# Unilateral pelvic floor atrophy, LG, odor + leakage



## Fpop (Aug 22, 2018)

Hi all,

I (23M) am posting here since I am getting desperate with my medical situation. My issues are mainly related to leaky gas/odor, an atrophy of some muscles of the pelvic floor and urgency and leakage.

*Detailed history*

About 5 years ago, I started getting more frequent urges to urinate than before. I have always used to hold it in as long as possible (bad idea I know) and suddenly, I was not able to. No incontinence, but the feeling of urge was much more present than before.

I decided to decrease my water consumption (another bad idea) to decrease the frequency, which in time caused a chronic constipation, and when I say chronic, it was every. single. day. Straining for 1 hour sometimes. This intense constipation lasted for about 2 years, up until I finally decided to increase significantly my water intake, and normal bowel movements were pretty rare during that time. After that two years, the constipation remained, but was less intense. Eventually, I had to have a bowel movement around 4 times a day. The stools are flat and, most of the time, are in small quantities. However, I can sometimes produce large formed stools but they are still flat.

I then started to notice something bulging (at least that's the feeling) when straining. I also lost all ability to control gas. I can't remember the last time I was able to consciously release gas. I also have a clear discharge that smells really bad. There seems to be this smell that follows me without me smelling it (only at times).

*Medical results*

*Colonoscopy: *did not reveal anything (under general anesthesia).

*Dynamic Pelvic MRI:* unable to even strain to use the muscles, so inconclusive. Revealed a pelvic floor atrophy on one side only. I can notice a difference when doing kegels, etc. between the two sides in terms of feeling/strength/movement. I don't feel the atrophied side at all when doing those exercises.

*Pelvic EMG:* did not reveal any nerve damage. The puborectalis nerve was not able to "relax". Had some technical issues with how the wires were placed, I did not really ask but I am not really confident with this result because of that.

*Physiotherapy: *diagnosed with pelvic floor tightness. Can it explain everything?

*Hypotheses*

Some kind of internal prolapse/intussusception? Could cause the nonrelaxing puborectalis/pelvic floor, frequent and flat stools. Is my atrophy a sign of prolapse?

Nerve damage: Even though the puborectalis nerve (I don't know which one it is) does not appear to be damaged, could other pelvic nerves cause the atrophy?

Thank you for taking the time of reading everything! Hope it's not too long.


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## PokerFace (Jan 13, 2017)

You may have descending perineum syndrome
I you do I suggest that you try a trial with the sns implant

I also suggest a full ct body scan to check for gastrointestinal tumors
And anoscopy with ultrasound to check the spinchters


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## feelinggross (Aug 21, 2018)

If you have a portable magnifying mirror you can check yourself for an anal fissure. They can be as small as a papercut so they're difficult to see without magnification. It should look like a small scar on the anus in the shape of a cut - you have to strain (as if you're passing gas) over the mirror to see it. It's not white like a normal scar, looks a darker shade of the color of your skin in that area.

I had this and because the fissure was close to the opening I couldn't hold any gas in until it healed up. And when you're constipated it causes more gas to build up from bacteria since the stool isn't evacuating. It makes it smell worse than normal gas too.

My doctor described it as the odors from the stool stuck inside can escape through the fissure. If you're not able to eliminate regularly, the stool inside you ferments, making the smell worse the longer it takes to get out. When you have hard stools it prevents it from healing up and can sometimes make the tear bigger. And some remnants of stool/discharge can get stuck in the fissure making it really difficult to clean, and it can get infected from that.

But my LG / odor problems started after really bad constipation too. I couldn't go for 2 weeks, and it was so backed up I couldn't even urinate. The straining gave me the fissure and the smell followed.

Have you tried stool softeners? I think warm baths can aid in digestion too.

Also when you were diagnosed with pelvic floor tightness, did they tell you what you needed to do to fix it? Did they say surgery might be needed? And were you able to ask them about your symptoms too to see if it was common with pelvic floor tightness?


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## Fpop (Aug 22, 2018)

Thank you for your answers!

@PokerFace

My neurologist actually mentioned SNS but said I was quite young to go through the procedure... I'll try to talk to him about the trial to see if it can have a effect. Also, for the condition of my sphincters, the MRI did not see anything wrong, do you think an ultrasound could provide a more detailed view?

