I can't understand pelvic floor mechanism. Stabbing pain when poop - they say it is not a fissure.

[Undiagnosed93]

Please help.

I can't understand what's going on in my body. I used to have a fissure, which was treated with a laser. Now 3 excellent proctologists can't see a fissure (anoscopy) or anything disturbing in my anus, and I have symptoms such as pain during the day and a stabbing pain or thorns during defecation. The entire Internet says it's a fissure, but doctors can't see anything.

Doctors say it's from excessively tense muscles in this area, the sphincter and pelvis.

Can someone explain to me what mechanism happens that I get stabbing during defecation? Or maybe they are wrong and I have a fissure?

[Lolaso]

I would say I have the same problem

Had a fissure or a bruise in my rectum which cause a lot of pain but after 2 years it got better , but what got me almost 100% back I would say is “stretching” sometimes because of the pain you are afraid to move and that can make your pelvic floor muscle tight and cause pain because they are compressing the nerve but depends maybe you are still healing , question is how long has is been since the laser surgery

[Undiagnosed93 in reply to Lolaso]

3 years since laser surgery

[Lolaso in reply to Undiagnosed93]

Yea you should be good all heal by now

And your pain is during bowel movement, mine is during the day and no pain when I have a bowel movement, it’s different than mine , I would say maybe you have a scar and when you have your bowel movements it stretches, is it stopping you from living the life you want ? Or how is it affecting you

And how is your diet , are you eating fibre or stool softeners? Are you pushing when going to the washroom? Do you have a step to poop in the right position which is essential to avoid straining and pushing ?

[Rocky68 in reply to Lolaso]

Have you tried Duloxetine 60mg? It is antidepressant which also helps with pain. I take 400mg of Lyrica in addition to Duloxetine. I have not experienced any emotional problems. You should ask your Dr about including Duloxetine with Lyrica. Rocky68

[Konagirl60]

Can you see a physiotherapist and get some insight? They can do internal work to…there are PT’s who specialize in pelvic pain.

[Hope4PN]

I have had rectal pain (as well as vaginal/urethral/clitoral) and it was partially attributed to pudendal neuralgia. Perhaps they can evaluate that. I have had some relief from nerve blocks and physical therapy. Am going to try a dorsal root ganglion (DRG) stimulator next month. It is to interrupt the pain signals going to my brain. I hope you are able to find some relief. Wishing you success.

[BlueLagoon007 in reply to Hope4PN]

Is the DRG that same as a neuromolulator, where they implant something under the skin on your back which interrupts the pain signals?It was suggested to me to try a neuromolulator. You can trial it for a week before deciding whether to have it implanted permanently.

[Konagirl60 in reply to BlueLagoon007]

I’ve read about some issues with the DRG stimulator. Research its success before you do it. It’s certainly much less invasive than a major surgery would be.

Have you seen a urologist, a neurologist or a neurosurgeon? You might require a fluoroscopy guided pudendal nerve block…it could be your pudendal nerve is irritated or pinched. They need to inject both anesthetic and at least 35 mg steroid. If the pain completely subsides, that is a positive block and a diagnostic tool,

Where is your primary pain. What are your symptoms? Where do you live? Thank you. Just trying to help.

[BlueLagoon007 in reply to Konagirl60]

Hi,

Thanks for your message. Yes, I have left pudendal nerve entrapment plus rectal intussusception, a rectocele and an enterocele along with other major bowel issues.

I have had many pudendal nerve blocks, botox into pelvic floor muscles, botox into anal sphincter, ganglion impar block, pulsed radio frequency to pudendal nerve, etc, etc.

Primary pain is chronic pelvic pain felt mostly in the rectum but probably referred pain from a cranky pudendal nerve which keeps getting irritated every time I have a bowel motion.

I live in Australia .

Thanks so much for your concern. I have been struggling with this for 3 years and still the doctors are baffled. I have an appt on 15th April with my colorectal specialist to go through latest MRI and then an appt on 12 the May with my gynaecologist/pain mgmt specialist to see what he thinks after seeing colorectal specialist. I am so over going to medical appts and doctors.

Take care 🙂

[Konagirl60 in reply to BlueLagoon007]

Can I be so blunt that I think you need decompression surgery? You sound just like I was….NOTHING rid me of the intractable 24/7 burning pain in my rectum. The longer you wait the less chance you’ll have successful surgery.

I feel you are being gas lit by your doctors. They could easily look on the Web and see that decompression surgery is your only hope. They aren’t baffled…that is nonsense.

I had decompression surgery and I’m 85% healed. Good luck.

[BlueLagoon007 in reply to Konagirl60]

Thanks for replying. In Australia they seem reticent to do decompression surgery these days.Wow, 85% healed, that's great. How long did you have pudendal neuralgia before you had the surgery? Apparently the success rate isn't huge.

Did you have searing pain after bowel motions as that is what triggers the pain in me as I believe the bowel is irritating the nerve, especially when it expands.

Because of my intussusception, rectocele and enterocele I often struggle to go properly. I have a feeling my colorectal specialist is goings to suggest a rectopexy but I am worried that it will irritate the nerve more. Such a difficult decision to know which way to go.

I am so pleased you are much better. Where do you live?

Thanks and take care.

[Konagirl60 in reply to BlueLagoon007]

I was left in intractable nerve pain for 3 1/2 years. I was near death by December 2010.

