Uncomfortable Rectal Pain that Comes and Goes

Richard Hampton felt rectal pain on and off for weeks. He first thought it was hemorrhoids, then constipation, and then something popped and drained. He didn’t think he had any outstanding medical problems. He hadn’t been worried about the occasional blood he’d seen after wiping. He talked with a few family members and a close friend, and the consensus was that he had hemorrhoids.

He researched the internet and discovered some options he could do on his own. He made it a goal to eat more fiber, drink more water, and avoid pushing too hard. He bought some steroid cream from Walmart. The first week, there was no change, but slowly the itching and burning pain went away, and the blood could no longer be seen on the toilet paper after he used the restroom.

Additional benefits were Richard felt better, lost some weight, and had less bloating. Every third or fourth day, though, he would get some rectal pain that almost put him on his knees. He didn’t understand what was happening but chalked it up to hemorrhoids.

Two weeks later, while driving home, he had had pain throughout the day. He didn’t feel that a hemorrhoid was his problem, and the pain was slightly up farther up the backside rather than between his legs. He had felt a small lump and worried about what it could be. He couldn’t see anything in the mirror and wanted to wait until his partner could look at the area.

Ten minutes from home, he turned a corner and felt a pop in his pants. Suddenly there was a gush of liquid in his underwear and a noticeable smell. It didn’t smell good. Richard worried he had an infection. The pain or discomfort he’d felt throughout the day was gone instantly.

When he got home, he ran to his bathroom, showered, and changed his clothing. He felt around the rectal opening and didn’t feel a lump, and he had no bleeding. He couldn’t identify where the liquid that had stained his underwear had come from. He felt around, but there was only minimal pain and no obvious infection. He decided not to tell his partner.

Time passed, and he forgot about the incident. Six months later, he woke up and felt some rectal discomfort. He had slipped a little on his improved health regimen, and the night before, he had some constipation. It had taken thirty minutes to finally have a bowel movement. Instead of relieving him, he went to bed in pain. The pain was worse this morning, and he had significant bloating and felt sick in his stomach.

He drank some liquid fiber supplements and went to work. Around noon, he started having some fever and chills. By two o’clock, he could barely sit down. He was having a large amount of bright red blood by this point. The pain and the pressure in his backside had tripled from earlier. He felt nauseous and had no choice but to go home.

As he left his office, he called his partner, and they suggested he stop by Urgent Care. “This has been a problem long enough,” they said. Richard agreed and stopped at a building ten minutes from his house.

How can I help you?” asked the front desk receptionist.

Stomach issues. Fever and chills, and I became nauseous a few hours ago. It’s getting worse and worse.

The information was written down. Richard answered some additional questions on a form and was slightly more forthcoming. Insurance issues were settled.

Forty-five minutes later, he was called out by a nurse who asked the same questions as the front desk receptionist. He was weighed, his temperature taken, and other vitals were done. He had a temperature of 101.9 and a slightly elevated blood pressure.

Because of the temperature, he was tested for COVID, given a mask, and placed in an exam room. Twenty minutes later, the doctor came in.

Doctor Shamo said, “The nurse tells me you have some flu-like symptoms, with fever, chills, nausea, and a temperature.

I don’t think it is the flu,” said Richard. “I don’t have sinus issues, cough, or nasal congestion. But I am having a lot of rectal pain.

Okay.” Doctor Shamo sat in his chair, turned and asked, “Can you tell me more?

I have some on and off again constipation. I take fiber but haven’t taken any in a few weeks. I felt plugged up last night, and it took a while to have a bowel movement. This morning, I didn’t feel any better. I took a large amount of fiber and went to work. I started feeling sicker around noon, and I noticed blood again around 2 pm. Add in some hot and cold flashes, along with nausea, and I came here.

When you say blood again, what does that mean?

I think I have hemorrhoids. I’ve had blood on the toilet paper before. That’s when I started taking fiber more frequently. I also bought some steroid cream.

Did that help?

