Anal Pain Research Articles

Rare recurrence pattern after complete response to chemotherapy in a patient with rectal cancer: a case report

BackgroundColorectal cancer (CRC) often metastasizes to the liver, lungs, lymph nodes, and peritoneum but rarely to the bladder, small intestine, and skin. We here report the rare metastasis of anal cancer in the left bladder wall, followed by metastases to the small intestine and skin, after abdominoperineal resection and left lateral lymph node dissection with chemotherapy in a patient with clinician Stage IVa disease.Case presentationA 66-year-old man presented with 1-month history of bloody stool and anal pain and diagnosed with clinical Stage IVa anal cancer with lymph node and liver metastases (cT3, N3 [#263L], M1a [H1]). Systemic chemotherapy led to clinical complete response (CR) for the liver metastasis and clinical near-CR for the primary tumor. Robot-assisted laparoscopic perineal rectal resection and left-sided lymph node dissection were performed. Computed tomography during 18-month postoperative follow-up identified a mass in the left bladder wall, which was biopsied with transurethral resection, was confirmed as recurrent anal cancer by histopathologic evaluation. After two cycles of systemic chemotherapy, partial resection of the small intestine was performed due to bowel obstruction not responding to conservative therapy. The histopathologic evaluation revealed lymphogenous invasion of the muscularis mucosa and subserosa of all sections. Ten months after the first surgery for bowel obstruction and two months before another surgery for obstruction of the small intestine, skin nodules extending from the lower abdomen to the thighs were observed. The histopathologic evaluation of the skin biopsy specimen collected at the time of surgery for small bowel obstructions led to the diagnosis of skin metastasis of anal cancer. Although panitumumab was administered after surgery, the patient died seven months after the diagnosis of skin metastasis.ConclusionsThis case illustrates the rare presentation of clinical Stage IVa anal cancer metastasizing to the bladder wall, small intestine, and skin several years after CR to chemotherapy.

Small Cell Carcinoma of Rectum - An Infrequent Aggressive Tumor

We report the case of a 63 year old man with small cell carcinoma of rectum. He presented with occasional rectal bleed, anal verge pain and generalized weakness. Colonoscopy revealed an ulcerated growth in proximal rectum. Endoscopic biopsy revealed poorly differentiated carcinoma. Laparoscopic anterior resection was done and histopathogical examination along with IHC confirmed small cell carcinoma(SCC). Colorectal SCC is a rare and aggressive tumor.

Rectal versus intravenous administration of acetaminophen; Clinical investigation of plasma level, analgesic, and antipyretic effects on 6-month to 6-year-old children in Zabol city, Iran

Acetaminophen is the most widely antipyretic analgesic medicine used in adults and children worldwide. Rectal acetaminophen is widely used in children who resist or cannot take oral medications. This study was designed to compare the efficacy of rectal and IV acetaminophen in children with fever and mild to moderate pain. Total 60 children aged six months to 6years, with fever and pain, that were treated with rectal or intravenous acetaminophen were selected and assigned in two groups. The IV group received 10mg/kg paracetamol as an IV infusion, and the rectal group received a 15mg/kg dose immediately after admission. Pain score was calculated using the FLACC method, and the axillary temperature was recorded at baseline and then 0.5, 1, 2, 4, and 6hours after drug administration. Blood samples were collected at baseline and then at 30min-intervals for the first 90minutes. The trend of changes in mean pain score at different time intervals was significantly different between the two groups. Body temperature decrease was more prominent in the IV group. The plasma concentration increased in both groups significantly with time. This increase was sharper in the IV group, just in the first 60minutes after drug administration. IV acetaminophen has more rapid onset of action, while rectal dosage form control fever and pain for longer duration. Considering its favorable effects with ease of administration and lower cost, rectal acetaminophen can be a reasonable option in selected patients with pain or fever.

Retroperitoneal Rectal Perforation Due to Pomegranate Seed Bezoar: A Rare Case

Various causes are involved in rectal perforation aetiology, including: Iatrogenic perforations, traumatic perforations, malignant or diverticular disease perforations, stercoral perforations, and idiopathic perforations. Rectosigmoid perforations are life-threatening and require immediate diagnosis and surgical treatment. Bezoars are accumulations of indigestible foreign matter that accumulate in the gastrointestinal tract. Seed vesicles are a subset of phytobizzars produced by plant seeds or undigested fruit kernels. Most Intestinal bezoura occur in the rectum, causing constipation or nonspecific abdominal or rectal pain. The following is a report of a case of pomegranate seeds in the rectum that resulted in retroperitoneal rectal perforation.

