Tuesday 27 November 2007

Pic of the day: Would this have happened if I had eaten my green vegetables?

Death by rectal spasm?

I think the title of the entry tells you that it is not to be taken with meals. Anyway, I am still alive, and almost two months later at that, so obviously I survived. I was a lot less sure about that at the time, though. And no thanks to you, by the way, especially those of you who have tricked me into going to the doctor when I was not dying. I am surely marked with "hypochondriac" in their database by now. And tonight didn't help... although it should have.

***

It all started in the early evening or late afternoon. I was happily writing when I started to feel pain in my guts. The pain was rather strong and it hit more than one place, either at the same time or in quick succession. It was not like the pains that I have felt in one side before. I started to get worried because it was a new type of pain. Pain in itself doesn't scare me until it reaches the level of agony, or lasts for a very long time. But unfamiliar pain is a warning that something is not working as intended, and I should check it out.

Then I started to shiver with cold, and this at least seemed familiar. It felt like a mild fat poisoning. (For those who don't know me out and in, I can only eat a small amount of fat without getting ill. The symptoms will typically not arise until a day later, at which point there is nothing I can do except reduce the impact by keeping as warm as possible. I make sure to not eat that much fat, but over time I tend to slowly gravitate toward the limit of what I can eat without getting sick, because fat Really Satisfies. Because I slowly drift into the danger zone rather than break down and pig out, the attacks have been mild the last two years after I found out what caused them.)

Fat poisoning is something I am familiar with and usually know how to handle. It causes my body temperature to fall (or so it seems on my thermometer) and then I start shaking and shivering as my body tries to heat up. Not only the muscles that we think of as muscles, but also the autonomous muscles of the digestive tract start twisting and turning in sympathy. Or was that parasympathy? Anyway, the guts start spasming, and it is not just a speeding up of the normal movement. It is more like there are spots of spasm where the guts contract and squeezes their content to either side, causing either high velocity bowel movements if near the rectum or a longer upset if further away. Well, it was about time for bowel movements anyway.

Except nothing did pass. Not even gas. The pressure kept rising, but nothing. It was as if someone had tied a knot on my rectum. This was not normal. It felt a bit like a constipation, but not quite the same. (I am familiar with constipation, I was an anal-retentive until around the age of 35 or so, at least in the literal sense. I had a great fear of loose stool ever since my childhood, and since I never had loose stool except during food poisoning or similar, this was reinforced. You don't need to remember all this to appreciate my suffering, though.) It literally felt like my rectum was tied off. I really needed to go but I couldn't.

I even went to the emergency room. At this time, I was convinced that my bowels had somehow become twisted. Straining to defecate had no effect. In fact, my body did that on its own, but to no avail. I explained the situation to a doctor eventually. Predictably, he wrote it off as constipation and told me to buy some laxative in the morning. I left disheartened. Laxatives were the least thing I needed. I was already having a diarrhea, except nothing came out, not even gas.

In the small hours of the night, the horror continued. My body was straining continuously. My heart was running as if I was mowing the lawn, and my body temperature slowly rose to a fever. At this point I was beginning to think that this might end my life, unlikely as this may seem normally.

Toward the morning, however, something finally gave. It was a bit painful, and I was sore for a while afterwards, but I didn't see any blood in the stool. And I did look. What I also didn't see was the supposed hard stool that should have blocked my anus. There was no unusual "objects" in the stool. What there was was huge amounts of medium soft stool. Normally this should have been a snap to eliminate, but somehow it hadn't been. After this I had diarrhea for a day or two before gradually returning to normal.

***

I have a working hypothesis on what happened, but I am not enough of a medical expert to say for sure. But it seems that the culprit was the very rapid filling of the rectum due to the spasms a little higher up. The rectum was distended and its shape changed so that it no longer aligned correctly with the anus. That's how it felt at least. Like a part of the intestinal wall was folded into the passage perhaps. The straining just kept this going and if anything getting worse. It was only when my rectal muscles were so exhausted from straining for hours that they briefly gave up, that the normal shape reasserted itself to some degree, enough that I could work around it.

I wonder if this is a beginning prolapse. Reading shows that rectal prolapse is a known problem, and I have vague memories of some elderly relative describing a full prolapse, in which part of the rectum actually came out through the anus. I suppose this may happen to me if I have enough of these episodes to completely unmoor the rectum. It is not a leading cause of death, even though it certainly feels like it could be fatal. But it may require surgical correction if it gets that far.

I am going to have this experience at least one more time this winter, though not for quite as long. After that I will pay more attention to having regular bowel movements so there can't accumulate so large stools. Whether that will have the desired effect is too early to say.