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[balo]

My friend has pain deep inside his butt , not sure if it's inside rectum or just muscle tissue that has been damaged but it is a constant pain , described almost like a toothache that never stops.

Should we just go to the nearest hospital , Bangkok Pattaya Hospital or is there a recommendation for a Bangkok hospital and specialists that knows what they are doing , this is not a normal problem I think,.

Thank you for any help .

Edited January 27, 2014 by balo

[prodriver]

It depends where your friend is in Thailand. You mention a hospital in Pattaya so I assume that this is where your friend resides.

That hospital will surely be able to perform a colonoscopy which it seems likely that is what is required.

It also depends on how much your friend is prepared to pay. Private hospitals will obviously charge more than Government hospitals.

I've had two colonoscopies done. Both in Bangkok. One at the Government hospital, Siriraj and one done at the private hospital, Thonburi.

[Robby nz]

I had rectal cancer (2008) and the first thing was a digital exam then ultra sound.

I went to Premonkutklau the army hospital in BKK on the recommendation of a top retired rectal surgeon.

They have a large colo/rectal unit with several surgeons, My doctor was Dr Sahapon, recon I owe him my life.

I met the doctor at a private hospital and he gave me a choice of having the work done at the private hospital or the army hospital at around half the price, same doctor.

However I never had any pain only irregularity, a pain in that area could also be something to do with the tail bone (Coxys spelling).

Go get it seen to, the longer these things are left the worse they can get.

[Prbkk]

But sooner rather than later, that kind of pain is not to be ignored , particularly when it is constant....

[balo]

He had blood tests done already in the government hospital in Pattaya , and all tests were fine including stool and urine. PSA etc. Except Alt SGPT, they were a bit too high ,64 .

So the only problem is the constant pain , it gets worse when he sits down .

Any recommendations of good english speaking doctors in Bangkok and I will let him know where to go . Or maybe BPH here in Pattaya is good enough if they have the latest technology, I read something about 3D ultrasound scanning that can find anything if there is a problem, that would probably be a good idea.

.

Edited January 27, 2014 by balo

[Sheryl]

Balo, I am really not clearwhat the problem is. Can you be more specific as to the location and type of pain?

As this might be a rectal problem but might also be a spinal issue. So I don't know if he needs a rectal specialist or an orthopedist.

[balo]

I already asked him if the pain was located in the spine or tailbone but no pain there so it seems to be coming from deep inside , maybe some muscles or tissue around it , if its an infection maybe antibiotics will help but he had this problem for a long time and the pain is increasing. Any good hospital should be able to perform an ultrasound to check everything in that area ? What do you think Sheryl.

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[Sheryl]

He does not necessarily need an ultrasound. It really depends on where exactly this pain is, which I still don't know.

If he feels sure the pain is within the rectum, then he needs to see a proctologist, a manual exam would be the first step possibly followed by endosopy.

But if the pain is within the buttocks then a spinal cause remains possible. The pain would radiate along the sciatic or other nerves and would not be over the bone or spine. But it would be somewhat to the side of the anus/rectum and deep within.

Arte his bowel movements normal? Any pain on defecation?

Does the pain worsen with any particular movement? Sitting/Standing etc? Does it radiate towards the thigh?

[balo]

I asked about the bowel movement and he had diarrhea more often after this started , but the pain remains the same before , during or after defecation, he had his stool checked already at the hospital and that was fine.

Yes he feel worse pain a few seconds when he is standing up after been sitting for a while. But no radiation towards the thigh. He feel a bit embarrassed going to any doctor with this problem but I want to make sure he see the right specialist about this.

His age is 55 and no history of any big problems in the past.

[Sheryl]

Still unclear where the pain is.

Is it just in the buttocks or is it specifically within the rectum????

[balo]

That is a good question. When he press really hard on his butt muscles close to rectum the pain increases, so maybe this is buried deep inside the tissue, close to rectum , I tried to google for more information but it can be a lot of things causing this, maybe fistula or an abscess hidden deep inside . When he press the tailbone and other bones theres no pain .

That's why he needs a proper examination and a scan of the whole butt area .

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[Sheryl]

Well assuming the problem is in fact in the rectum or colon (and not musculoskeletal) I suggest he consult this extremely well qualified doctor at Bumrungrad who specializes in colorectal disorders

http://www.bumrungrad.com/doctors/Arun-Rojanasakul#sthash.t0SYJMkO.dpbs

There does not seem to be a colorectal specialist at BPH.

[balo]

Thankyou Sheryl, yes I was thinking about Bumrungrad , even if it's the most expensive hospital he will have to go there to get the best treatment . I will give him the details about this doctor.

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[balo]

After rectal examination and MR scan , the doctors could not find anything wrong and now the conclusion is it might be a damaged nerve near the muscles . And there is a condition called Pudendal Neuralgia which is very difficult to diagnose and Bumrungrad could not help with this.

Dr. Arun at Bumrungrad prescribed different medication to stop the pain .

Arcoxia 120mg, one tablet per day , and Ultracet (tramadol, paracetamol) as many tablets needed to reduce the pain .

So far the results are that Arcoxia works best , it's giving him a good pain relief, before he could not sit for more than 30 minutes , now he can sit for many hours without pain .

But arcoxia is an expensive drug , and he really want to find a specialist that can diagnose him , if this really is Pudendal neuralgia.

So now we are looking for specialists that can do the necessary tests to diagnose this condition in Thailand. Thanks.

.

[thepool]

I must say that I am very surprised the Doctors at Brumungrad say that diagnosing Pudendal Neuralgia is beyond their capability.

Where did the suggestion about Pudendal Neuralgia come from --------?

If the suggestion came from the Doctor(s) were they not able to make a suggestion or facilitate a referral ?

Just seems "odd"

Edited March 24, 2014 by thepool

[balo]

I must say that I am very surprised the Doctors at Brumungrad say that diagnosing Pudendal Neuralgia is beyond their capability.

Where did the suggestion about Pudendal Neuralgia come from --------?

If the suggestion came from the Doctor(s) were they not able to make a suggestion or facilitate a referral ?

Just seems "odd"

No it was suggested by the research we did online , and the doctor knew about this condition but explained it was difficult to diagnose.

When I read about pudendal neuralgia online only a handful specialists worldwide will do the necessary tests and try different treatments.

Dr. Arun suggested to try an injection with steroids but he could not guarantee it would work .

Edited March 24, 2014 by balo

[Sheryl]

A neurologist is probably your best bet. One who specializes in peripheral neuralgias and/or pain management. Let me look around a bit and get back to you.

[balo]

Thanks Sheryl , appreciate your help.

[Reborn]

I also suspect that I have pudendal nerve entrapment even if not so serious now, after a long long time making myself physiotherapy. But I investigated this and other matters and I found two doctors that can help, one of them I personally tested ( it is Great ! ) but not ( yet ) for pudendal nerve, only for problems with tendons, ligaments ( muscles ). They are both using Prolotherapy and you cannot find a Prolotherapy doctor in Thailand and most probably even a doctor that know what Prolotherapy is. If I should not be able to control 100% my suspected pudendal nerve problem with physiotherapy I will ask the doctor from Kuala Lumpur ( my doctor ) if he can check and make me a Prolotherpy injection on the nerve, if he has not experience for this problem I will flight directly to HK were ( also if much more expensive = trip + medical expenses ) there is a specialist for this problem.

You can find the doctors in Facebook. Dr.Zulkafperi Bin Hanapi in Kuala Lumpur and Dr. Stanley K H Lam in HK. If you should need more details kindly contact me in Facebook, I am Renato De Boni, I live in Chiang Mai