Tenesmus Or Proctitis

[mle-ii]

I just learned of these terms yesterday. And it fits exactly with my remaining symptoms. Before going gluten-free I would have painful diarhea more than normal, now along with not eating dairy or too much fructose (malabsorbtion) I seem to have a pretty good grasp on being symptom free except for the Tenesmus/Proctitis symtoms that I have every once in a while.

I have gluten intollerance as determined by stool testing via Enterolab, and I have been diagnosed with Lymphocytic Colitis. LC is an inflmation of the lymphocytes in the colon.

Anyone else have this? Found anything that helps? Any help would be very much appreciated as this seems to be the last symptom that's really limiting me in my life right now.

Tenesmus:

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Alternative names

Pain - passing stool; Painful stools; Difficulty passing stool

Definition

Tenesmus is the constant feeling of the need to empty the bowel, accompanied by pain, cramping, and involuntary straining efforts.

Considerations

Tenesmus is generally associated with inflammatory diseases of the bowel, which may be caused by an infection or by other conditions. Tenesmus is characterized by a sensation of needing to pass stool, accompanied by pain, cramping, and straining. Despite straining, little stool is passed.

Common Causes

Inflammatory bowel disease (IBD)

Crohn's disease

Ulcerative colitis

Anorectal abscess

Infectious colitis (infection of the colon)

Colorectal cancer or tumors

Radiation proctitis or colitis (inflammation of the colon or rectum from radiation)

Proctitis:

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Thanks,

Mike

[mle-ii]

Well, it appears there is a link between celiac and proctitis.

  Quote

1: Scand J Gastroenterol. 1987 May;22(4):471-7. Links

Coeliac proctitis.

Breen EG, Coughlan G, Connolly CE, Stevens FM, McCarthy CF.

An increased association of ulcerative colitis and coeliac disease has been reported, as have the results of several small-bowel biopsy studies in ulcerative colitis. Forty-two patients from a population of 438 patients with coeliac disease had rectal biopsies. Fourteen of these showed inflammation of various degrees of severity, including three compatible with a diagnosis of ulcerative colitis. The presenting complaint in 34 of these patients was diarrhoea or steatorrhoea. Twenty-seven patients had coeliac disease diagnosed at the same time or after their rectal biopsy. The other 15 were previously diagnosed coeliacs. Twelve of the 14 patients with abnormal rectal biopsy specimens were known to have subtotal/total villous atrophy at the time of rectal biopsy. Proctitis as seen in these coeliac patients had no unique features to differentiate it from proctitis caused by other disorders. The diarrhoea/steatorrhoea stopped in all patients on commencement of a gluten-free diet, except in those with ulcerative colitis. Proctitis is common in patients with coeliac disease presenting with diarrhoea/steatorrhoea. This study supports the finding of an increased association of coeliac disease and ulcerative colitis and is, to our knowledge, the first rectal biopsy study of a coeliac population.

[NicoleAJ]

I was diagnosed with proctitis through a colonoscopy. Though I maintain a gluten free diet, my GI did believe that there was a link between my celiac disease and the proctitis. My treatment has been 1000 mg Canasa suppositories prescribed by my doctor. Proctitis is a chronic disorder that will recur throughout your life, so each time I get it (I can usually tell if there's blood visible on or in my stool), I just take the suppositories daily for a week or so and it goes away.

[mle-ii]

  NicoleAJ said:

I was diagnosed with proctitis through a colonoscopy. Though I maintain a gluten free diet, my GI did believe that there was a link between my celiac disease and the proctitis. My treatment has been 1000 mg Canasa suppositories prescribed by my doctor. Proctitis is a chronic disorder that will recur throughout your life, so each time I get it (I can usually tell if there's blood visible on or in my stool), I just take the suppositories daily for a week or so and it goes away.

I don't regularly see blood visible on or in my stool, but all of the other symptoms fit very well. Thanks for the info, I'll have to talk to my Dr about this.

