Pelvic Pain Support Network
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Info needed re pain relief suppositories (for anal pain associated with rectocele)

Hi,

Apologies for the 'too much information' that follows, but I'm desperate for advice re pain relief - preferably in suppository form - for the following (I am in the UK)...

I've got a rectocele which I've been coping with relatively ok for the last 7 years - I eat a lot of fibre and have to 'splint' my perineum with my fingers to be able to poo. However, just over 5 weeks ago, during a strong bowel movement, I suddenly got severe pain in my rectum/anus (which nearly sent me through the roof) and ever since then I've been in a lot of pain (it feels like I've got a burning golf ball up my backside). It hurts all the time and only gradually lessens a bit when I'm lying on my side in bed at night (so, thankfully, atm I'm managing to get some sleep, but the pain is gradually getting generally worse, so I fear it's going to be only a matter of time before I'll be in pain all night too.) My GP has referred me to the local hospital to see a NHS colorectal surgeon for investigations (my GP couldn't see or feel any piles or fissures, so I guess the pain could be neurological)...

Anyway, as the pain has got worse since I saw my GP, I want to go back to ask to be prescribed something to help reduce the pain. I have IBS and a gallstone, so I'd prefer an analgesic in the form of suppository, if that's at all possible, i.e. rather than something taken orally. Does such a thing exist that I can ask for to help me cope while I'm waiting to see a surgeon? (Of note it that I also have fibromyalgia for which I've tried all sorts of oral pain killers over the years to include gabapentin and pregabalin, but didn't get on with them.)

Thank you in advance for any replies.

P.S. Even though I don't seemingly have haemorrhoids, I have tried haemorrhoid creams - which, because of the lidocaine in them, do help a bit - but I'm in need of a greater amount of pain relief, so something stronger would be wonderful.

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Hello there, I have been using suppositories for some time, until my recent surgery, and have been given paracetamol and diclofenic (?voltorol) by my gp but they had mentioned it is very costly! I have been told it’s a very European way of taking medication :)

It is definitely out there and available. Good luck.

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Hi Jr2607,

Many thanks for your reply. Do the suppositories that you were using have a particular brand name - so that I can be specific in what I ask for? (I'm so desperate for some pain relief that I'd raid my savings, if necessary, to pay for the suppositories.)

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I know the diclofenac are voltarol suppositories (just checked the box) not sure if you can still buy them over the counter, you may be able to, worth checking but it is cheaper to get them on prescription. Other than that it was just paracetamol I think that’s all they were labelled as. Hope this helps :)

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Thanks very much for that :) The voltarol suppositories seem to be prescription only...I'll ask my GP if I can try them and enquire about the paracetamol too.

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The pain will either be neurological - pudendal nerve stretching, or spasm of levator ani muscle. I have used Ultraproct suppositories for years, prescription only,(steroid and local anaesthetic). They work well.

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Thanks, doctorjudi.

Would I need to go to a specialist pain clinic to get the Ultraproct suppositories or would it be likely that a GP would prescribe them? And are they available on the NHS or do I have to get them privately?

Is it possible for me to somehow tell whether the pudendal nerve has stretched or whether my pain is due to a spasm of my levator ani muscle? If it's not possible for me to know, would they be able to determine it at a pain clinic somehow?...

My pain (which reduces gradually but considerably and sometimes altogether when I lie down in my bed to go to sleep at night) is mainly on the left side of my anus and radiates into my left buttock (and down the back of my leg sometimes)...Could a levator ani muscle spasm cause the pudendal nerve to stretch? I ask this because my current pain began with a strong muscle spasm that happened while I was having a natural bowel movement and splinting my perineum - although my poo was soft, it was horrendously painful - like I was passing a baseball bat :( Or would the pudendal nerve only stretch through the rectocele getting bigger/more prolapsed (I've noticed mine's got a little bit bigger recently).

Thanks in advance - and thank you also for all of the recent replies you have made to my postings - they're greatly appreciated.

