[20F] Experiencing recurrent rectal and abdominal pain

Patient Description

A 20-year-old female reports experiencing sharp, recurrent rectal pain and abdominal pain at the bottom of the stomach. These pains have been present on and off for years but have recently returned with greater intensity. The patient notes that the pain is particularly severe when coughing, sneezing, or sitting down, and is exacerbated by masturbation. Touching or washing the affected area also causes discomfort. No bleeding with bowel movements or changes in bowel habits have been reported. The patient's menstrual cycle is normal, and there are no additional symptoms such as fever, weight loss, or changes in sexual health. The patient has a history of asthma and allergies and is currently taking Symbicort, albuterol, Flonase, Claritin, and montelukast. No known drug allergies or adverse reactions to medications have been mentioned.

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Arora's Assessment

What might be happening

Based on the information you've provided, possible diagnoses include:

  • Hemorrhoids: These are swollen veins in your lower rectum and anus. They're fairly common and can cause pain, discomfort, and anal itching. They can be internal or external, and symptoms can vary depending on their location.

    • Treatment typically involves over-the-counter creams, ointments, pads, or suppositories. In more severe cases, minimally invasive procedures or surgery may be needed.

  • Anal fissures: These are small tears in the thin, moist tissue that lines the anus. They can cause pain and bleeding during bowel movements. You mentioned that you don't have any bleeding, but the pain you described could be consistent with an anal fissure.

    • Treatment typically involves topical creams to relax the muscle around the anus (sphincter). In some cases, surgery may be needed.

  • Endometriosis: This is a disorder in which tissue similar to the tissue that forms the lining of your uterus grows outside of your uterine cavity. It can cause pain in the lower abdomen, rectum, or pelvis, especially during menstruation or sexual intercourse.

    • Treatment typically involves medication to manage pain and hormonal therapy to slow the growth of endometrial tissue. In severe cases, surgery may be needed.

  • Pelvic inflammatory disease (PID): This is an infection of the female reproductive organs. It can cause lower abdominal pain and pain during intercourse. It's usually caused by sexually transmitted bacteria.

    • Treatment typically involves antibiotics to eliminate the infection.

What you can do

It would be best to consult a doctor about your symptoms so that they can provide a formal assessment and order relevant tests if necessary. In the meantime, you can try the following to relieve your symptoms:

  1. Over-the-counter pain relievers: Non-prescription medications like ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others) can help relieve pain.

  2. Warm baths: Sitting in a warm bath can help soothe the anal area and may help reduce pain and discomfort.

  3. Avoid straining during bowel movements: Straining can worsen hemorrhoids or anal fissures. Try to avoid constipation by eating a high-fiber diet and drinking plenty of fluids.

What you should look out for

Reasons to see a doctor more urgently:

  • If you notice blood in your stool or develop severe abdominal pain
  • If your symptoms worsen or do not improve with home care
  • If you develop a fever or chills

Please remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for appropriate examination, testing, and care recommendations.

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9 mo ago

People Also Ask

What are the common symptoms of hemorrhoids and how can they be treated?

Common symptoms of hemorrhoids include pain, discomfort, itching, and swelling around the anus. They can be treated with over-the-counter creams, ointments, pads, or suppositories. In more severe cases, minimally invasive procedures or surgery may be needed.

How can I differentiate between anal fissures and hemorrhoids?

Anal fissures are small tears in the anal lining and typically cause sharp pain during bowel movements and possible bleeding, whereas hemorrhoids are swollen veins that may cause itching, discomfort, and swelling. A healthcare provider can help differentiate between the two through an examination.

What are the potential causes of recurrent rectal and abdominal pain in young women?

Potential causes of recurrent rectal and abdominal pain in young women include hemorrhoids, anal fissures, endometriosis, and pelvic inflammatory disease (PID). Each condition has distinct symptoms and requires specific treatments.

How can endometriosis affect abdominal and rectal pain, and what are the treatment options?

Endometriosis can cause pain in the lower abdomen, rectum, or pelvis, especially during menstruation or sexual intercourse. Treatment options include pain management with medication, hormonal therapy to slow tissue growth, and surgery in severe cases.

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