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What is wrong with my rectum?
Jun 11, 2000

Four months ago I noticed a change in my bowel movement and notified my doctor, who in turn suggested that I was obsessed with my bowel movement. He told me it was hemorrhoids. All of a sudden I completely stopped having bowel movements because of constant anal bleeding (blood clots) and tons of gas. This caused me to have a constant urge to have bowel movements 12 or more times a day. When I go, I have no stool and am like this for days, and at one time I had no regular stool for over two weeks. I felt like something was blocking me from having a bowel movement. I asked my doctor to refer me to a specialist and he referred me to a GI. The GI put a scope inside me and did a biopsy with the pieces they took from my rectum. Before my test results came back I went to another doctor for another opinion, and without any testing except for a finger exam I was told the reason for the bleeding and lack of stool was Anal Condyloma. My test results from the GI finally came back and nothing was cancerous. They told me I had ulcers in my rectum and this was the reason for the bleeding, because my rectum was completely swollen. The GI prescribed Asacol and Hydrocortisone Enemas to be taken daily. Four months later I feel like I am in no better shape today than I was when this started in March 2000. I'm still bleeding, have tons of gas, and have very little stool if any. This has caused me to lose my appetite, 15 lbs, fatigue, and fever and chills at night before I go to bed. Is it possible the Colorectal Surgeon who told me I had Anal Condyloma is right? Could my GI be wrong? Will the bleeding and gas ever stop, and will I gain my appetite back, and regain stool movement? Whatever it is, is it HIV-related?

Response from Dr. Feinberg

Your problem could be HIV-related, and what you need is a clear diagnosis so you can get specific treatment. I'm wondering if the GI doctor knew that you are HIV+. In HIV+s, rectal ulcers are usually due to infection, and the treatment should be directed at the germ causing the problem as well as making you more comfortable (which is what the enema, etc., was for). It is possible that you have condylomas, but the GI doctor should have seen them with the scope, especially if they were extensive enough to block the passage of stool. Condylomas can sometimes become cancerous, but your biopsies didn't show that, and the condylomas themselves don't typically bleed to the extent of forming clots.

I suggest you find a GI doctor who has expertise in treating patients with HIV. It is important for this person to know your T-cell count and other details about your HIV disease. Even for an HIV-, it sounds to me like another opinion is needed. It would be useful for you to get a written copy of the biopsy and endoscopy reports; just request them (it helps to do this in writing) from the GI doctor you already saw. Good luck!

Progressive Multifocal Leukoencephalopathy (PML)
Herpes Zoster

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