Post-Defecation Pain: Causes and Solutions

Pain during defecation?

Hello Doctor: About a week ago, I experienced pain after a bowel movement due to constipation, and I noticed a small amount of blood on the skin around my anus.
Upon examining with a mirror, I saw some redness and swelling around the anal area.
This issue has persisted until now; normally, I do not experience pain during bowel movements, only itching afterward, which I assumed was due to an anal fissure, so I applied ointment on my own.
However, in the past couple of days, the pain during bowel movements has become very sharp, accompanied by a burning sensation.
Upon inspection, I found multiple small, red, broken areas around the swollen part of my anus, resembling ulcers.
I have previously had external hemorrhoids and occasionally dealt with anal fissures due to constipation, but this situation is unlike anything I have experienced before.
Could this be an issue with the ointment not being suitable, or could there be other possibilities? Thank you!

Miss Ye, 20~29 year old female. Ask Date: 2019/04/17

Dr. Ke Fangxu reply Surgery

Based on your description, it seems more like the typical symptoms of an anal fissure, which include pain during bowel movements accompanied by slight bleeding.
The common causes are often constipation or diarrhea.
The fundamental treatment is to improve bowel habits, along with warm sitz baths.
Warm sitz baths can help alleviate pain, maintain cleanliness, and promote blood circulation.
You can also purchase hemorrhoid suppositories at the pharmacy for use.
If symptoms persist without improvement, it is best to consult a physician.
As for whether a specific ointment is suitable, it is difficult to determine without knowing which ointment you are using; you may want to consult your doctor about that as well.

Reply Date: 2019/04/17

More Info

Understanding post-defecation pain can be quite complex, especially when accompanied by symptoms like bleeding, redness, and swelling around the anal area. Based on your description, it seems you are experiencing significant discomfort following bowel movements, which has escalated from mild itching to sharp pain and visible irritation.
The symptoms you are describing could be indicative of several conditions, including anal fissures, hemorrhoids, or even infections. Given your history of external hemorrhoids and occasional constipation, it is plausible that you may be experiencing a combination of these issues.

1. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. They can lead to sharp pain during and after bowel movements, and may also cause bleeding. The pain can be exacerbated by the irritation from bowel movements, especially if the stool is hard or if there is straining involved.

2. Hemorrhoids: External hemorrhoids can become inflamed and painful, particularly after bowel movements. They may also bleed, and the area can become red and swollen. If you have a history of hemorrhoids, it is possible that they have become aggravated due to constipation or straining.

3. Skin Irritation or Infection: The redness and swelling you observe could also suggest a skin infection or irritation, possibly due to the use of topical medications that may not be suitable for your condition. If the skin around the anus is broken, it can become susceptible to infections, which can cause pain and discomfort.

Solutions and Recommendations:
- Dietary Changes: To alleviate constipation, consider increasing your fiber intake through fruits, vegetables, and whole grains. Staying hydrated is also crucial, as it helps soften the stool and makes bowel movements easier.

- Over-the-Counter Treatments: For immediate relief, topical treatments such as hydrocortisone cream or witch hazel pads can help reduce inflammation and soothe irritation. However, if you suspect that a particular ointment is causing irritation, it may be wise to discontinue its use and consult a healthcare professional for alternatives.

- Warm Sitz Baths: Taking warm sitz baths can provide relief from pain and help with healing. Soaking the affected area for about 15-20 minutes several times a day can promote blood flow and reduce discomfort.

- Pain Relief: Over-the-counter pain relievers such as acetaminophen or ibuprofen can help manage pain. However, it’s essential to follow the recommended dosages and consult a healthcare provider if you have any concerns about interactions with other medications.

- Consult a Healthcare Provider: Given the persistence and worsening of your symptoms, it is advisable to consult a healthcare provider. They may perform a physical examination to assess the area and determine the underlying cause of your pain. In some cases, a referral to a specialist, such as a gastroenterologist or a proctologist, may be necessary for further evaluation and treatment.

Potential Complications:
If left untreated, conditions like anal fissures or hemorrhoids can lead to chronic pain, recurrent bleeding, and even infections. It is crucial to address these symptoms promptly to avoid complications and ensure proper healing.

In summary, while there are several potential causes for your post-defecation pain, dietary adjustments, topical treatments, and professional medical advice are key components in managing and alleviating your symptoms. Please prioritize seeking medical attention to receive a proper diagnosis and tailored treatment plan.

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