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Rectal Malodor

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22 Aug, 2018

Rectal malodor is when the rectum, i.e. the anus or the perianal region emits a very offensive foul smell. It is a pathological indicator that may hint towards any disease or disorder. Normal body processes like flatulence or defecation do cause temporary rectal malodor which disappears shortly thereafter. However, if bad odor persists, it could indicate a serious pathological disease or problem.

 

Classification

The mechanism of rectal malodor can be classified into 3 categories

  • When any anatomical closure between the gastrointestinal tract and the external environment is compromised: This includes both problems with the continence mechanisms (e.g. fecal incontinence) as well as pathological interactions with the external environment (e.g. anal fistulae). Hemorrhoids and anal fissures can also cause malodor.
  • Malodorous substances passing the rectum: Even though flatus and feces are normally malodorous in a healthy person, but their odor can be significantly altered by pathological processes. Malodorous substance expelled from the rectum can be gaseous (e.g. passing gas produced in the colon due to bacterial action), liquid (fluidic stools, mucus, pus, blood, etc.) or solid (feces, coagulated blood)
  • Malodorous perianal conditions

 

Causes

  • Poor anal hygiene
  • Fecal incontinence
  • Gas incontinence
  • Fecal leakage
  • Rectal discharge
  • Flatus
  • Obstructed defecation
  • Anismus
  • Incomplete evacuation
  • Perianal conditions

 

Diagnosis

  • Your doctor may ask about:
    • Your medical history. This may include any history of bleeding disorders, inflammatory bowel disease, episodes of rectal bleeding, STDs or radiation treatment for cancer
    • Your bowel habits (especially any constipated related issues)
    • Whether you are already on any medication that may cause rectal bleeding
    • If you practice anal intercourse or have had any history of anal trauma
  • Physical examination of the abdomen.
  • External examination of your anal area including a digital rectal examination (DRE; i.e. using a finger)
  • Anoscopy (where a tiny tube is inserted into the anus to look inside the anal canal) and sigmoidoscopy (a short telescope to inspect the rectum and lower colon).
  • A rectal swab can be sampled for bacterial/fungal culture analysis.

 

Treatment and management

  • Treatment depends on the medical condition causing malodor. It could range from treating it with various antibacterial/antifungal medications to surgery in extreme cases. Chemotherapy is required in case of any rectal cancer.
  • Maintain proper hygiene. The anal and perianal area should be thoroughly washed and cleaned after passing stool.
  • Dry toilet paper may not always be enough. Using a moistened toilet paper or flushable wet wipes is a better option. Following that, the area must be thoroughly dried as moisture attracts germs.
  • Bathing daily is important. Bathing twice a day is highly recommended if you have a persistent body odor problem. Fragrant and/or antibacterial soaps or gels can be used.
  • Wear clean and dry clothes. Change your innerwear and underwear daily (preferably more than once per day).
  • Wash your clothes properly
  • Never wear wet or damp underwear as it encourages the buildup of bacteria or fungi.
  • Talcum powder can be used temporarily in the anal region to ward of malodor.
  • Try avoiding eggs, meat, chicken, fish etc. A vegan diet has been shown to reduce malodor.