A new case report published in Japan has established a potential link between COVID-19 and what experts are calling "Restless Anal Syndrome."
The singular 77-year-old patient developed chronic gastrointestinal pain that experts describe as a constant urge to defecate.
More research is needed to determine a link between the new syndrome and COVID-19, but experts say that GI discomfort may be an overlooked symptom associated with long-lasting COVID-19 side effects.
While the virus that spreads COVID-19 has mutated into more viral variants, the symptoms associated with the disease have largely remained the same — but a new report out of Japan has experts revisiting the severity of potential side effects now that the Delta variant is the most common worldwide. Limited evidence may suggest that certain kinds of symptoms may be exacerbated by newer strains of the disease after specialists in Japan shared the story of a 77-year-old man who developed what they now refer to as "Restless Anal Syndrome."
As detailed in a case report published by BMC Infectious Diseases in late September, the elderly man is believed to be the first to have developed this particular set of symptoms after initially recovering from his COVID-19 infection. Authors of the report indicate that a case of this kind — which began after the man spent three weeks in the hospital being treated for COVID-19 — has yet to be studied in-depth, and that data is extremely limited to establish a better understanding of what occurred.
Charles Bailey, M.D., the medical director of infection prevention at Providence St. Joseph Hospital, says that COVID-19 symptoms have shifted slightly since the beginning of the pandemic. But as gastrointestinal distress and irregularity have been well-documented as symptoms of a COVID-19 infection, experts are keen to learn more about this particular diagnosis, which could affect more patients in different forms than is currently realized.
What is Restless Anal Syndrome?
The patient treated by experts at Tokyo Medical University Hospital turned to doctors well after his initial COVID-19 infection, when he began feeling what's been described as a constant urge to defecate.
"Several weeks after discharge, he gradually began to experience restless, deep anal discomfort," the study's authors wrote, adding that the man rarely felt relieved even after a trip to the restroom. The urge to run for the bathroom was worse for the man when he slept at night and when he was resting throughout most of the day. Only when he was moving or breaking a sweat did he feel temporary relief before the sensation rushed back later, the authors noted.
In investigating his symptoms, experts conducted colonoscopies and neurological tests for reflexes in the man's anus, but neither could explain why these symptoms arose weeks after his infection. While hemorrhoids were found, experts also didn't detect that there were any sensory issues or a spinal cord injury.
The study's authors indicated that Restless Anal Syndrome appeared to impact the body in the same way as Restless Legs Syndrome (RLS), linking it to COVID-19 as more evidence indicates that the disease can impact the central nervous system.
Eventually, the man was prescribed a daily dose of Clonazepam, which has also been used to treat RLS — sadly, the authors noted that it alleviated some discomfort but didn't solve it outright. While much more research must be done to fully understand this case and a further potential link to COVID-19, because gastrointestinal COVID-19 symptoms have long been established, the study's authors warn that the condition may be overlooked currently. "COVID-19 related RLS or RLS-variant may be underdiagnosed and we should pay attention to similar cases in order to clarify the relation between COVID-19 and RLS," the report reads.
Other digestive symptoms associated with COVID-19:
More evidence is needed to effectively deduce if Restless Anal Syndrome can be attributed to COVID-19, but healthcare officials have indicated that gastrointestinal side effects can be active symptoms — even though the disease is respiratory in nature.
Officials at the Centers for Disease Control and Prevention (CDC) have indicated that there are 11 symptoms currently associated with a COVID-19 infection, but indicate that others may potentially experience unique symptoms as well. The main gastrointestinal issues that could impact you during a sickness include:
Abdominal pain in the form of body aches
Experts also know that COVID-19 impacts our GI tract because they've been able to trace virus in stool samples as well as biopsy samples, Dr. Bailey explains. "This aligns with observed clinical complications like elevated liver enzymes, or liver inflammation; ileus, or slow bowel motility; and bowel ischemia, which is poor blood flow to intestines resulting in pain, potential bowel perforation, or sepsis," he adds. "[Doctors] have also seen gallbladder inflammation without gallstones, and pancreatic inflammation."
Because COVID-19 is still a relatively new disease, experts have yet to determine why exactly it impacts one's gastrointestinal system. But Dr. Bailey says GI issues and side effects remain less common than respiratory symptoms like fever, cough and shortness of breath. Healthcare providers do actively check for any GI issues when treating someone who contracted COVID-19 — but just as the Restless Anal Syndrome report indicated, doctors like Dr. Bailey aren't sure if GI issues arise directly due to COVID virus or because COVID-19 interrupts the blood flow to the smallest vessels inside the intestines, for example.
The bottom line is much more research is needed to fully understand Restless Anal Syndrome, and its relevance is likely extremely low on a global scale. But experts stress that it's more important to monitor GI issues as potential symptoms for COVID-19 infection. Consult your primary healthcare provider if you notice that you're experiencing the gastrointestinal symptoms above and can't trace it back to causes; it may be time to get tested for COVID-19.
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