Struggling - please help, new onset

[Louise77]

Hello. This may be long but I want to include all the salient details.

About 4 months ago I strained a little hard on the toilet. I'm not usually constipated but like everyone else, I have the odd day or two of it.
Immediately after finishing, I felt like I still had to go even though there was definitely nothing left in there.
Since that day I have had 24 hour a day rectal pressure and the feeling of something inside the rectum that I want to push out/bear down to get the feeling to go away. It is driving me insane and I am struggling to sleep etc. Very very very down.
I have seen a colorectal surgeon who did a rectal exam and said he though he could feel a "fullness" on the anterior rectal wall but he carried out a colonoscopy and said it was clear. No inflammation, no fissures, no sign of any disease or pathology at all He referred me to gynae, who did an ultrasound and said there was a small 2.5 cm fibroid that may or may not be causing the symptom of rectal pressure/fullness.

I have since seen a urogynaecologist who diagnosed me with grade 2 uterine prolapse, grade 2 cystocele and grade 1 rectocele. He ordered an MRI defogram which confirmed all of the above, but he said my uterus is not pressing on the rectum apart from at the very end of the defecating phase an would not account for why I have this rectal fullness at rest and even when lying down. He is at a loss as to explain the symptom. He said the fibroid is too small to be causing an issue and that it is on the opposite side from the rectum anyway.

Having done a lot of research myself, I came upon pudendal neuralia or even levator ani. The urogyn said it cant be levator ani (or unlikely) as I can pass stool no problem and am not constipated etc. so no anismus. There is no problems pushing stool out so its not being trapped anywhere (and also, I had the pressure when I was 100% cleared out for the colonoscopy so I don't see how stool can be causing this pressure).

Is it possible that I have stretched or damaged the pudendal nerve in that one episode of hard straining? To clarify, there is no pain and never has been, just this incessant constant unrelenting feeling of a full rectum despite no stool being there, a sensation of a foreign object in the rectum and a desire to just sit on the toilet and push the feeling away.
No burning, no urinary symptoms etc. Just pressure 24 hours a day with no let up.

Urogyn has given me a script for 10mg Amitryptiline to start tonight to see if it helps but I am very very scared this is going to be forever and that no-one will be able to help me.

Has anyone else got this constant rectal fullness/heaviness/pressure feeling but with NO pain? Just the sensation of rectal fullness?

I am using a coccyx cushion and trying my hardest not to strain, potty stool etc. Drinking lots. I am at a loss what to do.

Could this be a pudendal nerve issue and that is why nothing is showing up on the MRI?

I'm 49 year old female.
Thank you.

[Violet M]

Hello Louise,

According to the article by the Nantes team, one of the criteria for diagnosis of pudendal nerve entrapment is a sensation of a foreign body in the rectum. You can read the article at the following link:

https://www.pudendalhope.info/wp-conten ... iteria.pdf

That's not to say that you have pudendal nerve entrapment but it does suggest that you could have an issue with the pudendal nerve, particularly the inferior rectal branch of the pudendal nerve. Often, for a number of reasons, nothing shows up on the MRI even if you have a problem with the nerve -- for example an MRI doesn't always enhance the image of the nerves enough to show a problem, or it wouldn't necessarily show muscle tension, or a musculskeletal anomaly such as sacroiliac joint dysfunction or lax ligaments - just to name a few possibilities.

So, could the one incident of straining on the toilet have caused an issue with the pudendal nerve? Yes, it could have, but there might have already been an underlying problem and the straining just triggered the symptoms.

You could consider having a phone consultation with a pudendal neuralgia specialist to get their opinion. Many of them are listed on our website at https://www.pudendalhope.info/list-of-doctors-2/
For diagnostic purposes, you could try a pudendal nerve block at the typical sites of entrapment to see if a nerve block temporarily stops or dampens that uncomfortable sensation. You could also try a ganglion impar block which is sometimes considered as a diagnostic or a treatment option for people with strictly rectal symptoms. Another option would be to have an evaluation by a pelvic floor physical therapist to determine if your pelvic floor is tight and to determine if there are any musculoskeletal anomalies that wouldn't show up on an MRI that might be contributing to your symptoms. You could also ask about trying some suppositories for symptom relief -- such as baclofen suppositories, or possibly a topical rectal ointment such as nitroglycerin to ease the symptoms. Just brainstorming some ideas here. Hopefully you will be able to figure this out.

Violet

[stephanies]

It is possibly PN. I have had that full rectum feeing you describe off and on. How have you responded to the Amitriptyline?

Stephanies

[Louise77]

Hi.
The amityryptyline has helped me to get a little sleepy at bedtime but I don't feel it is making any difference to the rectal pressure. I've only been on it for a week so I don't know if its still going to work magic, but I have a feeling not.

Still struggling.

It's s 24 hour a day feeling for me, there's no break from it.