The impact of transcutaneous electrical acustimulation (TEA) on rectal distension-induced pain in patients with irritable bowel syndrome (IBS)-A study to determine the optimal TEA delivery modalities and effects on rectal sensation and autonomic function.

Treatment options for abdominal pain in IBS are inadequate. TEA was reported effective treatment of disorders of gut-brain interaction but its mechanism of action and optimal delivery method for treating pain in IBS are unknown. This study aims to determine the most effective TEA parameter and location to treat abdominal pain in patients with IBS-Constipation and delineate the effect of TEA on rectal sensation and autonomic function. Nineteen IBS-C patients underwent TEA at acupoints ST36 (leg), PC6 (wrist), or sham-acupoint. Each patient was studied in five randomized sessions on separate days: (1) TEA/ST36-100 Hz; (2) TEA/ST36-25 Hz; (3) TEA/PC6-100 Hz; (4) TEA/PC6-25 Hz; (5) TEA/Sham-25 Hz. In each session, barostat-guided rectal distention (RD) was performed before and after TEA. Patients graded the RD-induced pain and recorded three rectal sensation thresholds. A heart rate variability (HRV) signal was derived from the electrocardiogram for autonomic function assessment. Studied patients were predominantly female, young, and Caucasian. Compared with baseline, patients treated with TEA/ST36-100 Hz had significantly decreased pain scores at RD pressure-points 20-50 mmHg (p < 0.04). The average pain reduction was 40%. Post-treatment scores did not change significantly with other TEA modalities except with sham-TEA (lesser degree compared to ST36-100 Hz, p = 0.04). TEA/ST36-100, but not other modalities, increased the rectal sensation threshold (first sensation: p = 0.007; urge to defecate: p < 0.026). TEA/ST36-100 Hz was the only treatment that significantly decreased sympathetic activity and increased parasympathetic activity with and without RD (p < 0.04). TEA at ST36-100 Hz is superior stimulation point/parameter, compared to TEA at PC-6/sham-TEA, to reduce rectal distension-induced pain in IBS-C patients. This therapeutic effect appears to be mediated through rectal hypersensitivity reduction and autonomic function modulation.

Recent Developments in On-Demand Voiding Therapies.

One cannot survive without regularly urinating and defecating. People with neurologic injury (spinal cord injury, traumatic brain injury, stroke) or disease (multiple sclerosis, Parkinson's disease, spina bifida) and many elderly are unable to voluntarily initiate voiding. The great majority of them require bladder catheters to void urine and "manual bowel programs" with digital rectal stimulation and manual extraction to void stool. Catheter-associated urinary tract infections frequently require hospitalization, whereas manual bowel programs are time consuming (1 to 2 hours) and stigmatizing and cause rectal pain and discomfort. Laxatives and enemas produce defecation, but onset and duration are unpredictable, prolonged, and difficult to control, which can produce involuntary defecation and fecal incontinence. Patients with spinal cord injury (SCI) consider recovery of bladder and bowel function a higher priority than recovery of walking. Bladder and bowel dysfunction are a top reason for institutionalization of elderly. Surveys indicate that convenience, rapid onset and short duration, reliability and predictability, and efficient voiding are priorities of SCI individuals. Despite the severe, unmet medical need, there is no literature regarding on-demand, rapid-onset, short-duration, drug-induced voiding therapies. This article provides in-depth discussion of recent discovery and development of two candidates for on-demand voiding therapies. The first, [Lys3,Gly8,-R-γ-lactam-Leu9]-NKA(3-10) (DTI-117), a neurokinin2 receptor agonist, induces both urination and defecation after systemic administration. The second, capsaicin (DTI-301), is a transient receptor potential cation channel subfamily V member 1 (TRPV1) receptor agonist that induces defecation after intrarectal administration. The review also presents clinical studies of a combination drug therapy administered via iontophoresis and preclinical studies of neuromodulation devices that induce urination and defecation. SIGNIFICANCE STATEMENT: A safe and effective, on-demand, rapid-onset, short-duration, drug-induced, voiding therapy could eliminate or reduce need for bladder catheters, manual bowel programs, and colostomies in patient populations that are unable to voluntarily initiate voiding. People with spinal injury place more importance on restoring bladder and bowel control than restoring their ability to walk. This paradigm-changing therapy would reduce stigmatism and healthcare costs while increasing convenience and quality of life.