@feelinggross

I actually forgot to mention that I had an anal fissure that was only diagnosed by my colorectal surgeon when he did an anoscopy. I was treated with nifedipine (I applied it on and off) and apparently the fissure is healed (according to the surgeon). I can't say I have intense pain anymore, only some slightly painful discomfort when having bowel movements or having trapped gas/trying to hold it. Could there still be internal damage not clinically visible? I seem to have a sentinel pile (there this weird "extra flesh" feeling when I wipe), and when I checked in the mirror it was like this long skin fold that goes from the inside to the outside of the anus.

For the pelvic floor tightness/anismus, it mainly focused on exercises, there was no talk of surgery at all. Scratch that, actually my neurologist mentioned botox injection to relax the muscles. However, I am afraid that this would make my condition worse. I read here that anismus could be a symptom of some form of prolapse : https://www.ncbi.nlm.nih.gov/pubmed/21689279

I also forgot to mention that I was diagnosed with 4 internal hemorrhoids that were banded. Also, I only seem to be able to pass gas while on the toilet, since there is always a wet/prolapse feeling. This actually started while being on colonoscopy prep... At one point, the diarrhea was so intense and necessitated so much straining that I felt something hanging from the anus, with a degree of incontinence (more than usual). I figured the gastroenterologist would mention something but he did not and I did not have the chance to mention it before the procedure and did not really talk to him after (I was under anesthesia during the colonoscopy). However, after the colonoscopy I did not feel the hanging flesh anymore, but when having bowel movements I feel something somewhat similar.

Sorry if it feels disjointed... and thanks again for your help!


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## feelinggross (Aug 21, 2018)

So the hanging feeling is beginning to disappear? I wonder if the fissure came back from the straining / diarrhea that came with the colonoscopy prep, but is beginning to heal up. Mine had that hanging out and moist feeling while sitting as well until it healed. About the skin folds, is it in the same area as the bulge you mentioned earlier? I have that too and mine was from the strain bulge after it flattened down.

An infection would have shown up through the colonoscopy so it's good that at least that could be ruled out. Idk if it could be prolapse either tbh since it seems like that might obstruct them from doing the colonoscopy.

Yeah I heard botox gives temporary incontinence, but ppl say it lasts only for a week.

After the procedure did they hand you paperwork listing their observations? Maybe there's a phone number on there you can call to ask the surgeon if they saw anything amiss? That way you can tell them about your symptoms as well. If not you can schedule a follow-up appointment with your doctor.

I hope you're able to find a solution soon! Keep us posted on how everything goes


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## Fpop (Aug 22, 2018)

Well, the "hanging feeling" from the colonoscopy prep was really intense and it was clear there was something wrong. Now, it's only when I strain and have a bowel movement that it feels that way. Oh and when I touch it as well, it's really loose. As for the colonoscopy prep, it was 1 year ago, so any fissure that occurred then should have healed, no? I'm wondering if I have a chronic fissure that still needs to heal completely...

And for the prolapse, it only occurs when straining apparently, so it is frequent that they don't see it on the colonoscopy. However, related to that, there was a stricture in my colon identified by the MRI (I was not asleep at that time).

When I touch the region, I also feel some hard bumps, but they are not painful at all, and they don't seem to be hemorrhoids (they seem to be larger). Is that a symptom of perineal descent? I've seen my surgeon many times to ask my questions and he's pretty sure I don't have a prolapse or descending perineum... But my symptoms remain...


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## feelinggross (Aug 21, 2018)

I have heard stories of ppl having them for years tbh... or that they keep coming back within weeks after they healed up. Mine lasted over 5 months. I think some become so severe they need to be removed by surgery. I hope that's not the case though because it sounds expensive!

Did the doctor seem concerned about the stricture at all?? It could explain and be the cause of some of your symptoms! Especially the fact that it can cause chronic constipation since constipation in itself causes so many problems and odor...

Could you get a second opinion, maybe with a proctologist? They'd be able to see if you have any descent or prolapses. The bumps sound concerning even if they're not painful.

I didn't find a lot of information about perinal descent online so I'm not really sure if it could be causing the bumps. I'm so sorry you're going through this, I hope the doctors can find an answer for you!


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