Managing Painful Bowel Movements Without Bleeding: A Guide

Experiencing frequent pain during bowel movements without any bleeding?

I previously had issues with anal abscesses and fistulas.
The doctor always advised me to not clean too thoroughly and to allow some dirtiness.
After making significant efforts to improve, I haven't experienced symptoms of abscesses or fistulas for a long time.
Earlier this year, I had a hard and large stool that caused an anal fissure with bleeding during bowel movements.
However, I later experienced frequent pain during bowel movements, mostly without bleeding.
After a while, my stools became thinner, and I noticed a protruding polyp, which I thought was hemorrhoids, so I went to the hospital for an examination.
The doctor said that I still had the same issues as before, caused by cleaning too thoroughly.
The polyp was not hemorrhoids but a part of the anal canal that was pushed out due to the narrowing caused by the anal fissure.
The doctor advised me again not to clean too thoroughly and did not prescribe any medication or ointment, making me feel like there was no difference between seeing the doctor and not seeing one.
Months have passed, and this symptom persists without any relief.
Currently, my stool's size and color are normal, but I often experience pain during bowel movements without bleeding.
However, if there is bleeding, the pain becomes severe for a long time, though it doesn't always lead to bleeding.
I would like to know what I can do now.
What should I do when there is bleeding? What should I do when there is pain but no bleeding? Would taking acetaminophen help? Is it advisable to buy an ointment from the pharmacy to apply? Thank you.

Tòng a, 20~29 year old female. Ask Date: 2020/06/16

Dr. Xu Kaixi reply Surgery

If there is pain, it may indicate inflammation of the anal mucosa.
If there is also bleeding, it could suggest a concurrent mucosal abrasion or tear.
It is recommended to consider the use of topical ointments or to combine them with anti-inflammatory and analgesic oral medications.

Reply Date: 2020/06/16

More Info

Managing painful bowel movements, especially after experiencing issues like anal abscesses or fissures, can be quite challenging. It’s essential to address both the pain during bowel movements and the potential for bleeding. Here’s a comprehensive guide to help you manage your symptoms effectively.

Understanding the Pain and Symptoms
1. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. They can lead to significant pain during bowel movements and may cause bleeding. The pain can persist even after the fissure has healed if the area remains sensitive.

2. Hemorrhoids: While your doctor indicated that the protruding tissue is not hemorrhoids, it’s important to understand that hemorrhoids can also cause pain and bleeding. They are swollen veins in the rectal area that can become inflamed or thrombosed.

3. Narrowing of the Anal Canal: This can occur due to scarring from previous fissures or abscesses, leading to pain during bowel movements.

Management Strategies
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1. Dietary Changes
- Increase Fiber Intake: Aim for a diet rich in fiber to soften stools and make them easier to pass. Foods like fruits, vegetables, whole grains, and legumes are excellent sources.

- Stay Hydrated: Drink plenty of water throughout the day to help prevent constipation and keep stools soft.

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2. Bowel Habits
- Regular Bathroom Routine: Try to establish a regular time for bowel movements, allowing yourself enough time to relax and not rush.

- Avoid Straining: Straining can worsen fissures and cause more pain. If you feel the urge to go, don’t delay.

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3. Pain Management
- Over-the-Counter Pain Relief: Medications like acetaminophen (Tylenol) can help alleviate pain. However, avoid NSAIDs like ibuprofen if you have a history of gastrointestinal bleeding.

- Topical Treatments: Over-the-counter creams or ointments containing hydrocortisone or witch hazel can reduce inflammation and provide relief. However, consult your pharmacist or doctor for recommendations based on your specific symptoms.

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4. Sitz Baths
- Warm Sitz Baths: Soaking in warm water for 10-15 minutes several times a day can help soothe the anal area, reduce pain, and promote healing.

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5. Avoiding Irritation
- Gentle Cleaning: After bowel movements, clean the area gently with water instead of toilet paper. Consider using moist wipes that are alcohol-free and fragrance-free.

- Avoid Excessive Cleaning: As advised by your doctor, avoid over-cleaning the area, which can lead to irritation.

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6. When to Seek Help
- Persistent Pain or Bleeding: If you experience significant pain that doesn’t improve with home management or if you notice fresh blood in your stool, it’s crucial to consult a healthcare provider. They may recommend further evaluation or treatment options.

Conclusion
Managing painful bowel movements requires a multifaceted approach that includes dietary changes, proper bowel habits, pain management, and gentle care of the anal area. While over-the-counter medications can provide relief, it’s essential to monitor your symptoms closely and seek medical advice if they persist or worsen. Remember, your comfort and health are paramount, and addressing these issues early can prevent further complications. If you have any concerns about specific medications or treatments, don’t hesitate to reach out to your healthcare provider for personalized advice.

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