Yes. The blood went away.

Have you had any other symptoms?

Not really. I just feel really sick, and there’s a lot of pressure when I sit.

How old are you?

Forty-nine,” Richard said.

Have you ever had a colonoscopy?

Richard shook his head. “I don’t think so.

Doctor Shamo leaned in closer. “It’s when they give you something to drink or some pills, and you use the restroom a lot. Then the next day, they knock you out and put a scope into your rectum.

Nope,” said Richard. “Never had that experience, and I really don’t want to.

It’s a common concern. But, when we talk about blood in the stool in an older man or woman, we first think of something in the intestines. It’s recommended for those older than forty-five.

I don’t know.

Doctor Shamo continued, “Is the blood bright red or a darker color?

Bright red.

Have you ever seen blood within your stool?

I’ve never looked that hard.

Any history of stomach ulcers?

Not that I am aware of.

Doctor Shamo sat back. “Any drainage, infection, or other problems.

Richard thought for a moment. Until this moment, he had forgotten about the episode in his car. He couldn’t recall if what he was feeling now was similar to back then. He wasn’t sure he wanted to tell the doctor about that last episode. In the end, he said, “More than six months ago, I had this tremendous pain close to my rectum. I thought I had an infection, but as I was driving home, something popped, and the pain disappeared.

Interesting,” said Doctor Shamo. “Was it a cyst or something? Did a hemorrhoid burst?

Can they?

If they’re bad enough. But it’s unlikely.

The discharge got into my underwear, and it smelled really bad. I couldn’t find where the boil popped if it was a cyst.

Doctor Shamo stood. “It’s time for an exam.

What kind?

Doctor Shamo pulled on some gloves and pulled out a packet of petroleum jelly. “First, I will look at the rectal opening to see if I can see any hemorrhoids. I will check the prostate next and see if I can find any other problems.

Richard said nothing but nodded. A moment later, he pulled down his pants and underwear. He checked the rectal opening. He placed his hand on the upper portion of the buttocks, and Richard felt a jolt of pain descending to his rectum. “Ouch,” he cried.

Doctor Shamo pushed the area again, and the same pain returned. He pulled open the crack and said, “I think I know part of the problem.”

Richard asked, “I don’t think I can handle any fingers in my rectum at present.

I completely understand,” said Doctor Shamo, and he stepped away and pulled off his gloves.

Is that it?” asked Richard.

Not entirely,” said Doctor Shamo, and he sat back on his chair. Richard pulled up his pants and sat down as well.

What’s wrong? Do I need to take an antibiotic?

Eventually, you will.

That doesn’t sound horrible.

Mr. Hampton. You have a severe case of what we call a Pilonidal Cyst.

A cyst,” interrupted Richard.

Yes. I’ve seen this several times, but you have a significant one. There is an area at the top of the buttock crease that can have such a cyst. Sometimes these are overlooked because of their location. However, when they get worse, the skin in that area can be firm, raised, and red. That’s what I am seeing in your case.

And antibiotics will treat this.

It actually needs to be cut open. We’ll need to do this here. We will numb up the area as best as possible. Usually, we get a lot of drainage, and it smells terrible.

Are you serious?

Doctor Shamo nodded.

An hour later, Richard was finished. The entire experience was horrifying. The medication used to numb the area only partially worked. The amount of drainage was staggering. In addition, Dr. Shamo found a ball of hair, and a cup or two of drainage. Dr. Shamo said that in other cases, they had found pieces of teeth, but he’d never seen any. It was usually drainage and hair.

Richard was placed on antibiotics for a few weeks. He had a huge bandage on his buttocks. He felt dizzy for several minutes after the procedure. His symptoms would resolved, but he was warned that he might be in pain for several days after the procedure. He was extremely embarrassed.  He was told this had nothing to do with cleanliness but he wasn’t so sure.

As he walked out of the Urgent care, Dr. Shamo said, “Don’t forget about getting your colonoscopy in the near future.

Yeah, right,” said Richard.

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