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Your GP would have to prescribe them because of the steroid content.Doesn't really matter which causes the pain at any particular time because the pudendal nerve(a branch of the sciatic nerve) supplies the levator ani muscle, so basically the pudendal nerve is the problem. It can be compressed by the piriformis muscle, then if you bend over or twist or lift anything it stretches.If you're straining to have a bowel movement that stretches the pelvic floor(levator ani), which will pull on the pudendal nerve, but the treatment should be for the pudendal nerve as the cause. Levator ani spasm is just a symptom. Rectocoele pulls on pelvic floor and if full, would stretch the nerve. Lying down takes the pressure off the pelvic floor and allows the nerve to unstretch. You're welcome for the advice, I must be an expert on this after all these years and combing the internet for information since I got my laptop 15 yrs ago. Glaad to pass it on if it saves you time

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Thank you so much for the explanation; it all makes sense to me now. I'm definitely going to ask for the Ultraproct suppositories. I wish I could try them now.

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Just a tip while you're waiting. If you go to your pharmacy you can buy 1% hydrocortisone cream 30g tube. The pharmacist will ask what its for. Say insect bites. They wont let you have it for any other reason. Put a bit on your finger and rub it on the sore place inside your rectum. Should give you some relief, not as good as the suppos though. By the way I didn't tell you that!!!!

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I've got some 1% hydrocortisone cream in my first aid box - Just checked and it's still in date :) I'm going to try it...

Slightly off this thread's topic, but I just wanted to ask you if there are any movements or positions I can put myself in that you might have found helps calms down the situation with the piriformis muscle at all? I've been lying flat on my back with my legs raised on a leg raiser like this one putnams.co.uk/collections/p... several times a day for a while, which seems to help, but I haven't come up with any other positioning that helps at all.

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That looks comfortable, but I find the only way to be really comfortable is lying on my side, usually left, with my knees slightly bent, sometimes with a cushion or pillow between my knees. I cant lie on my back for very long, sometimes I lie on my right side but always go back to the left. Frustrating when you're trying to read a good book.

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Extremely frustrating - and uncomfortable trying to read in that position. I'm best on my side too...I have to sleep on my side with a pillow between bent legs - with me lying on my right side is more comfortable than my left. How do you watch TV? - Lying on your side or do you have a cushion that helps you to sit at all?

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I have a recliner chair with a footstool and have a big cushion underneath me with my foam diy cushion on top. Cant watch much tv, 2 hrs max or I'm in pain and lying down for a couple of days. Spend half my life lying down. Have to plan tv watching carefully. Esp as my pudendal nerve causes rectal spasm then abdo pain with partial obstruction. Cant eat any fibre at all. No fruit/veg, v bland diet. Have to use anal irrigation to have a bowel movement twice a day. That's life!

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It sounds like you've got things down to a fine art. I also have to lie down a lot, so much so that I have a day bed (with a memory foam mattress on it) in my living room instead of sofa. (I'd like to move around more, but I suffer with ME.) I eat a lot of fibre and am thinking about cutting down on it because, although it makes my stools soft, it also makes them so bulky and enormous to pass, what with them being 'molded' in my rectocele first....and it's the main thing that triggers my pain.

What anal irrigation method do you use? I sometimes use a bulb enema to squirt warm water up there, but am thinking about asking my GP to prescribe me the Qufora mini (although I doubt that they will prescribe it because of the ongoing costs)...It's just that the bulb enema is a bit tricky to use as it hasn't got a one way valve to stop back-flow and sometimes some air gets in there which isn't comfortable. It's early days of using the bulb enema though, so I might get better at using it.

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I use Peristeen anal irrigation system by Coloplast, advised by my colorectal consultant and prescribed by my GP direct from Coloplast. Very easy to use, much better than than the old gravity system. When you empy the rectum with this it relieved the pain. Highly recommend it, has changed my life

Day bed sounds a brilliant idea, never occurred to me, thank you.

