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Excruciating rectal pain after my lymphoma treatments
Sep 27, 2001

I was diagnosed with high grade anal dysplasia (HPV). I had surgery two years ago. I had severe pain for two months after. I was diagnosed with Non-hodgkins lymphoma Jan of this year. The lymphoma was in my rectal area/GI tract. I underwent 3 cycles of CHOP and 29 sessions of radiation. During the radiation I was very sore in my anus area. My last radiation treatment was 5 months ago. I'm still having horrible pain. The pain is worse when I have severe diarrhea. I apply Xylocaine when the pain becomes too unbearable. Why do I still have this pain? Could it be that I still am recovering from radiation treatment? Could the lymphoma be back? I'm 30 years old,I have a CD4 cell count of 59 and a VL of 39,000. Please help me.

Response from Dr. Dezube

This sounds just awful. The intense rectal pain is most likely related to the radiation treatment; you may have a condition called "radiation proctitis", which is inflammation of the rectum caused by radiation. Fortunately there are very good treatments for this condition.

Proctofoam-HC is a topical aerosol foam for anal use. It is supplied in an aerosol container with a special anal applicator. You use it 3 to 4 times a day. It's best applied after a bowel movement. Another effective agent is anusol-HC suppositories, which are also used 3 times a day (e.g., morning, afternoon, and night); they too are best applied after a bowel movement. Some patients respond better to one agent than the other, so please try both. The HC in both of these agents stands for hydrocortisone. It's important that you resee your radiation therapist or his(her) nurse.

On occasion, the inflammation can lead to bleeding. Are you bleeding at all? This is important to know since sometimes bleeding vessels need to be cauterized. Good luck. Please try not to get discouraged since ultimately the situation should improve. Please write back and let me know if the proctofoam and/or anusol work.

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