Anal pain while sitting

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seattlesounders

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Dear all,

I'm hoping you can provide some theories on what maybe the cause of my pain, and suggest questions I should ask of a specialist in Crohns.

Background: I had a fissurectomy, LIS and some hems removed in June (7 months ago). MY CRS told me that my pain came from hem wounds that were not healing (some had ulcers on them). I also found out that I have some ulcerations in my illeum, and have a rise in an antibody associated with Crohns.

Today: Thank God I have had some healing - I can sleep on my side without pain now, and poop without pain too. However I still need a cushion when I sit. Also if I wallk long distances I get some irritation at the site of my wound. I did feel a bump close to my wound, but the doc examined me and said it was a skin tag at the site of hem removal. So I'm puzzled at what is causing the pain as I have no discharge from the wound site anymore.

Questions:
1. Any theories as to what is causing the pain when sitting? Could it just be hem wounds that still need to heal more?

2. Any questions/tests you think I should take before I go to see Dr Hanuaer next month? My GI is pretty sure it is Crohns, so any suggested questions on treatment would be helpful

Thanks so much and positive healing wishes to you all
Jon
 
Hi Jon,

I understand about the pain, I've been living with that for the last six and a half years. I wish I had a definite answer for you, but I don't. This is the single most aggravating issue that I currently have to deal with in connection with my Crohn's.

I'm having a bit of a push for an answer to this at the moment and have recently discussed it with my Surgeon and GI. As the pain also involves my left thigh they are leaning towards it being referred pain from scarring were I've had multiple (ten) surgeries for abscesses and fistulas. I still have a seton in place, but that in itself is not usually painful. I've been taking 25mg of Amitriptyline a day for the last week and I think it's helping a little. It's not a quick fix as it can take four to six week to get maximum benefit.

Another possibility is a problem with the Sacroiliac joint at the base of the spine, so an MRI is scheduled for a couple of weeks time. Problems in this area are a recognised complication for some Crohn's patients.

I guess it it will be a bit longer until the root cause of the problem is known, that is if they find one?

I wish you well in your search for an answer to your problem.

Regards,

Mark
 
Mark, 6.5 years? I cannot imagine suffering for that length of time. I pray that you will get some better guidance here.

My gut instinct here is that my wounds have mostly healed and it feels like this pain is nearer my core. Sometimes when I lean back against my car seat I can feel a slight pain in the base of my spine that feels like it could be related. I also have to use my arms to push myself up to standing rather than use only my my butt muscles.

My plan of attack will be to first get a positive diagnosis for Crohns, take appropriate meds, and then see my CR Surgeon for another examination while I am under. I also have an appointment with a rheumatologist, that I hope may give me an other path to pursue. From my description does it sound like the pain could be a deep lying abscess or fistula alternatively could there be something like a sentinal pile in the skin tag that is making it feel sensitive?

Also ref MRI will that help identify where other possible fistulas are too?
 
I've never had rectal surgery as extensive as you guys, but I have had abdominal surgery. I've had pain in the same area of the surgery last two years, I think the outside heals faster than the inside. And let's be honest, anal surgery is not exactly an area that can be rested. I had a friend who was put on complete bowel rest and fed a strictly liquid prescription diet so the surgery could heal properly. She had this same surgery before and it was the only way she healed up properly. I know this isn't exactly the solution you would want, but it's an idea, anyway. Best wishes to you, keep us posted.
 
Mark63 said:
Hi Jon,

I understand about the pain, I've been living with that for the last six and a half years. I wish I had a definite answer for you, but I don't. This is the single most aggravating issue that I currently have to deal with in connection with my Crohn's.

I'm having a bit of a push for an answer to this at the moment and have recently discussed it with my Surgeon and GI. As the pain also involves my left thigh they are leaning towards it being referred pain from scarring were I've had multiple (ten) surgeries for abscesses and fistulas. I still have a seton in place, but that in itself is not usually painful. I've been taking 25mg of Amitriptyline a day for the last week and I think it's helping a little. It's not a quick fix as it can take four to six week to get maximum benefit.

Another possibility is a problem with the Sacroiliac joint at the base of the spine, so an MRI is scheduled for a couple of weeks time. Problems in this area are a recognised complication for some Crohn's patients.

I guess it it will be a bit longer until the root cause of the problem is known, that is if they find one?

I wish you well in your search for an answer to your problem.

Regards,

Mark
Click to expand...