Rectal duplication cyst presenting with change in bowel habits and rectal bleeding: A case report and literature review

We present a rare case of rectal duplication cyst (RDC) in an adult patient who presented with chronic fluctuating bowel habits and rectal bleeding. A faecal immunochemical test (FIT) and a faecal Calprotectin level showed negative results, and no previous abdomen-pelvis CT scan or MRI was identified. A Colonoscopy was performed, showing a benign rectal lesion causing colonic intraluminal compression leading to rectal ulceration and prolapse, and solitary rectal ulcer syndrome was suspected. A Transanal Minimally Invasive surgery (TAMIS) was performed to excise the lesion, with histopathology findings consistent with a rectal duplication cyst. The patient had no intraoperative complications and made an uneventful recovery. A systematic literature review showed 30 30 adult Rectal supplication cyst case reports. In conclusion, The most common presentation of RDC is anal pain and rectal bleeding. The diagnosis of RDC is challenging, and it requires Surgical resection to confirm the diagnosis.

Protocolo diagnóstico y terapéutico de la enfermedad fistulizante perianal

More than 30% of patients with Crohn's disease will present perianal manifestations of the disease. These include fissures, ulcers, and fistulas that produce symptoms such as perianal discharge, anal pain, and tenesmus. It is important to perform an adequate clinical interview as well as to ask about sexual practices and perform a perianal exploration. If perianal disease (PAD) is suspected, it is advisable to characterize the lesions using magnetic resonance imaging or an endoanal ultrasound. In the case of complex, active perianal disease, an examination under anesthesia with seton placement should be considered. In the case of perianal abscess, urgent surgical drainage is indicated. The management of PAD must also include medical treatment with TNFa-blocking drugs such as infliximab in combination or not with thiopurines. In refractory cases, a terminal colostomy or coloproctectomy may be required.

Laser Hemorrhoidoplasty Using Reusable Bare Fiber Combined Mucopexy on Grade IV Internal Hemorrhoid: A Case Report

Background: Hemorrhoids are the most common anorectal disease, affecting millions worldwide. Hemorrhoids are categorized as "internal" or "external" based on their proximity to the pectinate line, which separates the upper 2/3 and lower 1/3 of the anus. The hemorrhoidal disease can be treated in various ways, from non-invasive methods like rubber band ligation, cryotherapy, sclerotherapy, laser photocoagulation, and phototherapy to invasive methods like surgical excision for patients with severe symptoms, grade III or IV hemorrhoids, or persistent bleeding. This study described the results of Laser Hemorrhoidoplasty (LHP) using reusable bare fiber combined mucopexy, a diode laser with wavelengths of 980 nm and 1470 nm, specifically gallium aluminum arsenide (GaAIAs). Methods: a case of a 28-year-old male with complaints of rectal prolapse mass one day ago and could not be reinserted with a finger, bleeding while passing stool, and rectal pain with a Visual analog scale was 7. The patient had experienced similar symptoms and had a sclerobanding procedure four years ago. However, it has reappeared in the past year. The patient was diagnosed with grade 4 internal hemorrhoids and underwent Conclusion: Laser hemorrhoidoplasty using reusable bare fiber with combined mucopexy. After the laser hemorrhoidoplasty procedure on day 4, the patient felt no pain, rectal bleeding, rectal lumps, or soiling.

Rectal malakoplakia simulating a locally advanced rectal cancer: a case report

Malakoplakia is a rare and chronic granulomatous disease, resulting from the accumulation of large granular macrophages containing basophilic inclusion bodies in the cytoplasm named Michaelis-Gutmann bodies. The gastrointestinal tract is the second most common site after the urinary tract, though malakoplakia has the potential to manifest in multiple organs. Rectal malakoplakia is difficult to diagnose due to its unspecific clinical and radiological presentation, usually mimicking a malignancy. Most report cases are associated with immunosuppressive diseases or chronic prolonged illness. We present the case of a 64-year-old male with a history of anal pain. A pelvic magnetic resonance imaging showed a rectal mass with 38 mm invading the mesorectum. Colonoscopy was performed confirming a mass-like lesion and biopsies were taken. Histopathological examination revealed features consistent with malakoplakia. The patient underwent long-term oral antibiotic treatment and during follow-up there was a regression of the lesion and resolution of symptoms.

