Anal Issues: Symptoms, Causes, and Treatment Options

Anal issues

Hello, first of all, thank you, doctor, for clarifying my concerns regarding case number 130869.
I truly appreciate it! I visited regional hospitals and clinics to confirm my condition, including a colorectal specialist (who performed a digital rectal examination), a clinic (where I underwent auscultation, abdominal palpation, percussion, and abdominal ultrasound), and a gastroenterologist at a regional hospital (initially diagnosing me with irritable bowel syndrome due to my young age, but later conducting an immunochemical fecal occult blood test for safety, which returned normal).
After summarizing my symptoms for the doctor (initially experiencing pain near the anus, followed by rapid intestinal motility, frequent urges to defecate, and abdominal muscle tension—I suspect this is due to overdoing sit-ups for a whole month, as my abdominal muscles have softened recently, and my waist size has increased, which surprised me; my abdomen feels soft to the touch.
I even consulted a gastroenterologist who palpated my abdomen and concluded it was muscle and fat, which is normal), I informed the gastroenterologist about the symptoms that might be causing frequent urges to defecate (sometimes experiencing sharp pain near the anus, feeling tightness around the buttocks while sleeping, and experiencing soreness and numbness when palpating the muscles in that area).
I was told that this could be due to chronic straining during bowel movements, leading to hypertrophy of the anal sphincter (although this was not directly confirmed).
In elementary and middle school, I sometimes experienced sharp pain after defecation, which was quite distressing.
I acknowledge that I had poor bowel habits as a child (although in high school and college, I focused on maintaining my health, ensuring that at least one meal a day included three servings of vegetables and consuming a whole bottle of yogurt weekly to promote good bacteria, even switching brands weekly and walking to class every day).
After a month of extensive consultations, I finally identified a potential cause.
I would like to ask you: I can feel a muscle near the anus that is firm when I exert pressure and softens when relaxed (while others are training their abs, I seem to have developed my sphincter muscle...).
How can I alleviate the feeling of fullness and occasional pain near the anus? Should I try warm sitz baths? How can I improve suspected irritable bowel syndrome? The doctor prescribed me with loperamide; should I also consult a proctologist?

cdyism, 20~29 year old female. Ask Date: 2017/12/12

Dr. Ke Fangxu reply Surgery

1.
Excessive sphincter muscle tension can lead to chronic anal fissures, which is a condition that has historically troubled colorectal surgeons.
Conservative treatments often yield poor results, yet the situation may not be severe enough to warrant surgical intervention.
Warm sitz baths are currently recognized as effective, although the improvement may be minimal.
Surgical treatment involving sphincterotomy is considered the most effective option, but it requires hospitalization.
There has been a method involving botulinum toxin injections into the sphincter muscle to reduce tension, but it is not covered by health insurance and has inconsistent efficacy, leading to few physicians performing it.
You may need to weigh your options carefully.
2.
Irritable bowel syndrome (IBS) can be managed with oral medications, and it is advisable to reduce the intake of spicy and fatty foods.
Increasing dietary fiber from plant sources can also be beneficial.

Reply Date: 2017/12/12

More Info

Understanding anal issues, particularly those related to symptoms like pain, discomfort, and changes in bowel habits, can be complex and multifaceted. It’s great to hear that you’ve taken proactive steps by consulting with various specialists, including gastroenterologists and colorectal surgeons. Your detailed observations about your symptoms are crucial for diagnosis and treatment.

Symptoms and Possible Causes
From your description, it seems you are experiencing several symptoms: pain around the anal area, frequent urges to defecate, abdominal muscle tension, and discomfort that may be linked to your bowel habits. These symptoms can be indicative of several conditions, including:
1. Irritable Bowel Syndrome (IBS): This is a common gastrointestinal disorder characterized by symptoms like abdominal pain, bloating, and altered bowel habits (diarrhea or constipation). Stress and dietary factors often exacerbate IBS.

2. Overactive Anal Sphincter: As you mentioned, excessive straining during bowel movements can lead to hypertrophy (overdevelopment) of the anal sphincter muscles. This can cause discomfort and a sensation of tightness or pain.

3. Muscle Tension: Engaging in exercises like sit-ups can lead to muscle tension in the abdominal area, which may contribute to discomfort. If the abdominal muscles are overly tight, they can affect the pelvic floor and anal region.

4. Poor Bowel Habits: As you noted, irregular bowel habits during childhood may have long-term effects on your bowel function. Straining can lead to hemorrhoids or anal fissures, which can cause pain and discomfort.

Treatment Options
1. Dietary Adjustments: Since you are already consuming a diet rich in vegetables and probiotics, continue to focus on fiber intake to promote regular bowel movements. However, be cautious with high-fiber foods if they cause bloating or discomfort. Keeping a food diary can help identify any triggers.

2. Hydration: Ensure you are drinking enough water throughout the day, as hydration is key to preventing constipation and promoting healthy digestion.

3. Relaxation Techniques: Stress can exacerbate gastrointestinal symptoms. Techniques such as mindfulness, yoga, or deep-breathing exercises may help reduce tension in the abdominal and pelvic areas.

4. Physical Therapy: A physical therapist specializing in pelvic floor dysfunction can help you learn how to relax and strengthen the appropriate muscles. They can provide exercises tailored to your needs.

5. Warm Sitz Baths: As you suggested, warm sitz baths can help soothe the anal area and relieve discomfort. This is a simple yet effective home remedy.

6. Medications: If you have been prescribed medications like loperamide (Imodium) for diarrhea, follow your doctor’s instructions. If symptoms persist, it may be worth discussing with your healthcare provider about the potential need for additional medications or a referral to a specialist in colorectal health.

7. Follow-Up with Specialists: If your symptoms do not improve or worsen, it may be beneficial to return to a colorectal specialist. They can perform more specific evaluations, such as anal manometry or endoscopy, to assess the function of the anal sphincter and rule out other conditions.

Conclusion
It’s commendable that you are actively seeking solutions and understanding your body. Managing anal issues often requires a combination of lifestyle changes, dietary adjustments, and sometimes medical intervention. Keep communicating with your healthcare providers about your symptoms and any changes you experience. They can help tailor a treatment plan that addresses your specific needs and improves your quality of life. Remember, it’s essential to be patient with yourself as you navigate this process.

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