Mechanical damage

In the past, most of my UC has been in my sigmoid... right where the colon turns the corner into the rectum. That corner turn has been the bane of my existence. I've been in remission the past year or so, but whenever I go to the bathroom, I have to strain a bit to get the stool around that corner. The straining has created hemorrhoids and sometimes fissures, so the proctologist I'm seeing mentioned gradual stretching over time.

Scoping reveals a lot of scarring in my sigmoid, but nothing else. On the advice of a proctologist I started seeing about narrow stools, I received an anal stretching kit from her. They're basically sex toy looking things of various sizes.

I ended up going too fast and I tore my insides. I could feel the tearing, it was very painful. It felt like really inflexible tissue being forced open. I was very sore for a couple of days, followed by some mucous, and now there is full on bleeding. Increased BMs, bloody stools though not full on liquid diarrhea, pain, nausea, and weight loss. So basically I am starting to flare. I can tell by how hot I feel that the inflammatory cycle is starting up. I'll be getting blood work tomorrow to see where my CRP is at.

I'm so disappointed. I had clinical remission for 1.5 years, now this... and it's all of my own doing.

My rectum itself seems OK. There is no urgency, I can hold my stool, there's no bleeding there. Depending on what I eat, the stool may be soft-solid and coated with blood, or a full on mush pile with blood mixed into it. It's more so the area where the rectum meets the sigmoid that is killing. It hurts like hell there and there's burning pain.

So I'm wondering... because this is mechanical damage rather than an ulcer, does it get treated differently? Should I be going straight for topical stuff and not bothering with systemic? Other than this injury, my diet and lifestyle have been pristine.

An actual doctor told you to do this?! Wow. I have no words.

If you're worried about mechanical damage from the dilation/stretching, I would have a gasteroenteroligist do some form of endoscopy to see what is going on up there. It's unlikely you have a perforation or else you'd have a high-fever and be hospitalization in very short order.

Dilation of scars can help restore muscle motion. I rarely see posts on it, every few years at most. Never heard one go bad like this before though. Sorry you gotta go through that!

Yes, some good replies. I was wondering how to approach this as I've never been in this situation before. In the past my UC started from the inside out. Now it seems to be starting from the outside in.

I'm not sure I agree about no anti-inflammatories. It's possible for an injury like this to cause a flare, no? I mean... with us UC folk, the immune system likes to get involved at the drop of a hat. In the past, I have flared from getting scoped if they took biopsies.

Bowel rest... does that mean fasting, or liquid diet?

The situation is just confusing me because I feel like if I do anti-inflammatories, I should also be doing something to address the actual internal injury, if there is one.

My GI doctor isn't available for 3 weeks. I may just end up going to the hospital, I guess, even though I really don't want to.

My main thing now is that I'm trying to decide when I should start taking prednisone. I would say my flare is moderate right now. BMs about 10 times a day, some pain and discomfort but not over the top, and of course blood and mucous. To me this is flare territory regardless of the cause. Does that make sense?

My meaning is, a mechanical injury coming from the outside is causing the current inflammation. It didn't start from stress, improper diet, infection, etc. Because of the outside cause, I am not sure if it should be treated differently or not.

I can't do mesalamine unfortunately, I am allergic to it.

I think I was wrong in my description of where the discomfort is. I looked at an anatomy chart. It's definitely rectal, although symptoms like urgency and high frequency aren't happening. I can hold it in if I need to, even though I don't want to.

Thanks IP.

I don't think there is a perforation or anything serious, but I do think my UC has somehow been reactivated. I am so upset... mostly because I followed the advice of a doctor and I did this to myself. 1.5 years of remission, down the drain, just like that.

My experience was that as I inserted the device that was too large, I felt something "give way" almost like a sudden and dramatic opening. It had a pinching feeling and I knew that I had pushed too far or something. The device would not insert further so I kind of pushed it a bit and that's when I felt the sensation of tearing. It was not the bowel wall that tore but I guess a scar/narrowing?

Obviously something got disturbed. Normally I'd just be content to let it heal over time, almost like you would an anal fissure... but the inflammation worsens each day and I am getting systemic inflammation signs, including right sided pain (around the cecum) which is normal for me when a full on flare is starting.

I feel like I should just take pred, even if a low dose Is 5mg too low?

I am really sorry you're going through a flare-up. I do think you need a scope to see what's going on. Can you call your GI and see if you can get on the cancellation list, or if there's another GI at the practice who will see you? I doubt anyone can really make any determinations without a visual. Maybe the hospital isn't the worst idea, you may be able to get scoped and figure out where things stand. I doubt the stretching caused the flare up, though, I am sure it didn't help.

Keith: Ok, I had no idea. This sounds horrible.

So sorry you're dealing with this Mark.

I'd say 20 is fine for a 95 CRP.

Crp of 95 is quite high...
If you are sensitive to pred, try 20... and get another blood test in a few days to see if it's come down.

I don't think the device triggered your flare, it has probably been simmering for a while. We tend to start doing things like dilations when we feel something isn't right!

Good luck

I know that "mechanical" things, as you call them, can cause flares because I had rectal surgery and it caused a flare and my rectal surgeon said that often happens with her patients with IBD. Also, I have had worsening flares after a scope at least one time.

There is improvement, but it's not major. Then again I just started the 20mg yesterday. I was well enough to go to work today at least. Sitting in my office chair has been killing my bowels though... the 90 degree chair angle is brutal.

It went from full of bloody water in the toilet to now grainy stool mixed with blood.

I was more or less fasting for a couple of days and now I've stopped that. I made chicken veggie soup that I pureed in the blender with some avocado and egg yolk. That seems to be making me feel better.

Other than more rest, I'm not sure what else I can do. If I don't see solid improvement in a few days I'll up to 40mg. I just wish I could stem the weight loss. I pretty much had a gym body and now I can see it withering away day by day. Sigh.

Certainly see your doc if you need to, if you are not getting better and get some labwork done to see exactly what is going on, maybe an xray or rectum-endoscopy. Maybe it was FCP I was thinking of a 95 being not bad, I'd have to look through my own past tests and see.