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Do you use the Peristeen with the 'balloon' and pump action? (I believe they do one without the 'balloon' and pump, if my memory serves correctly from the last time I looked. I just wondered which would be the best to opt for if I get offered a Peristeen instead of a Qufora mini, although tbh I think to be offered either might be a bit of miracle!)

Not everybody's taste, I know, but I got my day bed from here getlaidbeds.co.uk/wooden-be... - Mine's the 'modern day bed', but they now do a 'modern ohio day bed', which as you will see is more of a chaise longue design. I like them because they're more 'sofa-ish' for a living room than the usual kind of traditional day bed. (They don't come with a mattress, however.) There are also some companies on the Internet that I noticed make beds to a custom smaller size, if you're strapped for space at all in your living room. (Don't laugh, but my husband put my 'modern day bed' together for me in our living room and it fits in there really nicely, but we only realised afterwards that it's too big to go through the doorways if we ever want to get it out of there!)

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I use the peristeen with the bag, 2 tubes and a bulb connected to a 3 way valve system. The grey tube attaches to the bag and the valve to put water in, the blue tube connects to the bag and disposable rectal catheters with a balloon on the end. The blue tube puts air into the balloon after you insert it, then turn the valve to put water from the bag into the rectum , less complicated than it sounds. Think I would try IKEA for a daybed, and hope not to move house soon.

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Thanks for that. (I had wondered if the balloon might cause pain/difficulties, but as it obviously hasn't for you, I'll opt for the same version as you've got - if/when I can persuade someone to prescribe me one!)

Funnily enough, I almost bought a day bed from IKEA - They tend to be quite reasonably priced and the bonus is that they come with a mattress.

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Some of them look very comfortable, but never actually tried lying on one.

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I think one of the main things is to make sure that the mattress is nice and comfortable for you (I found that day bed mattresses can be rather hard) and that the bed isn't too narrow, especially if you're like me and need a lot of 'elbow room'. (I use my laptop while I'm lying on my day bed, propped up slightly with a low profile bed wedge and have small beanbag-type cushions under my arms for support, so I need a fair bit of space.)

When I was looking for one, I found that a lot of day beds aren't as wide as a normal single bed. With the mattresses tending to being rather hard, I guess you could always add a mattress topper to sort that out.

Another thing to consider is the gaps between the metal or wooden slat surrounds as it's annoying if you want to use pillows or cushions and they keep slipping through and on to the floor.

Hope you find something nice and suitable if you decide to go for one. (I haven't regretted getting mine :) )

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Thanks for the advice, they look nice and I like the different colours of the wood. I have to go upstairs to bed to use my laptop .

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Hello, I have rectal ache and I don’t know why but I asked for suppositories to numb the area and I got paracetamol suppositories 500mg they help I was also told they were very expensive so I may not get any more. I worked in Italy as a nanny when in my teens and they were very popular if kids were unwell. I had never seen anything like it.

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Hi Sheenahete51,

Thanks for your reply.

It would be interesting to know how much they cost - I'll google it and see if I can find out (as I'd be willing to raid my savings to pay for something that's going to help). If I manage to find out, I'll post it up.

I hope your rectal ache will be short lived.

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I've just found the drug tariff for paracetamol suppositories and they are pretty expensive, compared to how cheap oral paracetamol is (you just have to click on the 'suppositories' link and it takes you to the price list) bnf.nice.org.uk/medicinal-f...

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Diclofenac sodium (Voltarol) suppositories are seemingly a bit cheaper bnf.nice.org.uk/medicinal-f... ...but the paracetamol suppositories can be bought over the counter.

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Hello

I had similar issues and desperately wanted something to use topically to ease the pain. However, a very lovely female colorectal surgeon told me that there is sadly nothing. Your GP can prescribe a stronger lidocaine cream which you can't get over the counter so it may be worth a trip to the docs to speak to them. Shame your GP didn't do that when you went as it would save you a wait for another appointment.

Hope this helps.

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Thanks Suzydeans - that is really helpful to know. I'll try and get the stronger lidocaine cream from my GP.

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