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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Severe Pain Before Defecating?

Symptoms: 1.Abd pain severe before, during defecating then pain resolves. Since surgery. 2.Pencil thin stools since surgery(on Miralax QD) 3.Nausea without emesis x2wks. Nausea worse after eating requiring phenergan 12.5mg BID/TID. Case:44 y/o 4 wks postop from a TAH. Recovery complicated with a 4 day ileus. Had a choley done 6 mo ago without issues. Colonocopy 3 mo sgo 6 polyps removed,no other findings. Screening was for a family hx of colon ca. GYN unsure of whats causing this. GI thinks this is a post op complication?
Wed, 3 Aug 2016
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General Surgeon,  's  Response
Hi.
Thanks for your query.
Noted the history multiple surgeries at different times, colonoscopy 3 months ago showing 6 polyps - no histopath report provided; Choley 6+ months ago, TAH 4 weeks ago, had ileus for 4 days.
The present symptoms are:
1.Abd pain severe before, during defecating then pain resolves. Since surgery.
2.Pencil thin stools since surgery(on Miralax QD)
3.Nausea without emesis x2wks. Nausea worse after eating requiring phenergan 12.5mg BID/TID. Case:44 y/o 4 wks postop from a TAH
This may be due to complication of surgery in a sense that there is a lot of dissection during total abdominal hysterectomy.
Pencil thin stool can be due to fissure in ano or so.
Or there may be tightening of the ano-rectal angle giving all the symptoms.
I would advise you the following:
You have to consult a General Surgeon for per-rectal examination and colonoscopy to see for any stricture, tightening or so.
There may be a need for per-rectal ultrasound or CT scan of the whole abdomen.
Also needed are the tests of blood for CBC to see for any infection, Electrolytes and as may be required as per the clinical findings.



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What Causes Severe Pain Before Defecating?

Hi. Thanks for your query. Noted the history multiple surgeries at different times, colonoscopy 3 months ago showing 6 polyps - no histopath report provided; Choley 6+ months ago, TAH 4 weeks ago, had ileus for 4 days. The present symptoms are: 1.Abd pain severe before, during defecating then pain resolves. Since surgery. 2.Pencil thin stools since surgery(on Miralax QD) 3.Nausea without emesis x2wks. Nausea worse after eating requiring phenergan 12.5mg BID/TID. Case:44 y/o 4 wks postop from a TAH This may be due to complication of surgery in a sense that there is a lot of dissection during total abdominal hysterectomy. Pencil thin stool can be due to fissure in ano or so. Or there may be tightening of the ano-rectal angle giving all the symptoms. I would advise you the following: You have to consult a General Surgeon for per-rectal examination and colonoscopy to see for any stricture, tightening or so. There may be a need for per-rectal ultrasound or CT scan of the whole abdomen. Also needed are the tests of blood for CBC to see for any infection, Electrolytes and as may be required as per the clinical findings.