Safety and efficacy of ESD for laterally spreading tumors with hemorrhoids close to the dentate line

Background Endoscopic submucosal dissection (ESD) is a curative treatment for laterally spreading tumors (LSTs). However, the outcomes of ESD for LSTs with hemorrhoids remain largely unknown. Our study aimed to evaluate the usefulness of ESD in managing LSTs with hemorrhoids. Material and methods We retrospectively collected 418 consecutive LST patients treated with ESD between 2011 and 2023. A retrospective comparative analysis was conducted. Results There were 85 patients included in the hemorrhoids group and 333 patients included in the other group. The en-bloc resection rate, R0 resection rate, and curative resection rate were comparable in these two groups (p > 0.05). The LSTs with hemorrhoids have a significantly higher intraoperative bleeding rate during ESD when compared to the other group (12.9% vs. 5.4%, p = 0.028). Rates of intraoperative perforation and anal pain in the hemorrhoid group were significantly higher than those in the no-hemorrhoid group (2.4% vs. 0%, p = 0.041; 9.4% vs.0.6%, p < 0.001; respectively). Moreover, most of the related manifestations caused by hemorrhoids were relieved to various degrees after ESD. Conclusions ESD is a safe and effective treatment strategy for LSTs with hemorrhoids. A multi-center and prospective study should be conducted in the future to validate our results.

Anal Pathologies during Pregnancy and Postpartum: Diagnosis and Treatment at the Kalaban Coro Referral Health Center

Pregnancy and childbirth are generally considered to be happy episodes in women's lives, these events can be marred by anal affections. The exact epidemiology of anal pathologies is difficult to define, due to the reluctance of patients to discuss their symptoms and to be examined. In most cases, their diagnosis is delayed and their management is inadequate or inappropriate. Aim: To study anal pathologies during gravido-puerperality at the CS Ref of Kalaban Coro. Methods: This was a single-center descriptive and analytical prospective study with prospective data survey at the CS Ref of Kalaban Coro. The study was conducted over a 9-month period from January 1 to September 30, 2019. Results: During the study period, we identified 151 pregnant women. Of these pregnants, 88 or 58.27% had anal pathology. The different anal pathologies encountered were, hemorrhoidal disease (30.68%), anal fissure (30.68%) and anal incontinence (27.27%). The offending factors were dominated by constipation, a newborn weight &gt; 3500g, a foetal expulsion time &gt; 20 minutes. The clinic was conducted by interrogation and proctological examination. Clinical signs were anal pain, rectorrhagia, and pruritus. Treatment primarily includes the regulation of intestinal transit and topical topicals, analgesics, and those that improve blood circulation (Veinobiase, Daflon).

Pilonidal Sinus of the Anal Canal: A Rare Entity - Case Report

AbstractPilonidal sinus is the term first used by Hodges in 1880 to describe a granulomatous lesion containing hairs. It has been previously described as hair extracted from an ulcer and referred to as Jeep's disease, in world war days. Pilonidal sinus is the condition in which a sinus or fistula is situated at a short distance from the anus and generally contains hairs. It is commonly observed in the sacrococcygeal region and a few other sites, such as the axilla, umbilicus, face, etc. Its presence elsewhere is uncommon. Predisposing factors are traumatized, hairy skin, which leads entry of the hair inside the wound, thus forming a sinus. A 31-year-old patient presented with discharging endoanal sinus tract, which, on exploration, turned out to be an endoanal pilonidal sinus containing hair tufts, a rare case. The patient complained of recurrent pus discharge and anal pain for 45 days, reporting history of travelling around 70 km daily in a two-wheeler vehicle.On first physical evaluation, a small endoanal bulge was found. It was located at 1 o'clock in lithotomy position (anterior), with purulent discharge and anterior anal fissure. For confirmation, an endoanal ultrasonography (USG) was performed, which showed a sinus tract containing internal echoes and gas bubbles with a small amount of pus. The sinus was explored, and a wide excision was made and left open for secondary healing.Pilonidal sinus of the anal canal is a rare entity, and it can be found in hairy patients who are used to going on long, daily rides on two wheeled vehicles.