Just had to comment on your post regarding the Sacroiliac joint Mark. This is the first time I have seen anyone making a link between this and Crohn's. For the last 3 months I have had severe pain & stiffness in the base of my spine with restrictions in bending and an xray on my lumber & Sac Joint shows problems with the joints L5 & S1. My consultant has totally ruled out this has any link with my Crohn's but I am unconvinced!!... I am also scheduled for an MRI later today.... :)
 
Hi Gayle,

Just Google "sacroiliitis crohn's" and you'll get plenty of references.

Hope you got on ok with the MRI.

Mark
 
Mark63 said:
Hi Gayle,

Just Google "sacroiliitis crohn's" and you'll get plenty of references.

Hope you got on ok with the MRI.

Mark
Click to expand...

Hi Mark, thank you ... Didn't like the MRI machine, very noisy and was in the tunnel for over 30 mins!! :/ Didn't have any results today but I'm keeping my fingers crossed all will be ok..


Gayle
 
Jon,

I too understand the pain as i have been suffering from abcessess and fistula's for almost 10 years. I have had a few stomach surgeries and am recovering from one now. I just went to my GI last week and he gave me Cipro and Flagly to see if that would reduce the swelling, infection and pain. I am glad to say that this has been working well. I also used a heating pad and or very warm baths which seem to help.

Hopefully your GI will solve this for you. Sometimes the pain was unbearable even standing for me.
 
Scott, glad to hear the anti-biotics seem to be helping. Cipro when I tried it seemed to really help me.

I also wanted to share with folks that I've been seeing some healing from using a naturopath who puts electrodes around my lower back and butt. I had hesitation in going to one after my experiences with accupuncture, but I seem to be able to sit on a bus (albeit a cushioned chair) without any pain any more. Curious to know if others have had any joy from this?
 
Hi Jon
Before my surgery for an ileostomy in Jan I had very intense anal pain. To the point that I could not sit, and even rolling over in bed was painful. The pain would wake me at night. I described the feeling as being like a flaming stick had been shoved up my butt. My Mum ended up taking me to the hospital as I was in so much pain. The first surgery was for a "thrombosed hemy" and I was sent home a couple of days later. One week later, the pain had not subsided and my Mum took me back to the hospital. I had an EUA - the CRS found that my rectum was so ulcerated, I had to have an ileostomy so it could have any chance of healing.
Based on my experience - I'd try and get yourself a second opinion if you can. The first CRS was a younger guy and not that experienced. He got it wrong. The second CRS - very experienced professor - was on to it immediately. I have no idea how you have tolerated the pain for as long as you have. Ouch!!
 
Samboi thanks for sharing. Just read about ileostomys - I cannot imagine how tough that must have been.

Similarly part of my surgery was also for a thrombosed hemmy, and the surgeon also told me that the wound had become ulcerated. I am praying that time will heal, and if not that meds could help with wound healing too.
 
Hi guys,

Have some news after Dr Hanauer visit at Uni of Chicago -

The bad news: confirmed as Crohns as suspected (primarily due to ulceration in terminal illeum)
The good news: Looks like Mild Crohns. Suprisingly so mild he decided that I should not take medication.

At least I now have closure for the reason behind my slow healing. I'd say I'm close now maybe 95% healed. My question for you guys - anything else you can think I should be doing proactively to prevent this developing further without meds?

So far I have discovered that Tumeric and Ginger helped take down inflammation in my gut, while Vitamin D and Fish Oil seemed to have helped my wound healing.

Any other tips?
 
That is great news!! I wish I had advice but I am still new to all of this. Positive thoughts your way and I hope things continue going so well!! :)
 
I was in a very similar situation. My CRS thought I had Crohn's after seeing my fissures/ulcerations during my LIS. But thought it was just located in my peri-anal area and to mange things without meds. Then after another 9 months I developed an abscess and fistula. I always ask myself what if I would have been diagnosed officially and started meds could I have avoided the whole fistula/seton ordeal..... I am now on Remicade and my rear feels the best it has in 7 years. Granted the meds have there side effects and dangers.

Good luck and I hope you are able to manage things naturally.
 
Good to hear you're okay Gabismommy.

Paul so glad to hear from you! Yes this whole situation sounds similar. I wish there was some kind of scale for "Mild". Dr Hanauer did let me know if I could email him if I had any questions. Maybe I should ask him - how likely folks in my situation are to be able to manage without meds OR for how long. If you can think of any other questions you'd wish you'd have asked in my situation, feel free to chime in.

