Help ... UC flare with constant rectal pain

Hello
I was originally diagnosed with Proctitis in 2009 and was fortunate enough in that the next 10 years were relatively trouble free and any flares were quickly brought under control.
That all changed in September 2019 when I was re diagnosed following a sigmoidoscooy as having severe left sided Ulcerative Colitis.
I was immediately put on aural Prednisolone at 30mg a day for 4 weeks and then tapering off. The Pred seemed to work immediately in stopping the symptoms although I had some re occurance of blood and mucus by the end of the day , so I never quite got into remission with this course of Pred.
After the steroids I was put on combinations of aural and topical Mesalazine and also Predfoam.
None of these meds were as effective as the aural steroids and although symptoms were sometimes eased I still suffered with tenesmus , urgency , passing blood, mucus etc.
Unfortunately things have suddenly got worse recently in that I suddenly experienced severe rectal pain which made bowel movements very painful and also meant I was suddenly struggling to insert topical meds due to the pain. Worse still, the pain persisted after BMs for sometimes hours afterwards and the pain was severe enough to stop me sleeping.
At first this pain sounded like I had possibly had a fissure, but then I found a small external lump
around my anal opening which was sore to touch which I then wondered if this could be haemorrhoids. A visit to the emergency room
suggested that the lump was probably swollen lymph glands that would improve once my UC was brought under control.
I have been put back on aural Pred initially at 30mg a day but this time it doesn’t seem to be working and I have just increased dose to 40mg a day but so far with limited success.
I still have symptoms including diarrhoea and the constant anal pain that is still affecting my sleep.
I don’t know what to do next. Any advice?’

OP said...
I suddenly experienced severe rectal pain which made bowel movements very painful and also meant I was suddenly struggling to insert topical meds due to the pain. Worse still, the pain persisted after BMs for sometimes hours afterwards and the pain was severe enough to stop me sleeping.

At first this pain sounded like I had possibly had a fissure, but then I found a small external lump
around my anal opening which was sore to touch which I then wondered if this could be haemorrhoids. A visit to the emergency room suggested that the lump was probably swollen lymph glands that would improve once my UC was brought under control.

Get a 2nd opinion, this time from a GI who specializes in UC rather than a non-specialist working in an emergency room.

I once had severe rectal pain that was at first diagnosed as hemorrhoids. Each BM was a torture chamber that felt like I was expelling shards of glass. I doubted that hemmies were normally that painful so I got a 2nd opinion which determined that I had a perianal abscess.

The GI drained the abscess and placed me on a three week course of Flagyl (antibiotic). That was years ago and I haven't been bothered since.

I'd ask your gasteroenterologist if it is a concern.