A Qualitative Concept Elicitation Study to Understand Patient-Reported Symptoms and Impacts of Neisseria gonorrhoeae Infections in the United States.

Gonorrhea is the second most common bacterial sexually transmitted infection in the United States, with rising rates. Emerging antimicrobial resistance threatens public health, and vaccines are in development. This study documents patient-reported gonorrhea symptoms and health-related quality-of-life (HRQoL) impact in women who have sex with men (WSM), men who have sex with women (MSW), and men who have sex with men (MSM). Semistructured qualitative interviews were conducted (April 2021-March 2022) among US adults with recent (≤6 months) confirmed gonorrhea. Concept saturation was achieved, confirming adequate participant numbers to meet objectives. Elicited symptom and HRQoL impacts were used to develop a conceptual disease model. Common patient-reported outcome measure (PROM) items were compared with elicited concepts. Thirty-two participants (15 WSM, 8 MSW, and 9 MSM) were included. Eight were asymptomatic, 6 had repeat infections, and 5 women and 4 men had complications (i.e., infertility or pelvic inflammatory disease, and urethritis, respectively).The most frequently reported symptoms were vaginal discharge (n = 11 of 12), dysuria (n = 10 of 12), and abdominal/vaginal pain (n = 9 of 12) for symptomatic WSM; dysuria (n = 5 of 6) and penile discharge (n = 4 of 6) for symptomatic MSW; and throat, testicular, or rectal pain (n = 4 of 6) for symptomatic MSM. All (symptomatic and asymptomatic) participants reported HRQoL impacts including negative emotional experiences (n = 31 of 32), and interference with sexual activity (n = 30 of 32), relationships (n = 24 of 32), and social life (n = 17 of 32). Concepts were poorly represented in existing PROMs. Participants reported a diverse range of symptoms and HRQoL impacts, to help inform the value of new treatment and prevention options. More research is needed to quantify patient burden and develop PROMs.

Case report: atypical presentation of mpox with massive hematochezia and prolonged viral shedding despite tecovirimat treatment

BackgroundThe outbreak of mpox that occurred between 2022 and 2023 is primarily being transmitted through sexual contact. As of now, there is no consensus on the recommended duration of isolation to prevent sexual transmission of the virus. Moreover, this particular mpox outbreak has presented with distinct complications in comparison to previous occurrences. In this report, we present a case involving severe rectal bleeding from an ulcer in a mpox patient with a history of engaging in receptive sexual contact.Case presentationA 30-year-old Korean man presented at the hospital with complaints of fever, multiple skin lesions, and anal pain. Monkeypox virus polymerase chain reaction (PCR) results were positive for skin lesions on the penis and wrist. The patient received a 12-day course of tecovirimat due to anal symptoms and perianal skin lesions. Following isolation for 12 days and after all skin scabs had naturally fallen off, with no new skin lesions emerging for a consecutive 48 hours—conforming to the criteria of the Korean Disease Control and Prevention Agency—the patient was discharged. However, 1 day after discharge, the patient returned to the hospital due to hematochezia. His hemoglobin level had significantly dropped from 14.0 g/dL to 8.2 g/dL. Sigmoidoscopy unveiled a sizable rectal ulceration with exposed blood vessels, prompting the application of hemostasis through metal clipping. Subsequent monkeypox virus real-time PCR conducted on rectal tissue and swabs yielded positive results (with cycle threshold values of 28.48 and 31.23, respectively). An abdominal CT scan exposed a perirectal abscess, for which ampicillin-sulbactam was administered.ConclusionThis case underscores the importance of monitoring for bleeding complications and confirming the resolution of rectal lesions before discharging patients from isolation, particularly in cases where patients have a history of engaging in receptive sexual contact with men or are presenting with anal symptoms.