As time proceeded, I began to lose whole bowel movements in the bath, in the shower, in my underwear and in my pyjamas. It was a nightmare.

My GP NEVER believed me. She was CERTAIN I was bi polar. ( is losing BM’s a symptom of bi-polar disorder? ). It was utter nonsense!

I only got my surgery because I hired and paid a registered nurse consultant to advocate for me. She got a hold of all my consult notes and found that they were full of misrepresentations about me…..I was slandered.

I am truly very lucky to be alive. Vancouver doctors left me to die.

[BlueLagoon007 in reply to Konagirl60]

Oh, that's awful. I am so sorry to hear this. What an ordeal you have been through. Fancy being diagnosed as Bipolar with those systems- definitely utter nonsense.

I don't why in this day and age why we have to fight so hard for doctors to sit up and take notice. The trouble is they are time poor and have to try and see as many patients as possible but unfortunately there are many patients along the way that get overlooked.

I am so glad you got the treatment in the end. We can't hire a registered nurse consultant here in Australia. It is very hard to get someone to advocate for you, someone who understands what is going on. Everyone is too busy these days.

Take care

[BlueLagoon007]

Hi, I am sorry you are experiencing this. I, too, am experiencing the same symptoms as you.

I also had a fissure but it has healed. I was diagnosed with pudendal neuralgia about 3 years ago and since then have suffered terrible pelvic pain alongside searing pain after bowel motions. I also get pain in my perinem and vaginal area. I have just had a pelvic MRI to see if they can find out what is going on. It seems to be a mystery to all the doctors and trust me I have done nothing but go to medical appts for 3 years now.

I see a pelvic floor physio who helps as my pelvic floor is very weak but also tight. It might be worth having an appt with one to see if he/she can shed some light on it. With me, the pain goes away at night but as soon as I have a bowel motion the searing pain returns.

I do hope you can find someone to help you. It is like trying to navigate your way through a maze and frustrating when you can't get the help you deserve. I think our medical system is overloaded and doctors just don't have as much time these days as the used to.

Good luck and let me know if you find any answers.

Take care

[Hope4PN in reply to BlueLagoon007]

Oh my, it sounds like our stories are SO similar. I have lichen sclerosis and erosive lichen planus in addition to the pudendal neuralgia and genito -femoral nerve pain. I am doing everything and anything I can for pain relief… Physical Therapy and Softwave Therapy as well as medication’s. They don’t seem to make much of a dent in the pain. They tell me I have a hypertonic pelvic floor and all of the symptoms of pelvic congestion even though they don’t see it in the imaging. I had a venous ablation in my left leg and it seemed to help some of the pelvic pain so I do think there may be a vascular component as well. It is SO frustrating to go to SO many doctors and still not get relief.

Yes, the DRG is a neuromodulator specifically designed for chronic pain(as compared to a spinal cord stimulator). Here’s the url for the site:

neuromodulation.abbott/us/e...

Are you in the States? If not, you may need to look elsewhere in the site for your locale.

Anyway, would love to keep in touch. Let me know if you find any solutions. Best regards…

[VFR1200]

See a Pudendal Neuralgia Specialist, I don't know where you live but if in the UK try Bristol Pain Clinic - Dr Greenslade.

[Konagirl60 in reply to VFR1200]

Agree.

[Hockeynuts]

You're not going crazy. I have been in this terrible pain for 15 years. It's actually a nervous system problem. I've been checked by literally over a hundred doctors in 15 years. Colorectal, urologist, neurologist, pelvic pain specialists, psychiatrist, rheumatologist everybody under the sun even ones that don't even take insurance and had to pay totally out of pocket all over the country. Nobody can freak and help me it's freaking ridiculous. After I poop not when I poop about 5 minutes after the pain is unbearable! It's the kind of pain that's just stabbing and it's like somebody is sticking a freaking a file of your butt. The pain can last for hours and hours even days. The only way I even survive is I have to take a pain medicine along with Lyrica and the muscle relaxer at the same time and in an hour or two at least I'm able to breathe again and maybe do a few things. 15 freaking years and no one can help me it's unbelievable. So you're not going crazy. What it is is that you're nervous system not the one that you control, is basically on Overdrive and it's decided to use your anal muscles to direct all of this tension that is going on inside your body. I've had I don't know how many MRIs CAT scans everything you could think of they can't find anything wrong and I don't like how could you be in this much pain for this many years and you guys can't find anything wrong? A big portion of this pain is nervous system related. Don't ask me how you stop it I have no idea or I would be better by now. There are places that they say can fix this thing. Look up on your computer the wise protocol. This place has a clinic that you go to for like 6 days it's probably expensive and who knows about the insurance but they also have a home plan that you might want to look into. This is what they say about our pain syndrome.The protocol recognizes that pelvic floor dysfunction is both a systemic and local problem, with the nervous system often playing a role in chronically tight muscles. I hope this helps you and I sent this to you because I have been through every type of procedure and treatment you could imagine from pudendal nerve injections to spinal implants everything you could imagine but maybe in your case you can find some relief at least learn about the wise protocol and realize that you don't have to keep searching for an answer and it's not in your head. It's a form of trauma PTSD. Think about if you've had any kind of crime walk before this happened to you I know I did. Good luck to you I hope that you get better even if i don't, al