Pre-remicade how was you butt feeling in terms of percentage healed? I ask because I'm def not the way I used to be (a cushion feels more comfortable to me for example) but the docs tell me the hem wounds looks healed from the outside.
 
Pre-Remicade my butt was pretty much always sore and never healed completely. I had a fissure in the posterior position that never completely healed but it was better after having the LIS to treat them. I would have 3-4 days stretches that I would just ache but I contribute that to mostly the fistula/seton.

So over time I definitively think the disease progressed. I started only having fissures (which sucked) and then developed more advanced peri-anal disease. Plus I think my GI tract seems more sensitive to my diet now. They only found chronic inflammation on my ileocecal valve. So my crohn's is still considered "mild" since it is so localized. But since it is fistulizing I get to take the more hard core drugs.

Like anything though we are all different. So in your case it may never progress into something more advanced. Then taking the drugs and adding the risk/side effects wouldn't be worth it. But then if it does progress it could potentially be a lot of pain and suffering..... I sometimes think with Crohn's that you are damned if you do or damned if you don't in regards to taking drugs.

Good luck.
 
Thank you! :) I saw my GI today and he has now 'officially' diagnosed me due to the abscess/fistula. He wants to start me on Remicaid ASAP.
 
Hi guys some updates - it no longer hurts to sit, but I still have some irritation in my butt. I can't tell what is causing it though - is it irritated skin from the hem removal, or is that kind of irritation something caused by Crohns? Any idea.
 
Are you still in Seattle? I would recommend calling the University of washington digestive sease center. I was diagnosed last year. I transferred my care to Dr lee. I have not had anysurgeries yet but hope you get answers and healing soon.
 
seattlesounders,

Crohns is not helping you hem removal heal. I mean this is probably what is happening. I have some issues with rectal crohns and I was told that they could not do anything down there because the crohns would make it not heal, or not heal quickly. But I did eventually get an abscess with fistula and then seton. But I can tell you today it is healed! About a week ago the seton fell out and I am feeling completely healed! I was told that I had mild Crohns too because it was in my rectal area only. But let me tell you getting an abscess because of the Crohn's - to me - is not a MILD thing!!! Very serious! So I see Crohns as a very serious disease, mild or not!

But I can tell you what you can do to put your Crohns in remission (and hopefully not have to take any meds for it, and keep abscesses away!). I started the Specific Carbohydrate diet about 3 months after I was diagnosed with Crohns and after 30 days I was in remission! But after 3 months I just thought I was healed and went off the diet and cheat on the foods I ate and bamm! I got a major flare, then came the abscess, etc. Went back on the diet, continued to be in remission and now almost 2 years later the seton fell out on it's own! The fistula is gone! I am back to normal!! So there is hope out there. Does the diet work for everyone? I am not sure. All I know it that it worked for me, but I did it just like the book said, and did the intro diet for about a week, and did everything slowly. Today I can eat raw fruits and veggies, and not have a problem. But again, it's a slow process to get to that point. Takes about 30 days though. You should try it! It's wonderful to use food as medicine!

I also take L-Glutamine pure powder because it helps with colon inflammation. Do some research on it.

Good luck.

Hope4 (and it came true!!)
 
Thanks for this. I had a bath just today and my skin tag from my opp felt sore for seemingly no reason. No exercise, not especially bad food (I'm on yeast, dairy and wheat free) atm. There must be something more I can do though. For your SCD, did you just use info in the book or were there any other resources you used to get started?
 
Seattle,

The best thing to do is get the book and read it! There is so much information. But going to the site www.breakingtheviciouscycle.info and doing the Intro diet while waiting for your book is best. The inro diet is on the site and must be done till there are formed stools and no more than two or three a day ( the book is more specific) And forget about the dry curd cottage cheese and the yogurt for now now. A lot of people cant do that until 6 months or more and its not necessary as long as u take SCD safe acidophilus and dont do that either - wait for that too to be on the safe side. Also www.pecanbread.com had a lot of info on the diet and stage one recipes. They also list the most common mistakes. Read that too. Then when the book comes you will have a good start and there are great recipes in the book too. If u do this right you could be on the way to healing. Good luck. The stuff u are eliminating from your diet now is good but not good enough.
 