EXPERT SYSTEM FOR DISEASE IDENTIFICATION BASED ON HEMATOCHEZIA SYMPTOMS WITH NAÏVE BAYES METHOD

Hematochezia is a common clinical symptom in various gastrointestinal diseases, requiring accurate diagnosis for effective treatment. This study aims to develop an expert system for the rapid and precise identification of hematochezia-causing diseases. The expert system is designed to assist patients in efficiently recognizing diseases, minimizing treatment failure risks. It employs the Naïve Bayes method, a data calculation approach involving summing combinations and frequencies of each dataset. The expert system methodology begins with training using a dataset comprising hematochezia symptoms and corresponding disease diagnoses. The dataset is input into a database as training data. Subsequently, it undergoes classification and training stages. Symptom data can then be processed using the Naïve Bayes method. The system's end result displays probability values for each disease based on provided symptoms. This analysis relies on specific symptoms selected by the user, such as Rectal Pain, Hematochezia, Constipation, Fatigue, and Abdominal Cramps. It yields a Hemorrhoids diagnosis with a posterior probability of 0.514738. In testing with 35 sample cases, the expert system exhibited a remarkable accuracy rate of 94.29%. This expert system efficiently supports disease diagnosis based on hematochezia symptoms, aiding in swift and accurate identification.

Chlamydial Proctitis Mimicking Inflammatory Bowel Disease in a Young Active Duty Sailor With Undiagnosed Human Immunodeficiency Virus Infection: A Case Report.

Proctitis is an inflammation of the lining of the rectum that can be either acute or chronic in presentation. Symptoms include rectal bleeding, constipation, rectal discharge, rectal pain, and tenesmus. It is commonly associated with inflammatory bowel diseases (IBDs) such as ulcerative colitis and Crohn's disease. However, it is important to consider the infectious causes of proctitis such as the sexually transmitted infections (STIs), especially Chlamydia trachomatis and Neisseria gonorrhoeae, as these can mimic the symptoms and pathology of IBD. We present the case of a young male sailor with subacute rectal bleeding who was hospitalized with initial concern for an index presentation of IBD. Endoscopic evaluation revealed proctitis although findings were atypical for inflammation related to IBD. Acquisition of additional history revealed that he had both receptive and insertive anal intercourse with both male and female partners. A full STI screening, including HIV was performed. Results were positive for both rectal C. trachomatis and HIV antigen and antibody serology, which were confirmed as HIV-1 on confirmatory testing. He was treated with doxycycline for his chlamydial proctitis with symptom resolution and was also initiated on antiretroviral therapy for his HIV infection. This case highlights the importance of obtaining a sexual history and considering STIs as a cause of proctitis, as this will ensure proper screenings and prompt subsequent treatment and potentially avoid unnecessary endoscopic and medical evaluation, which could potentially worsen the underlying process.

(148) “Zebras” in Sexual Medicine from Cauda Equina Pathology

Abstract Introduction Unrelenting, bothersome sexual medicine problems in individuals with a vulva or penis sometimes do not respond to conventional therapies, frustrating both patient and provider. These distressing problems can be categorized as a genito-pelvic dysesthesia (GPD), including genito-pelvic (penile, scrotal, clitoral, vulvar, vestibular, vaginal, bladder, rectal) pain, persistent genital arousal disorder (PGAD), sleep related prolonged erections (SRPE) and hard-flaccid syndrome (HFS), currently considered as “zebras” in sexual medicine. We recently published a study on 20 patients with PGAD/GPD who underwent a multi-disciplinary management algorithm, were determined to have lumbosacral annular tear induced sacral radiculopathy, and with one year follow-up post-spine surgery, 80% revealed improvement in symptoms. Objective To apply our (spine-sexual medicine) multi-disciplinary management algorithm to sexual medicine “zebras”. Methods Patients who presented between July 1, 2021, and June 30, 2023, to our sexual medicine clinic were included in the study cohort. The management algorithm was as follows: biopsychosocial history, multiple validated instruments, physical examination, neurogenital testing, regional anesthesia testing, lumbosacral MRI, and when appropriate, a caudal epidural or transforaminal epidural spinal injection. Those with clinically significant symptom reduction from the spinal injection were offered appropriate spine surgery. Patient Global Impression of Improvement (PGI-I) was assessed post-operatively (1 = very much better, 2 = much better, 3 = better, 4 = no change, 5 = worse, 6 = much worse and 7 = very much worse. Results Our study cohort consisted of 24 patients, 14 with a vulva and 10 with a penis, mean age 42 years (range 25-69) who presented to our clinic over a period of two years. The patients' GPD complaints included genital pain (13), PGAD (6), SRPE (2), HFS (1), bladder pain (1) and rectal pain (1). All patients had results of neurogenital and regional anesthesia tests consistent with sacral radiculopathy, then underwent a diagnostic focal lidocaine spinal injection. Each had a positive response to either a transforaminal epidural spinal injection and underwent lumbar endoscopic spine surgery (n = 21) or a caudal epidural and underwent Tarlov cyst surgery (n = 3). PGI-I scores after surgery indicative of improvement (PGI-I = 1, 2, 3) at one week was 10/22 (45%), at 6 weeks was 9/17 (53%) at 3 months was 9/16 (56%) and at 6 months was 5/6 (83%). Conclusions Patients presenting with sexual medicine complaints not successfully managed by routine treatment strategies often experienced delay in diagnosis and excessive healthcare-seeking behavior resulting in significant distress. In our experience, GPD can result from triggers in the cauda equina, far from the location of the presenting genito-pelvic symptom(s). Our cohort of sexual medicine “zebras” who underwent our multi-disciplinary management algorithm were diagnosed with sacral radiculopathy. These patients opted for spine surgery and reported improvement of symptoms that continued to get better over time. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Eliquence.

