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Abdominal cramps and persistent smell from anus

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Hi, I am a 16 year old male highschool student and I have an embarassing and socially crippling health issue. The main issue that I have is the persistent odour emanating from my anus (rotten fish/feces smell). No matter how many times I wipe myself and how many baths/showers I have per day, I always stink. This problem started around mid October in 2013. Prior to this smell problem, I used to get abdominal cramps rather frequently. I can also recall straining to have a bowel movement nearly everyday for a long time. Some other symptoms that go along with the constant unpleasant odour are: fecal leakage (small amounts of feces leaking for 2-3 hours after having a bowel movement), occasional constipation, small spots of blood left on toilet paper (this symptom recently seemed to disappear, 3-4 weeks ago) and I noticed that my stomach seems to grumble and gurgle alot, especially when I go to bed. Approximately 3 weeks after I first noticed these symptoms, I went to go see my family doctor to see if he could solve my problem. He ordered that I get some blood tests done and an ultrasound. The blood tests, I believe, were to check blood sugar levels, as well as any bacterial related infections. The ultrasound, I believe, was to check for any lumps or abnormalities. All tests came back normal. There are many digestive and colon issues that 'run' in my family. My dad has diverticulitas and hemorrhoids. My Nana has IBS and I believe that she is diabetic and/or has Celiac disease (not positive about which one).

Possibly seperate from this issue, or maybe completely connected to this issue is another health problem(s) that I have been having. Since Grade 9 (2-3 years ago), I have had eye and mental issues. I get eye strain quite frequently and I feel like my eyes are always really wide open (abnormally so) all the time, and I can't control it. Whenever I am in a social situation, such as at school or a family get together, I get eye strain. I can also feel that my eyes are open wider than normal and dart around with a look that my friends describe as 'You look like your going to kill someone'. Some other syptoms that I am having is short term memory loss, speech problems, forgetfulness and a minor, infrequent studder. Interestingly though, I noticed that within my highschool, there are MANY other people dealing with these same eye and mental issues. Through a little bit of research, I came to notice that most of these symptoms in this paragraph listed above, directly correlate to Aluminum toxicity and possibly other metals too. Also, if you have what is considered to be a toxic amount of aluminum in your body, it can lead to various digestive disorders. This may possibly be the cause for my issue listed in the first paragraph, however I have not come to any definite conclusions yet. IMPORTANT: the only reason that I provided information about the issues listed in this second paragraph was to provide as much information as possible to hopefully solve my problem listed in the first paragraph.

I am sorry for the large content of writing that I have provided but this smell problem has really affected my life (mostly negatively as of now). I used to be an A student before this smell problem started. I would always get 80's and 90's in every subject, but since my smell problem started, my marks have significantly dropped. I have been staying home from school 2-3 days per week. I have been depressed and I never want to leave my house. My teachers think that I have a very serious health problem going on because I stay home all the time. All I want is for my smell problem to go away so I can regain my social and academic life back. I have literally spent hundreds and hundreds of dollars on possible solutions and products but nothing has worked yet. Again, I am sorry for writing so much and I realize that you are not a psychiatrist but I just needed someone to talk to about this issue. I would GREATLY appreciate if you could email me back and maybe shed some light on what my health problem may be and possible solutions for it.

PS I forgot to mention that I tried preparation H ointment (as I thought that I may have hemorrhoids) but it didn't provide any relief in terms of the smell. Also, I'm thinking that the cause of the smell may be because my anal opening isn't closing properly. I'm just not exactly sure what would be causing it to not close properly.

Thanks alot,
Ryan


Category: Internal Medicine Specialist

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Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.

Hello Ryan

Thank you for choosing DoctorSpring.

Lets approach the problems one by one. The major concern here is the fecal smell from the anal canal. This could be due to a couple of reasons and all of them are potentially amenable to treatment.

Two possibilities are a SIBO (Small intestinal bacterial overgrowth) and Inflammatory bowel disease with secondary infection. Many abdominal symptoms you have mentioned are suggestive of this. You will need evaluation in form of certain blood test, an endoscopy and colonoscopy. You will need to consult a Medical Gastroenterologist for this purpose. Usually an accurate diagnosis and short course of antibiotics like Rifaximin will take care of the issue.

I do not agree with the possibly of aluminium toxicity. Atleast at this point. You take any heavy metal poisoning the manifestation have many similar component. And most of the cases they are non specific.

In my opinion other symptoms are non specific and could be stress or anxiety induced. Especially short term memory loss, eye strain etc. I hope you have your eyes cheeked for refractive errors.

Do not use preparation H or any OTC medications . Take an multivitamin supplement once a day. Do schedule a consult for further evaluation with your Doctor / gastroenterolgist.

Hope this helps
Feel free to ask followups
Thank you


Patient replied :

Thank you for your expersise and advice, I appreciate it. I just have a couple other questions to ask and I forgot to mention a few other things in the original email.

