Anal Discomfort: Causes and Solutions for Young Adults

Anal issues

Hello Doctor, I am 21 years old.
Since middle school, I have experienced frequent diarrhea and abdominal pain.
Therefore, in September of this year, I underwent a colonoscopy at a large hospital.
The doctor said my colon was clean, with only a small hemorrhoid, and since there were no significant issues, the doctor did not schedule a follow-up appointment.
However, for the past two weeks, I have been experiencing a persistent itching sensation around my anus, and sometimes I feel a sharp pain near the anal area, similar to anal fissures, especially when I have the urge to pass gas.
I also feel a sharp object pressing against the side of my anus (specifically on the right side).
This itching sensation has been common for me, but this time it has lasted for two weeks, which makes me more anxious.

My usual habit after using the toilet is to wipe with toilet paper, then I insert my finger wrapped in toilet paper into my anus and rotate it until no fecal residue is visible.
I also wash my hands by inserting my fingers while showering until there is no slippery feeling.
In the past, if I did not perform this action of inserting my finger into my anus to clean or wash, even if I wiped the outside of my anus and did not see any feces, I would soon feel a prickly, warm sensation around my anus after some activity.
When I go to the bathroom again, I often find feces, which leads me to feel the need to insert my finger deeply into my anus to ensure there is no fecal matter before I feel comfortable wearing underwear.
I am concerned if this habit could be causing the issues I described earlier.
Please advise, Doctor.

Jack, 20~29 year old female. Ask Date: 2019/12/20

Dr. Ke Fangxu reply Surgery

This is damage to the mucosa and skin caused by excessive cleaning of the anus, similar to how obsessive-compulsive disorder can lead to "dishpan hands" from over-washing.
Although your cleaning frequency may not be high, the skin and mucosa around the anus are quite delicate, which can lead to this condition.
It is normal for the anal area to have some discoloration due to intestinal peristalsis and gas release, so there is no need to be overly concerned.

Reply Date: 2019/12/20

More Info

Understanding anal discomfort, especially in young adults, can be a complex issue that often involves multiple factors, including hygiene practices, dietary habits, and underlying medical conditions. In your case, the symptoms you describe—itching, sharp pain, and a sensation of something pressing against the anal area—can be indicative of several potential causes.

Firstly, it’s important to consider the possibility of hemorrhoids. You mentioned that during your colonoscopy, the doctor noted the presence of hemorrhoids. Hemorrhoids can cause discomfort, itching, and pain, particularly during bowel movements. They can also lead to a sensation of fullness or pressure in the anal area. Given that you have a history of diarrhea and abdominal pain, it’s possible that frequent straining during bowel movements could exacerbate hemorrhoid symptoms.

Another potential cause of your discomfort could be anal fissures. These are small tears in the lining of the anus that can occur due to passing hard stools or straining. The sharp pain you experience, especially when you feel the need to pass gas, could be related to fissures. If you are experiencing pain that feels similar to what you would expect from a fissure, it may be worth discussing this with your healthcare provider.

Your hygiene practices may also play a role in your symptoms. While it’s important to maintain cleanliness, excessive cleaning or aggressive wiping can irritate the sensitive skin around the anus, leading to itching and discomfort. The habit of inserting fingers into the anus to ensure cleanliness could potentially cause micro-tears or irritation, especially if done frequently or without proper lubrication. It’s generally recommended to clean the anal area gently with water and mild soap, avoiding aggressive scrubbing or insertion.

Dietary factors should also be considered. A diet low in fiber can lead to constipation and hard stools, which can exacerbate hemorrhoids and fissures. Conversely, a diet high in fiber can help regulate bowel movements and reduce the likelihood of straining. Staying hydrated is equally important, as it helps soften stools and promotes regular bowel movements.

Given that your symptoms have persisted for two weeks, it would be advisable to consult with a healthcare professional, preferably a gastroenterologist or a proctologist. They can perform a thorough examination to determine the exact cause of your discomfort and recommend appropriate treatment options. This may include dietary changes, topical treatments for hemorrhoids or fissures, and advice on proper hygiene practices.

In summary, your symptoms could be related to hemorrhoids, anal fissures, or irritation from your cleaning habits. It’s crucial to address these issues with a healthcare provider to ensure you receive the appropriate care and to prevent further complications. Remember, maintaining a balanced diet, practicing gentle hygiene, and seeking medical advice when needed are key steps in managing anal discomfort effectively.

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