Painful Bowel Movements Without Bleeding: Causes and Solutions

Pain in the anus during bowel movements without bleeding?

Hello, Dr.
Ke.
Recently, I've been experiencing pain in my anal area when having a bowel movement, which feels like a sharp pain.
I believe it’s due to hard stools, but there has been no bleeding.
My last bowel movement was three days ago, and although I've felt the urge to go, I've been holding it in due to the fear of pain.
Today, I finally endured the pain to have a bowel movement, and the stool was a single hard mass that sank to the bottom of the toilet, brown in color, with no blood present.
There were no blood streaks on the toilet paper either.
After finishing, I still felt the urge to go, but due to the hardness and pain, I couldn't continue.
I initially thought it might be hemorrhoids or an anal fissure, but I read that those conditions usually involve bleeding, which has me worried that there might be an issue with my intestines.
I also did not feel any lumps around the anal area.
I've been drinking less water and staying up late these past few days.
Additionally, about six months ago, I noticed faint blood stains on the toilet paper after a bowel movement, but my stool was normal, and drinking more water resolved it.
However, this issue has recurred in the last two weeks and seems to be getting worse.
Last time, I felt pain on the left side, but today it feels like both sides are painful.
My abdomen doesn’t hurt, but I feel a bit of pressure in my lower abdomen, which seems like it could be due to stool accumulation.

1.
Is this hemorrhoids or an anal fissure, or could it be a problem with my intestines?
2.
Will this resolve on its own? Do I need to take medication?
3.
Should I go to the bathroom when I feel the urge?

Miss Zhou, 10~19 year old female. Ask Date: 2021/07/19

Dr. Ke Fangxu reply Surgery

1.
This condition is more akin to anal fissures.

2.
The fundamental treatment is to improve bowel movement issues along with warm sitz baths.
Warm sitz baths can help alleviate pain, maintain cleanliness, and promote blood circulation.
Over-the-counter hemorrhoid suppositories can also be purchased for use.
If symptoms persist without improvement, it is advisable to consult a physician for further evaluation.

3.
Yes, intentionally holding in the urge to defecate can also easily lead to anal fissures.

Reply Date: 2021/07/19

More Info

Experiencing painful bowel movements without bleeding can be concerning, and it’s important to understand the potential causes and solutions. Based on the symptoms you've described, it seems likely that you are dealing with issues related to hard stools, which can lead to discomfort during bowel movements. Let's break down the possible causes and recommendations for your situation.

Possible Causes
1. Hard Stools: The primary cause of pain during bowel movements is often hard or dry stools. When stools are hard, they can cause strain and discomfort as they pass through the rectum. This can lead to a fear of going to the bathroom, which can create a cycle of constipation.

2. Anal Fissures: Although you mentioned there is no bleeding, anal fissures can occur with hard stools. These are small tears in the lining of the anus that can cause sharp pain during bowel movements. While bleeding is a common symptom, it is not always present.

3. Hemorrhoids: While you are not experiencing bleeding, hemorrhoids can still cause pain and discomfort. They are swollen veins in the rectal area that can become irritated, especially with hard stools.

4. Constipation: The fact that you are experiencing infrequent bowel movements (three days since your last one) suggests constipation, which can lead to the formation of hard stools. This can exacerbate pain during bowel movements.

5. Diet and Hydration: Insufficient fluid intake and a low-fiber diet can contribute to hard stools and constipation. If you’ve been drinking less water and not consuming enough fiber-rich foods, this could be a significant factor in your symptoms.

Recommendations
1. Increase Water Intake: Aim to drink plenty of water throughout the day. Staying hydrated helps soften stools and makes them easier to pass.

2. Dietary Changes: Incorporate more fiber into your diet. Foods like fruits, vegetables, whole grains, and legumes can help promote regular bowel movements and prevent hard stools.

3. Regular Bowel Habits: It’s important to respond to your body’s signals. If you feel the urge to go, try not to hold it in. Delaying bowel movements can lead to harder stools and increased discomfort.

4. Over-the-Counter Remedies: If dietary changes are not enough, consider using over-the-counter stool softeners or mild laxatives. These can help ease the passage of stools and reduce pain during bowel movements. However, consult with a healthcare provider before starting any medication.

5. Warm Baths: Taking warm baths can help relax the anal muscles and provide relief from pain. This can be particularly soothing if you suspect an anal fissure or hemorrhoids.

6. Consult a Healthcare Provider: If your symptoms persist or worsen, it’s important to consult a healthcare provider. They can perform a thorough examination to rule out any underlying conditions and provide tailored treatment options.

Conclusion
In summary, while your symptoms may not indicate a serious underlying condition, they do suggest issues related to hard stools and possibly anal fissures or hemorrhoids. By making dietary changes, increasing hydration, and establishing regular bowel habits, you can alleviate your symptoms. If the pain continues or if you develop new symptoms, seeking medical advice is crucial for proper diagnosis and treatment. Remember, taking care of your digestive health is essential for overall well-being.

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