OpenHealth Q&A

Persistent Rectal Displacement in a 24-Year-Old Female

At 24 years old, I have a medical history that includes idiopathic sinus tachycardia and gastroparesis. Starting from March, I noticed a firm, immobile mass pressing against my rectum from the exterior, which has increased in size from the initial marble-like dimension to at least twice its original size over the past months. Initially, this mass caused occasional pressure, but now the sensation is constant, and I consistently feel as though I cannot fully empty my bowels. I have been prescribed prucalopride to address constipation, but adjustments with osmotic laxatives did not yield improvements. After some weeks of discomfort, I began to check for abnormalities, which was not something I had done before. In late April, during an appointment with my gastroenterologist, I had him inspect the area, leading to a flexible sigmoidoscopy that returned normal results. In June, a follow-up with another physician resulted in a hesitant MRI referral of my anal sphincter, as he doubted any issue existed (he declined my request for a physical examination). By this point, I was experiencing difficulty with both soft and hard stools becoming lodged during passage. This MRI also returned normal results. The only conceivable conclusion is that the mass, while accessible to touch, is positioned high within the rectum; I can maneuver around it, but that is all. Shortly thereafter, my regular gastroenterologist had me undergo a transvaginal ultrasound (TVUS), which also revealed no abnormalities, leading them to withdraw from further investigations. Although they planned to refer me to pelvic floor specialists, this has not been mentioned recently. Beginning in July, I began dealing with partial obstruction, necessitating manual stool extraction due to blockages occurring behind or beneath the mass. I have also started to experience pain in the bowel wall near the protruding mass itself; although the lump is not tender, the surrounding tissue is. The area around the mass has become noticeably tougher—not completely hard, but firmer. Initially, discomfort arose only upon touch or during/after bowel movements, but this discomfort has become more recurrent and now occurs without direct stimulation. Despite having experienced mucus in my stools since the onset, I have recently noticed a clear, watery discharge that has not been present before. A couple of weeks ago, I consulted a colorectal surgeon who confirmed that the mass was external to my bowel and applying pressure to it. He did not provide a diagnosis but has placed me on the list for an examination under anesthesia (EUA) with the potential for another camera insertion. Given the size increase of the mass, I am concerned that my finger may not fit for manual removal—let alone a camera. Over the past ten days, I have been surprised by unexpected daytime sleepiness, which is unusual for me as I typically do not nap regardless of fatigue. Now, I find myself sleeping for up to three hours during the day. I cannot identify any other factors contributing to this change. Since I receive regular hydration support for my gastroparesis, dehydration is not a concern. I also had an episode of low iron without anemia earlier this year, receiving an infusion in June (with blood tests pending), and my GP intends to monitor my levels at the end of this month to assess the need for another infusion. Notably, prior to the infusion, I did not experience daytime sleepiness, and this sensation feels distinctly different. I am beginning to question whether I am overreacting or if the upcoming EUA is necessary based on the gastroenterology team's feedback. Given what I’ve shared, what could be the underlying issue? Endometriosis seems unlikely, having been ruled out due to the absence of accompanying symptoms and results of a normal ultrasound. Additionally, I underwent a comprehensive investigation for inflammatory bowel disease last year, which was also excluded from the potential diagnosis.

Answers (1)

9/10/2025, 11:31:14 AM

OpenHealth AI

It sounds like you’re going through a challenging and frustrating situation with the persistent mass and associated symptoms. Given your detailed medical history and the evaluations you've already undergone, it’s understandable that you’re feeling uncertain about your diagnosis and the next steps. Let's break down the situation and clarify what could be happening and what you might consider doing next.

Summary of Key Points:

1. You have a firm, immobile mass near your rectum causing pressure and difficulty with bowel movements.
2. Multiple investigations (flexible sigmoidoscopy, MRI, transvaginal ultrasound) have shown no abnormalities.
3. Increased bowel discomfort and new symptoms like daytime sleepiness are concerning.
4. You have an upcoming examination under anesthesia (EUA) planned with a colorectal surgeon.

Possible Underlying Issues:

• Rectocele or Prolapse: The mass could be related to a rectocele, which is a bulge of the rectal wall into the vagina. This can cause pressure and bowel symptoms. It's possible that other pelvic floor abnormalities are contributing to your symptoms as well.
• Pelvic Floor Dysfunction: Based on the difficulty you’re experiencing with bowel movements, it seems like pelvic floor dysfunction may be playing a role. This can lead to obstructed defecation.
• Muscle Spasms or Neuromuscular Issues: Given your gastroparesis and symptoms of daytime sleepiness, there could be an underlying neuromuscular component affecting your bowel function.

Next Steps:

1. Preparation for EUA: As you wait for the EUA, consider discussing your concerns about the size of the mass and the discomfort during the procedure with your surgeon. They can reassure you about how they plan to proceed and what options may be available if manual intervention proves difficult.

2. Monitor Symptoms: Keep a journal of your symptoms, especially noting any changes in bowel habits, pain levels, and the nature/frequency of the discharge. This information may be helpful for the surgical team.

3. Pelvic Floor Therapy: While waiting for the EUA, it could be beneficial to consult with a pelvic floor physical therapist, who can assist you with exercises and techniques to improve bowel movements and help manage any discomfort.

4. Iron Levels & Fatigue: Continue to follow up on your iron levels, as fluctuations and deficiencies may also contribute to fatigue. Make sure to report any new symptoms related to fatigue to your GP.

5. Consider Emotional Well-being: The stress of ongoing health issues can be taxing. If you’re feeling overwhelmed or anxious, it might also help to seek support from a mental health professional.

In summary, your ongoing concerns are valid, and maintaining good communication with your healthcare team is essential. The upcoming EUA can provide more clarity, and don't hesitate to raise your concerns and the new symptoms you've experienced. You deserve answers and relief from your discomfort. Please ensure you take care of both your physical and emotional health during this time.