Mike

[trents]

Before celiac disease dx and going gluten free, I had symptoms similar to what is described in the definitions of these symptoms. I also had rectal seepage which would cause me to brown spot my undies nearly every day. This has also disappeared. Looking back, these were the primary GI symptoms I had. At the time, I just thought it was IBS. Thanks for the info.

Steve

[mle-ii]

  trents said:

Before celiac disease dx and going gluten free, I had symptoms similar to what is described in the definitions of these symptoms. I also had rectal seepage which would cause me to brown spot my undies nearly every day. This has also disappeared. Looking back, these were the primary GI symptoms I had. At the time, I just thought it was IBS. Thanks for the info.

Steve

Glad to hear it's over for you.

For me this only happens every once in a while, and seems to be the symtoms I mostly get when I feel ill. Sometimes it's diarhea, but mostly it's like this with soft unformed stools. It used to be D a lot more with this than it is now.

I get a very sharp pain that feels like it's about 3 inches below my belly button. The pain is very sharp and intense, like someone's taking a knife and stabbing it into that area and moving it around. Sometimes it's so painful I feel like I'm going to pass out. Luckily it's not as often as it used to be, but I still get it every once in a while.

The most prevelant part of it is the feeling like I have to go, going, not much coming out and feeling like I have to go again, and again, and again, for hours. Ugg.

So something is causing an inflamation of the rectum and lower part of the colon I'm guessing. What I'm not sure. From what I've read stress can agrivate it, but doesn't cause it. So it's gotta be something I eat or something I'm not absorbing or who knows that's causing it.

Mike

[burdee]

Mike:

I had symptoms of both those conditions before going gluten/dairy/soy free. However I STILL have milder symptoms occasionally. So I plan to get the ELISA test panel to determine whether I have other food sensitivities. Enterolab now offers the soy/egg/yeast panel, but I decided to visit a local naturopath who does the ELISA panel, because I don't really have a local doc who advised me about celiac disease and food intolerances. I'm tired of those symptoms and want to figure out what else might be bothering me. However, I may also just be overlooking a source of gluten, dairy or soy ...

BURDEE

[mle-ii]

  burdee said:

Mike:

I had symptoms of both those conditions before going gluten/dairy/soy free. However I STILL have milder symptoms occasionally. So I plan to get the ELISA test panel to determine whether I have other food sensitivities. Enterolab now offers the soy/egg/yeast panel, but I decided to visit a local naturopath who does the ELISA panel, because I don't really have a local doc who advised me about celiac disease and food intolerances. I'm tired of those symptoms and want to figure out what else might be bothering me. However, I may also just be overlooking a source of gluten, dairy or soy ...

BURDEE

Forgot to add that my symptoms are also flu like. I feel achy, irritable and very tired. I get nausous, but don't throw up. I end up not wanting to eat anything at all.

I'm thinking about going to a local naturopath as well to get some sort of food sensitivity test done. I just wasn't sure which to take? Seems like there is a lot of different testing that can be done.

I did have Enterolab test for soy/egg/yeast, and all came back negative, but then there are other sugars/proteins in those foods that I could be sensitive to.

Thanks,

Mike

[tiredofdoctors]

Because of the previous hassles which were involved in discussing this on a professional, clinical level in the past, I would be happy to talk with you about this . . . you can e-mail me at bodyworxinc@hotmail.com. I'm a physical therapist, and prior to having to close my practice, 80% of my patients were diagnosed with some type of proctalgia fugax, outlet dysfunction constipation, anismus . . . Lynne

[mle-ii]

  NicoleAJ said:

I was diagnosed with proctitis through a colonoscopy. Though I maintain a gluten free diet, my GI did believe that there was a link between my celiac disease and the proctitis. My treatment has been 1000 mg Canasa suppositories prescribed by my doctor. Proctitis is a chronic disorder that will recur throughout your life, so each time I get it (I can usually tell if there's blood visible on or in my stool), I just take the suppositories daily for a week or so and it goes away.