I'd like to go back to the original question in this thread about pain in your anus. Fortunately, I do not have fistulas or abscesses, but I do have a skin tag in my anus. From time to time, I will have pain in/at my anus, especially when I sit. It feels as though the pressure from sitting makes it worse. I will also have bright red blood when I have a BM from time to time, but I know I do not have hemorrhoids. Can skin tags bleed? Can skin tags be causing the pain in my anus?
 
Swit, please get chevked for Crohns. These were my symptoms too and the doc thought hemmriods and so did i. In fact my skin tags were painful and they thought external hemmies. I also had red blood from bowel movements. It turns out those skin tags are Crohns related and they hurt because they get inflammed from the crohns and sitting on them while upur crohns is very active will cause pain. The skin tags can grow too and it hurts when it does. Cant be 100 % sure but please have a colonoscopy. If its IBD it will get worse if u dont change your diet to SCD and/or take medication for it. My Crohns was in my rectum onlt and doc said it was "mild" and i believed him until i got the perianal abscess with fistula, and seton placement. This is a serioud disease!
 
Snap. Those were my symptoms too. I had surgery (part of which was to remove hems). I sometimes wonder if they were actually skin tags, hence why it took so long to heal.
 
hope4,
Thanks for the reply. The skin tag is Crohn's related. I was diagnosed with Crohn's in 2010 and had a right hemicolectomy in April of this year because of Crohn's. I am on Remicade and Lialda becasue some Crohn's still exists in the remainder of my colon. I'm sure the pain is related to Crohn's, but I'm just trying to figure what to expect in the future. I sure hope that skin tags are not a precurser to fistulas and abscesses.

Seattlesounders, interestingly, the surgeon who removed part of my colon told me to never have the skin tag removed.
 
Seattlesounders, I'm so glad to hear that your Crohns is mild! I know many people who can correct their diet to alleviate symptoms, so start conducting your own mini experiments to see what works and what doesn't work for your body. You may have to be very picky for a while, or ask a lot of questions, but don't let that stop you from taking care of yourself! For the next few months, just concentrate on your health and figuring out what the best way will be for you to manage this going forward. good luck to you!
 
Swit, ok so i didnt know. Hmmm, good question though. I think as long as you have the Crohns under control or even get it in remission then i dont see why u could get an abscess, but if that skin tag is actually bleeding itselt and you still get flare ups well then an abscess is always a possibility. I dont think i got an abscess because of the skin tags. I know i got it from the Crohns flare. It was a strange flare too. It burned really bad. When i had that bowel movement about 2 years ago, it felt like my colon was an open wound and the stool was salt, or acid. That is what created my abscess. I know why i got the Crohns flare too. I consumed the wrong things. I know better now. Best of luck to u and i hope u never have to suffer with an abscess or fistula.
 
Mountaingem said:
I've never had rectal surgery as extensive as you guys, but I have had abdominal surgery. I've had pain in the same area of the surgery last two years, I think the outside heals faster than the inside. And let's be honest, anal surgery is not exactly an area that can be rested. I had a friend who was put on complete bowel rest and fed a strictly liquid prescription diet so the surgery could heal properly. She had this same surgery before and it was the only way she healed up properly. I know this isn't exactly the solution you would want, but it's an idea, anyway. Best wishes to you, keep us posted.
Click to expand...
I had a seton break! Do you think I should just pull it on out? it has been in 10 months!
 
You should be ok to pull it out but call your surgeon when you can.
My surgeon warned me that it can happen and that it is ok but to let him know.
 
Thanks for replying back. Do you think a fistula will heal on its own? the only driainage i have is after a bm. its nice someone else understands. :cool2:
 
A year ago I was having horrible pain/pressure when sitting or going to the bathroom. Turns out, I not only had a fistula but abscess that required drainage, a botox injection and also some kind of band contraption for that and the fistula (mainly the fistula, though). After the abscess was drained and the injection done....I can't tell you how great the improvement!

It's always a pondering game for those of us with IBD, until we can get confirmation of the problem. Anyway, I wish you luck and a quick answer.
 
Updates; so for the most part the anal pain for me has gone. however i do find that if I eat something disagreable like sugar or something with wheat in it, within 30mins i get some anal itching. i also found that last night i awoke with what felt like a pain in my bowels. i went to the restroom but i didn't need to go. i'd eaten pho with rice noodles with was quite bulky but rice normally doesn't cause a problem. Can anyone relate to this type of pain, and what does this mean for my condition given i am supposed to have mild perianal crohns?
 

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