Anal Pain: When to See a Specialist for Relief

Anal pain

Hello Doctor, I would like to ask about my symptoms of anal pain that I have been experiencing for the past few months.
The pain occurs when I contract my anus, when I stand up after sitting for a long time, and when I move my buttocks while sitting.
I do not feel any pain when lying down or walking.
There is no external injury, and I occasionally experience constipation, but there is no blood in my stool, and the color is normal.
Interestingly, I tend to force a bowel movement even when I don't feel the urge (for example, I squat in the restroom before going out, even if I don't feel the need).
I have both internal and external hemorrhoids, but they have not caused pain in the past.
However, I suddenly experienced pain earlier this year due to external pressure (after sitting for a long time and then standing up/contracting my anus).
Does this sound like a hemorrhoid issue? I also suspect it could be related to my coccyx, but I have not fallen or experienced any other bone injuries.
Additionally, resting while lying down provides temporary relief, but after sitting for a long time, I experience a moment of pain when I stand up.
Should I see a colorectal specialist or an orthopedic doctor for these symptoms? Thank you.

Miss Zheng, 20~29 year old female. Ask Date: 2018/04/19

Dr. Ke Fangxu reply Surgery

If there is no external injury, the possibility of skeletal damage is not considered.
This situation is mostly attributed to neuropathic pain or pelvic muscle coordination issues.
Nerve damage caused by a herniated disc is also possible.
It is advised that you avoid straining to have a bowel movement if you do not feel the urge.
Instead, try taking warm sitz baths and observe your condition.
If there is no improvement, you may want to consult a neurologist or a colorectal specialist for further evaluation.

Reply Date: 2018/04/19

More Info

Anal pain can be a distressing and uncomfortable experience, and it’s important to understand the potential causes and when to seek specialized medical help. Based on the symptoms you’ve described, it seems that your pain is associated with certain movements, particularly when sitting for extended periods or during bowel movements. This could indeed be related to conditions such as hemorrhoids, but there are other possibilities that should be considered as well.

Possible Causes of Anal Pain
1. Hemorrhoids: Given that you have a history of both internal and external hemorrhoids, it is plausible that they could be contributing to your pain. Hemorrhoids can become inflamed or thrombosed, leading to discomfort, especially during bowel movements or prolonged sitting.

2. Anal Fissures: These are small tears in the lining of the anus that can occur due to passing hard stools, which might explain the pain during bowel movements. They can cause sharp pain and may lead to a cycle of constipation and pain.

3. Coccyx (Tailbone) Issues: Pain that is exacerbated by sitting and relieved by lying down could indicate a problem with the coccyx, such as coccydynia. This condition can occur without a specific injury and may be related to prolonged sitting or poor posture.

4. Muscle Spasms: The anal sphincter muscles can sometimes go into spasm, leading to pain during contraction or certain movements. This can be exacerbated by anxiety or stress related to bowel movements.

5. Other Conditions: Conditions such as pelvic floor dysfunction, infections, or even referred pain from other areas (like the lower back) could also be contributing to your symptoms.

When to See a Specialist
Given the complexity of anal pain and the variety of potential causes, it is advisable to consult a specialist. Here are some guidelines on when to seek help:
- Persistent Pain: If the pain has been ongoing for several months and is affecting your quality of life, it’s time to see a doctor.

- Changes in Bowel Habits: If you notice any changes in your bowel habits, such as increased constipation or changes in stool consistency, this warrants further investigation.

- New Symptoms: If you experience any new symptoms, such as bleeding, significant changes in bowel habits, or any unusual discharge, you should seek medical attention promptly.

- Impact on Daily Life: If the pain is affecting your ability to perform daily activities or causing significant distress, it’s important to get evaluated.

Which Specialist to See
In your case, it would be most appropriate to see a colorectal specialist (also known as a proctologist or gastroenterologist) first. They can perform a thorough examination, which may include a digital rectal exam or anoscopy, to assess for hemorrhoids, fissures, or other rectal conditions. They can also provide guidance on management strategies, including dietary changes, medications, or procedures if necessary.

If the colorectal specialist rules out any rectal issues and suspects that your pain may be related to the coccyx or musculoskeletal issues, they may refer you to an orthopedic specialist or a pain management specialist for further evaluation.

Conclusion
In summary, while your symptoms could be related to hemorrhoids, there are several other potential causes that should be evaluated. It’s important to seek the advice of a colorectal specialist who can provide a comprehensive assessment and appropriate management options. Early intervention can help alleviate your discomfort and improve your quality of life. Remember, you don’t have to suffer in silence, and there are effective treatments available for anal pain.

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