Hi Nicole,

Do you do anything different diet wise than you do for celiac? I've read a bit saying that diet doesn't make a difference, but I can't belive that's the case.

Thanks,

Mike

  burdee said:

Mike:

I had symptoms of both those conditions before going gluten/dairy/soy free. However I STILL have milder symptoms occasionally. So I plan to get the ELISA test panel to determine whether I have other food sensitivities. Enterolab now offers the soy/egg/yeast panel, but I decided to visit a local naturopath who does the ELISA panel, because I don't really have a local doc who advised me about celiac disease and food intolerances. I'm tired of those symptoms and want to figure out what else might be bothering me. However, I may also just be overlooking a source of gluten, dairy or soy ...

BURDEE

Hi Burdee,

Ok, I was on the fence about getting the ELISA test, but after reading some more I'm going to get this done. Insurance or not I really need to figure this out. I too am tired of these symptoms and wonder what else I might be overlooking.

Let me know how the testing goes.

Here are a couple of articles that lead me to agree more with getting the testing done. I know that they're part of the lab that does ELISA testing, but it was very convincing. And the references were spot on as well. This is the same lab that my naturopath uses.

Open Original Shared Link

Open Original Shared Link

Thanks,

Mike

[mle-ii]

  mle_ii said:

Hi Nicole,

Do you do anything different diet wise than you do for celiac? I've read a bit saying that diet doesn't make a difference, but I can't belive that's the case.

Thanks,

Mike

Hi Burdee,

Ok, I was on the fence about getting the ELISA test, but after reading some more I'm going to get this done. Insurance or not I really need to figure this out. I too am tired of these symptoms and wonder what else I might be overlooking.

Let me know how the testing goes.

Here are a couple of articles that lead me to agree more with getting the testing done. I know that they're part of the lab that does ELISA testing, but it was very convincing. And the references were spot on as well. This is the same lab that my naturopath uses.

Open Original Shared Link

Open Original Shared Link

Thanks,

Mike

Just found out that it is inded covered by my insurance. CPT 86001 is the code the insurance folks need. The bummer is that the office is closed and so I haven't heard back yet. Gotta make sure that they have the test, get it done and it'll take 2 weeks for the results.

[mle-ii]

Well look here:

Open Original Shared Link

  Quote

Scand J Gastroenterol. 1987 May;22(4):471-7.

Coeliac proctitis.

Breen EG, Coughlan G, Connolly CE, Stevens FM, McCarthy CF.

An increased association of ulcerative colitis and coeliac disease has been reported, as have the results of several small-bowel biopsy studies in ulcerative colitis. Forty-two patients from a population of 438 patients with coeliac disease had rectal biopsies. Fourteen of these showed inflammation of various degrees of severity, including three compatible with a diagnosis of ulcerative colitis. The presenting complaint in 34 of these patients was diarrhoea or steatorrhoea. Twenty-seven patients had coeliac disease diagnosed at the same time or after their rectal biopsy. The other 15 were previously diagnosed coeliacs. Twelve of the 14 patients with abnormal rectal biopsy specimens were known to have subtotal/total villous atrophy at the time of rectal biopsy. Proctitis as seen in these coeliac patients had no unique features to differentiate it from proctitis caused by other disorders. The diarrhoea/steatorrhoea stopped in all patients on commencement of a gluten-free diet, except in those with ulcerative colitis. Proctitis is common in patients with coeliac disease presenting with diarrhoea/steatorrhoea. This study supports the finding of an increased association of coeliac disease and ulcerative colitis and is, to our knowledge, the first rectal biopsy study of a coeliac population.

[mle-ii]

  mle_ii said:

Well look here:

Open Original Shared Link

Open Original Shared Link

It appears that the rectal tissue can be affected by gluten, at least I think this is what it's saying:

  Quote

Gastroenterology. 1989 Jul;97(1):29-37.

Studies of intestinal lymphoid tissue. XII. Epithelial lymphocyte and mucosal responses to rectal gluten challenge in celiac sprue.

