It's one year I have problems in my anal area. It began with itchiness, then some minor mucus seepage, then, passed time, I began to have pain: pain when sitting and pain when walking. Then bloating, some days really painful bloating and constipation. And cramps, which became stronger and stronger, until today when I almos cry for them. I can't go to the bathroom cause the time I need (15 seconds or 2 minutes, it's the same) to reach the toilet, the urgency disappear, the cramps disappear and I expell almost nothing. Then, I experience pain, until next strong cramp. If I'm near the toilet, sometimes I can empty, and for some hours I stop with having problems. I don't know what to thing. I consulted a proctologist who told me I have rectal puberal syndrome ("anism") and I have to take dilatators. I began with small and then medium diltator, and I noticed things were going well, I began to empty myself well, and was optimistic. Two days ago I started the bigger dilatator. I don't know if its a coincidence, but I began to exacerbate my symptoms. When I take antibiotics things improve, but I always suspended after 10 days under my doctor advice. I'm wondering if this is "just" pouchitis and perhaps I need long term antibiotics (perhaps rotating). I'm so desperate. I would like to stay better but it seems impossible. I don't know what to thing and I'm beginning again to be so pessimistic. 

Original Post

This is way too early in the process for you to even begin to consider abandoning hope. That being said, you do present a confusing picture. It’s possible that you have two things going on. I’m not sure what the doctor observed that suggested a need for dilation, but it did seem to help you. If the stricture is structural then only dilation can help it, but if it’s functional (the muscles clamping too tightly at the wrong times) then pelvic floor physical therapy can be more useful.

It’s hard to know why antibiotics are helping if you have some sort of physical obstacle to stool progression. One guess might be that if the antibiotics are reducing cramping and straining (by treating pouchitis) then the anal muscles might get less twitchy.

If I were in your situation I’d find a *knowledgeable* gastroenterologist (not a surgeon, like a proctologist), and explore whether long-term antibiotics might take care of this. If you can find several that help, rotating them is a good idea. If you can only find one that helps then that’s okay too. The search is worth your time and trouble. Good luck!

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