I am a 27 yo male. Could someone please help me with something since the physicians here seem stumped.
 Dr.M.Aroon kamath - Thu Jul 01, 2010 6:37 am

User avatar Hi,
I gather from your profile that you are 27 years old and were diagnosed with Hirschsprung's disease in 2009. You also have diabetic peripheral neuropathy.You have not indicated whether you had undergone any surgery for Hirschsprung's disease.

Hirschsprung's disease (HD) in adults is rare and often undiagnosed or misdiagnosed.The actual frequency of adult HD is unknown.Therefore, it is quite probable that adult HD is more common than previously recognized .

Adult Hirschsprung disease (HD) comes under the broader group of diseases known as "dysganglionoses".

"Dysganglionoses" include the following entities.
- Adult hypoganglionosis (HG)
- Hirschsprung disease (HD) &
- intestinal neuronal dysplasia.

Histopathologically, aganglionosis (HD) of the rectum or colon characteristically manifests during infancy or childhood. Milder forms of this disease may go undiagnosed and progress to adulthood, presumably due to compensatory changes that occur in the colon proximal to the distal obstructed segment. Patients learn to manage this condition by using bulk formers, cathartic agents, and enemas. At a later stage(during adulthood),the dilated proximal colonic segment decompensates and patients may experience rapidly worsening constipation or even acute colonic obstruction.

Ulcerations of the colonic wall caused by hard fecal matter may even result in colonic perforation and fecal peritonitis with serious consequences (even mortality).

Hypoganglionosis (HG), is characterized by scarce ganglionic nerve cells and a reduced number of parasympathetic nerves in the intestinal wall. Its presentation may mimic that of HD.

The hesitancy,tingling and numbness in the scrotum may be caused by diabetic distal autonomic neuropathy and result in bladder dysfunction. Diabetic neuropathy can occur type 2 diabetics and also in type 1 diabetics (generally, >5 years following the diagnosis).
Best wishes!
 aircrew1982 - Thu Jul 01, 2010 4:57 pm

no sir, i have not had any surgery for my hirschprungs diagnosis. i recently even had to go to the ED to have a cath inserted to empty my bladder. they did not leave it in and said i may be having bladder spasms caused by my diabetes. i was given cipro even though they said there are no signs of infection and take it as directed (1 tab po bid). this is getting really frustrating and all of the physicians that i have seen are stumped on what to do. i do not have health insurance and rely on indian health service which is limited by resources to get me to specialists.
 Dr.M.Aroon kamath - Sat Jul 03, 2010 11:03 am

User avatar Hi,
You did not mention in your first post that you had a catheter inserted. May be it happened later on. The problem is begining to look more and more like a diabetic distal autonomic neuropathy.
For the present you need to consult your family physician and see to it that your glycemic control is optimized and urinary tract infections (UTIs) excluded. If your problem should continue despite this, then full urodynamic work-up may become inevitable.
Good luck!

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