Loft DE, Marsh MN, Sandle GI, Crowe PT, Garner V, Gordon D, Baker R.

Department of Medicine, University of Manchester School of Medicine, United Kingdom.

The immunopathologic, structural, and functional changes within rectal mucosa of known celiac sprue subjects were quantitated during local challenge with a peptic-tryptic digest of gluten. In the celiac sprue patients challenged with 2 g of digest, major effects occurred in lamina propria, submucosa, and local microvasculature. The lamina propria swelling was biphasic, starting 1-2 h after challenge with widespread extravascular deposition of fibrinogen, indicative of increased microvascular permeability, receding by 24 h postchallenge. A rapid fall in mast cells together with granule discharge suggested their involvement in this response. The late-phase swelling (48-72 h) was preceded by a rapid influx of neutrophils and basophils, the latter showing evidence of degranulation beyond 72 h. Reestablishment of vessel lumina, a rise in mast cells, and loss of neutrophils indicated tapering of the inflammatory cellular cascade by 96 h. Lymphocytes, first seen to enter the lamina by 2 h postchallenge, increased progressively, thereby resulting in substantial infiltration between 36 and 96 h. A marked rise in epithelial lymphocytes, maximal at 6-8 h, waned by 24 h. Volumes of surface and crypt epithelium remained constant throughout. In another challenge series with 4 g of gluten digest, electrical potential difference across rectal mucosa decreased significantly 12 h postchallenge, but the associated decreases in net sodium and chloride absorptive fluxes were insignificant. It is concluded that rectal mucosa is sensitized to gluten in celiac sprue disease and thus offers a promising and convenient in vivo substrate for investigative and diagnostic purposes.

What is also interesting is to not the time frames. Given that it takes some time to get to the rectum via the GI and given the times until reaction and reactions are over, no wonder it's so difficult to pinpoint where gluten is getting in.

Mike

[mle-ii]

And here's some info I've found in a quick search on transit time in the GI, no wonder I've got proctitis. Given the transit time (estimated/average) the gluten I might ingest and react to is in the colon (30-40 hours) a long time. Here's some info:

  Quote

it is difficult to state with any precision how long ingesta remains in the stomach, small intestine and large intestine. Nonetheless, there have been many studies on GI transit, and the table below presents rough estimates for transit times in healthy humans following ingestion of a standard meal (i.e. solid, mixed foods).

50% of stomach contents emptied 2.5 to 3 hours

Total emptying of the stomach 4 to 5 hours

50% emptying of the small intestine 2.5 to 3 hours

Transit through the colon 30 to 40 hours

Remember that these are estimtes of average transit times, and there is a great deal of variability among individuals and in the small person at different times and after different meals.

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[mle-ii]

Yes, I'm talking to myself now, but perhaps some other enginerd type person like myself is interested as well.

Ok, this info now has me wondering how many celiac folks have some form of colitis. Seems that given the transit time of the colon, surface area of the colon and that gluten can make it's way there undigested that there would be a large number of folks diagnosed with celiac who would have some sort of colitis or inflamation.

Why isn't more damage done to the rectum/colon in celiac diagnosed? Why is more damage done to the villi in the small intestine? 30-40 hours in the colon vs 1-2 hours in the small intestine.

Perhaps colon transit time is faster in celiac folks, perhaps once they are diagnosed celiac little is done about investigating damage to the colon, perhaps the villi are more suseptable to damage than the tissues of the colon.

Any ideas? Am I missing something here?

Mike

[NicoleAJ]

Hi Mike,

Sorry I've lost track of the thread and of the question you asked. I don't change my diet because I haven't noticed any difference with a change in diet.

[andrew1234]

Mike,

there's more damage to the small intestines than the colon because the concentration of gluten is higher in the duodenum, and jejunum than in the colon. Gluten is digested or broken down into peptides along the length of the small intestine, and these peptides are absorbed before they reach the colon in great quantities. That's why a biopsy only looks at the duodenum because this is where gluten concentration and damage is the highest.