Bowel Preparation Burden, Rectal Pain and Abdominal Discomfort: Perspective of Participants Undergoing CT Colonography and Colonoscopy.

This study aimed to evaluate bowel preparation burden, rectal pain and abdominal discomfort levels and to determine the association between demographic characteristics and those levels among participants undergoing CT colonography and colonoscopy. A cross-sectional survey was conducted in eligible Thai citizens who consented to participate all four visits of a free colorectal cancer screening protocol. Three levels (mild, moderate and severe) of burden, pain and discomfort were used to ask the perspective of participants at the final visit, one week after undergoing those two procedures. Data from 1,271 participants completed for analyses - females 815 (64.1%), males 456 (35.9%). The majority of participants experienced mild burden, pain and discomfort. Association between characteristic groups and burden levels differed regarding own income, chronic disease and laxative. Between characteristic groups and pain and discomfort levels differed regarding own income and chronic disease. Participants without their own income rated severe burden lower than those who had (p<0.001), but those without chronic disease rated moderate burden lower than who had (p=0.003). Participants prepared bowel with spilt-dose of PEG rated moderate burden higher than those who prepared with NaP (p<0.001). Participants undergoing CT colonography without their own income and presenting no chronic disease faced severe rectal pain lower than those who had (p<0.001 and p=0.04). Participants without their own income rated moderate and severe abdominal discomfort lower than those who had (p<0.01 and p=0.008). Participants undergoing colonoscopy without their own income and no chronic diseases faced severe rectal pain lower than those who had (p<0.001 and p=0.007). Participants without their own income and no chronic disease rated severe abdominal discomfort lower than those who had (p<0.001 and p=0.005). Evaluating the perspectives of customers alongside quality improvement and innovation to reduce unpleasant experiences remains needed in CT colonography and colonoscopy to promote CRC screening.

Therapeutic Effects of Tretinoin and Caffeine-Treated Bone Marrow-Derived Mesenchymal Stem Cell on Immunological Features of Ulcerative Colitis: An Animal Model Study.

Ulcerative colitis (UC) is one of the inflammatory gastrointestinal diseases. It causes irritation, inflammation, and ulcers in the digestive tract. UC is distinguished clinically by abdominal and rectal pain and intestinal secretion abnormalities. Mesenchymal stem cell (MSC) therapy could be the underlying treatment for UC. This study aimed to compare the results of MSC therapy with tretinoin and caffeine in an animal model. Sixty male BALB/c mice were randomly divided into six equal groups. Five groups were exposed to acetic acid-induced colitis, and one healthy negative control group was designed. The positive control group was UC-induced mouse model with no treatment. Besides, treatment groups were MSCs (n = 2×106) that received tretinoin and caffeine. The treatment group was given mesalazine orally. The decision to begin treatment was taken after monitoring the symptoms of the UC. MSCs, tretinoin, and caffeine-treated MSCs significantly decrease inflammatory cytokines (interleukin (IL)-1, IL-6, and tumor necrosis factor (TNF)-α) and inflammatory mediators (myeloperoxidase (MPO) and nitric oxide (NO)) compared with the positive control group. However, the alleviated effects of tretinoin-treated MSCs significantly were more than those of MSCs and caffeine-treated MSCs. MSC therapy is an effective option for UC and can prevent disease progression. The results represented a high developmental rate and simple cell application of MSC therapy in UC patients. Also, MSC therapy's ability for immunomodulation is strengthened by drugs that improve their microenvironment by binding to their receptors.