Differential Diagnosis for Foreign Body Feeling in the Rectum
- Single most likely diagnosis
- Proctalgia Fugax: This condition is characterized by recurring, severe pain in the rectum that can be accompanied by a feeling of a foreign body. The fact that steroid cream treatment and endoscopy did not reveal any abnormalities supports this diagnosis, as Proctalgia Fugax is a functional disorder without visible lesions.
- Other Likely diagnoses
- Anal fissure: Although endoscopy did not show anything out of the ordinary, an anal fissure could cause a feeling of a foreign body due to the spasm of the anal sphincter. The lack of response to steroid cream does not rule out this diagnosis, as fissures may require more specific treatments.
- Levator ani syndrome: This condition involves pain and discomfort in the rectal area due to spasms of the levator ani muscle. It could explain the persistent feeling of a foreign body without any visible abnormalities on endoscopy.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Rectal cancer: Although less likely given the lack of findings on endoscopy, rectal cancer can present with a variety of symptoms, including a feeling of a foreign body. It is crucial to ensure that all diagnostic avenues have been explored to rule out this potentially deadly condition.
- Invasive rectal infection (e.g., rectal tuberculosis, amoebiasis): Certain infections can cause rectal symptoms without obvious findings on initial endoscopy. These conditions require specific diagnostic tests and treatments.
- Rare diagnoses
- Rectal endometriosis: This condition, where endometrial tissue grows outside the uterus and attaches to the rectum, can cause a variety of rectal symptoms, including a feeling of a foreign body. It is more common in women with a history of endometriosis.
- Solitary rectal ulcer syndrome (SRUS): Although SRUS can cause rectal symptoms, it is less likely given the normal endoscopy findings. However, some cases might not have visible ulcers, and the diagnosis could be considered if other symptoms like rectal bleeding or difficulty evacuating are present.