One of the symptoms that I forgot to mention is that I have excessive sweating around the groin/anal region only. I'm not sure if that is connected to the smell problem or not. I also forgot to mention that I have irregular bowel movements and I get diarrhea quite frequently (not sure if this is connected with the constipation or not). Also, because there is an odour of feces escaping through my anus 24/7, would that not mean that my anal opening isn't closing properly? And if so, how can I solve this. Also, when you mentioned that my problem could be inflammatory bowel disease with a secondary infection, what do you mean by a secondary infection? Is going to a gastroenterologist the only way to determine my problem? Is it possible that there could be self-tests or things that I could do? How long of a wait would it be to go see a gastroenterologist? And finally, is there an effective way that I can get rid of or cover up the smell until I get this problem solved?


Expert:  Dr. Deepu Sebin Sebastian replied 3 Days.

Hello,

Usually the anal orifice can hold back solids, but not liquids. The end of the intestine (rectum ) is supposed to contain only solid fecal matter. So when there is diarrhoea the leak can happen. It need to mean there is a "structural leak " .

Secondary infection means bacterial infection over an existing condition (possibly inflammatory bowel disease here)

And YES, you need to consult a Medical Gastroeneterologist for sure. Quick fixes don't work (as you might have realised already). You can take a Probiotic capsule twice a day for 4 days . This might result in some improvement. Body sprays, avoiding milk, eating high fibre foods etc also may provide a temporary solution.

The increased sweating is unrelated. It is just an individual variation and there is nothing to worry about it.

I would strongly recommend a Gastro evaluation. Delay might result in permanent damage in the intestines, which you would want to avoid at any cost.


Hope this helps
Feel free to ask followups
Thank you


Patient replied :

Okay, thanks for the advice. Recently, I asked my mother some more questions about the blood work and ultrasound that had been done through the request of my family doctor. She said that my doctor said that all tests showed absoutely no indictions of infections or anything abnormal. If true, would that not mean that I don't have a SIBO or anything infection related? Also, I have recently done a self-examination of my anus via a mirror. I immediately noticed what looked like small purplish/bluish lumps. Would this not be hemorrhoids? Practically the whole area was kind of a purple/blue colour with what looked like lumps, and any area that wasn't like this was bright red. Could it be hemorrhoids or are there lots of veins in the anus? The area that I am referring to is not really in the anal canal but not externally either. It is kind of near the opening. If it is hemorrhoids, could it be that they are creating the smell, or because they are causing the anal muscles to not close properly? I also noticed that when using toilet paper after a bowel movement, the anal region gets very irritated and red. However, this would not explain the constipation and cramps due to gas build up. Could there be a simple explanation for this? Or could there be 2 different conditions going on?

Thanks Again,
Ryan


Expert:  Dr. Deepu Sebin Sebastian replied 2 Days.

Hello Ryan,

Routine blood tests and Ultrasound will not identify bowel infection and inflammatory bowel disease. For this specific tests has to be done, including colonoscopy. This has to be under the care of a Medical Gastroenterologist.

The purplish lumps are most likely haemorrhoids as you rightly suspected. This will not cause of any of your symptoms including the leak. The redness and bruising while using toilet paper could be due to this. As of now both conditions seems different.

Hope this helps
Thank you


Patient replied :

Okay, I am pretty sure that I do have hemorrhoids. That would explain why when using the preparation H cream, the smell did not go away. So most likely, the hemorrhoids were caused by the constipation and straining during bowel movements, correct? So your saying that there is no chance that the hemorrhoids are causing the smell or the leak, is that correct? The prescence of hemorrhoids does explain a lot of my symptoms, including the bleeding after wiping with toilet paper (causing irritation and redness). However, would it be likely that it is something like inflammatory bowel disease that caused the hemorrhoids? Also, it seemed like, from what I noticed at least, that the smell problem started rather abruptly (going from normal to not normal within a couple days). The same goes for the leak. Is that common for something like inflammatory bowel disease? Not related to this at all but I was wondering if there is a limit on the amount of questions that I am allowed to ask? I have a few more questions but I will leave them for the next follow-up. Thanks.


Expert:  Dr. Deepu Sebin Sebastian replied 1 Day.

Hello,

You are absolutely right. The haemorrhoids is caused by the constipation and straining. This is nothing unusual. Haemorrhoids as such is a nothing dangerous or uncommon. It is just normal blood vessels but dilated.

The bleeding could be from haemorrhoids . BUT the whole idea is not to jump into assumption. There is like 20-30% chance that the bleed could be from somewhere else and that what we need to find out. Considering you have other symptoms it is prudent to rule out other causes.

The rather sudden onset of the symptoms could be due to a secondary bacterial infection. Similar to a stomach bug. The bacteria could have worsened a pre existing condition or could have directly resulted in the symptoms like foul smell.
That is why I feel an antibiotic course could bring in some good chance.

Hope this helps
Thank you
The followup limit I think is 3. The consult closed after 3 followups. In that case you can email to support@doctorspring.com to know what needs to be done.


Dr. Deepu Sebin Sebastian
Category: Sexually Transmitted Diseases(STD)Specialist
Experience: 
MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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