Rectal Pain After Bowel Movements: Causes and Concerns

Pain in the rectal area after bowel movements?

Hello Doctor: For the past month, I have been having bowel movements that consist of two to three stools, which are not as thin as a pencil and do not contain blood.
After I finish, I feel a brief pain in the rectal area that disappears quickly, but sometimes it recurs subtly.
I visited a colorectal surgeon who performed a digital rectal examination.
Given my tendency to be anxious and my inability to relax, the doctor asked if I was afraid of colorectal cancer.
I do not have a family history of hereditary colorectal cancer.
After seeing the doctor, I insisted on undergoing a colonoscopy, but the doctor informed me that I would have to pay $3000 out of pocket.
The next morning, I called the doctor to cancel the procedure because I was scared, and I did not go through with the colonoscopy.
I have had an abdominal X-ray, blood tests, urinalysis, and a CT scan at a major hospital, and the doctor told me that there were no significant findings.
I would like to ask the doctor what these symptoms might indicate.
(If there were a tumor causing an obstruction in the intestine, would a CT scan be able to detect it?) After bowel movements, I feel a pain in the rectum that feels like there is air in it.

Mr. Chen, 20~29 year old female. Ask Date: 2019/02/11

Dr. Yang Zhichao reply Gastroenterology and Hepatology

Dear Mr.
Chen,
Hello.
Based on the symptoms you described, it could range from simple irritable bowel syndrome to colorectal cancer.
You may want to discuss this further with your doctor to see if you should start with a routine stool screening.
If necessary, a colonoscopy can be arranged for further examination.
Changhua Hospital cares about your health.

Reply Date: 2019/02/11

More Info

Understanding rectal pain after bowel movements can be a complex issue, often involving a variety of potential causes. Based on your description, it seems you are experiencing discomfort in the rectal area after bowel movements, which can be concerning, especially when accompanied by anxiety about serious conditions like colorectal cancer.

Possible Causes of Rectal Pain
1. Hemorrhoids: One of the most common causes of rectal pain is hemorrhoids, which are swollen veins in the rectal area. They can cause pain, especially during bowel movements, and may lead to a sensation of fullness or pressure.

2. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. They can result in sharp pain during and after bowel movements and may be accompanied by bleeding.

3. Muscle Spasms: The anal sphincter can sometimes go into spasm, leading to pain after bowel movements. This can be exacerbated by anxiety or stress, which may cause muscle tension.

4. Proctalgia Fugax: This is a condition characterized by sudden, severe rectal pain that comes and goes. It can occur without any identifiable cause and is often related to muscle spasms.

5. Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause rectal pain, along with other gastrointestinal symptoms. However, these are usually accompanied by other signs, such as diarrhea or weight loss.

6. Infections: Infections in the anal or rectal area can lead to pain and discomfort. This could be due to sexually transmitted infections or other bacterial infections.

7. Psychological Factors: Anxiety and stress can manifest physically, leading to increased muscle tension and pain perception. Your mention of anxiety and fear regarding colorectal cancer may contribute to your symptoms.

Diagnostic Considerations
You mentioned that you have undergone various tests, including X-rays, blood tests, and a CT scan, all of which returned normal results. While these tests can rule out many serious conditions, they may not always detect issues like hemorrhoids or anal fissures, which can sometimes require a physical examination for diagnosis.

A digital rectal exam (DRE) performed by a healthcare provider can help identify issues such as hemorrhoids or fissures. If these have been ruled out and your symptoms persist, further evaluation may be warranted.

Concerns About Colorectal Cancer
Regarding your concerns about colorectal cancer, it is understandable to feel anxious, especially when experiencing unexplained symptoms. However, the absence of family history and normal imaging studies are reassuring factors. A colonoscopy is the gold standard for colorectal cancer screening, especially for individuals over 45 or those with concerning symptoms. If cost is a concern, discussing this with your healthcare provider may lead to alternative options or financial assistance programs.

Management Strategies
1. Dietary Changes: Increasing fiber intake can help soften stools and reduce straining during bowel movements, which may alleviate pain. Consider incorporating fruits, vegetables, and whole grains into your diet.

2. Hydration: Drinking plenty of water can also help prevent constipation.

3. Warm Baths: Soaking in a warm bath can help relax the anal muscles and relieve pain.

4. Topical Treatments: Over-the-counter creams or ointments for hemorrhoids can provide relief if that is the underlying issue.

5. Stress Management: Techniques such as mindfulness, yoga, or therapy may help manage anxiety and reduce muscle tension.

Conclusion
While your symptoms are concerning, they do not necessarily indicate a serious underlying condition, especially given the normal results of your previous tests. It is essential to maintain open communication with your healthcare provider, express your concerns, and consider a follow-up for further evaluation if symptoms persist. If you experience any new symptoms, such as significant changes in bowel habits, weight loss, or persistent pain, seek medical attention promptly.

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