Searching for cause of mystery discharge

DEARDR. ROACH »

Back in late 2014,

I noticed a dampness in my underwear — no coloration, only dampness. I consulted a gastroenterologist about a possible anal discharge. After obtaining a history, we took some conservative ways to deal with this, including probiotics and exercises for the anal muscles. After there was no change, we did a colonoscopy and the report said my colon was normal, with no fistulas or fissures.

I was referred to a rectal surgeon, who did a sonogram with a new tool, and found no abnormalities. He dealt with my hemorrhoids with no change.

It has been over five years since this began, and while it has not improved, it has not worsened. There is no fecal or urinary incontinence, the discharge is clear and has a very faint smell. I have dealt with it by using padding in my underwear to catch it. The discharge seems to be more present in the front of the pad. What could this be? And what can I do about it?

— B.R.

DEARREADER » While leakage from the urethra or rectum is not uncommon, confusion about the cause after such a prolonged course is not the norm. It seems to me that you have had a thorough evaluation of the rectal area, so it should be worthwhile to evaluate the urinary side. The fact that the discharge is nearly odorless makes rectal leakage less likely.

A British physician once wrote, “Once you eliminate the impossible, whatever remains, no matter how improbable, must be the truth” (he put it in the words of his detective character, Sherlock Holmes). One consideration would be a urethral diverticulum. This is a blind pouch coming off of the urethra, the tube that drains the bladder. A small amount of urine can enter the diverticulum and you would not be able to control it, nor possibly even notice it, when it comes out.

Another possibility is ejaculatory fluid. Most of the fluid in semen is made by the seminal vesicles and the prostate gland, with a small amount produced by the bulbourethral glands. Fluid from the seminal vesicles and prostate is thick and milky, with the bulbourethral glands making a clear fluid. Fluid can discharge from these glands, especially after a bowel movement. Try an evaluation by a urologist.