Nighttime Rectal Pain and Urgency: Causes and Solutions

Waking up in pain during sleep due to the need to defecate?

Hello, Doctor: Over the past year, I have occasionally woken up in the middle of the night with pain near the anal area, feeling the urge to have a bowel movement (approximately 3-4 times since January 2020).
However, when I sit on the toilet, I am unable to pass stool, the pain subsides, and I return to sleep.
I drink a large amount of water every morning, feel the urge to defecate, and usually have a bowel movement almost every day, with a substantial amount.
However, it is often not well-formed (not watery), but the color is normal.
Sometimes, I pass thin stools, but the color remains normal.
About two and a half months ago, due to discomfort from prolonged sitting, I visited a clinic for an examination.
After a digital rectal exam, the doctor noted mild inflammation of the anal glands (a small lump on the left side inside the anus) and prescribed an ointment (anti-inflammatory and healing ointment).
I have been applying the medication regularly in the morning and evening, and after 4-5 follow-up visits and examinations (digital rectal exams), the doctor said there has been some improvement.
I feel that when I sit for long periods at work or when under stress, I still experience some discomfort, but it alleviates when I stand up and walk around.
After a good night's sleep, I feel much better.
I would like to ask the doctor about the reason for "waking up in pain during sleep with the urge to defecate"? (The most recent occurrence was last night around 11 PM when I went to bed, but I woke up at 12:30 AM due to pain, rushed to the toilet, and passed a small amount of stool that was not well-formed but normal in color.
However, I felt some mild abdominal discomfort and slight rumbling before going to bed that night.) Thank you for your response, Doctor!

A Da, 30~39 year old female. Ask Date: 2020/09/07

Dr. Chen Shidian reply Gastroenterology and Hepatology

The pain may be caused by abnormal intestinal motility.
If it frequently occurs at night, it is considered abnormal, and you should consult a gastroenterologist for an examination.
Additionally, it is recommended to avoid eating late-night snacks before bedtime.

Reply Date: 2020/09/07

More Info

Nighttime rectal pain and urgency can be quite distressing and may stem from several underlying causes. Based on your description, it seems that you have experienced episodes of rectal pain that awaken you from sleep, accompanied by a sensation of needing to defecate, yet you find it difficult to pass stool. This situation can be influenced by various factors, including gastrointestinal issues, muscle tension, and even psychological stress.

One potential cause of your nighttime rectal pain could be related to the inflammation of the anal glands, as you mentioned having a mild inflammation diagnosed during your visits to the clinic. The anal glands can become blocked or infected, leading to discomfort and pain, particularly when lying down. The pressure from lying on the affected area may exacerbate the pain, causing you to wake up. The fact that you have been using a topical ointment and have seen some improvement suggests that this could be a contributing factor.

Another possibility is that your symptoms may be related to gastrointestinal issues, such as irritable bowel syndrome (IBS) or other functional bowel disorders. IBS can cause abdominal discomfort, changes in bowel habits, and urgency, which might explain the pain and the sensation of needing to defecate at night. Stress and anxiety can also play a significant role in exacerbating these symptoms, as they can lead to increased muscle tension in the pelvic area and affect bowel function.

Additionally, your description of feeling better after standing up or walking around indicates that muscle tension or spasms may be contributing to your discomfort. Prolonged sitting, especially in a stressful work environment, can lead to tightness in the pelvic floor muscles, which may cause pain and urgency. Engaging in regular physical activity and taking breaks to stretch can help alleviate this tension.

It’s also worth considering dietary factors. Although you mentioned that your stool is generally of normal color and consistency, the fact that it is sometimes not well-formed could indicate that your diet may need some adjustments. Ensuring adequate fiber intake, staying hydrated, and avoiding foods that may irritate your digestive system can help improve bowel regularity and reduce discomfort.

Given that you have experienced these episodes intermittently over the past year, it may be beneficial to keep a symptom diary. Documenting the frequency, duration, and intensity of your pain, as well as any associated factors such as diet, stress levels, and physical activity, can provide valuable insights for your healthcare provider.

If your symptoms persist or worsen, it would be advisable to consult a gastroenterologist or a colorectal specialist. They may recommend further diagnostic tests, such as imaging studies or endoscopy, to rule out any underlying conditions that may require more specific treatment.

In summary, nighttime rectal pain and urgency can arise from a combination of factors, including anal gland inflammation, gastrointestinal issues, muscle tension, and stress. Addressing these factors through lifestyle modifications, stress management, and possibly further medical evaluation can help alleviate your symptoms and improve your overall well-being.

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