Anal Pain: Insights on Hemorrhoids and Treatment Options

Hemorrhoid issues

Hello Dr.
Ke: Since September 2020, I have been experiencing anal pain, which has been diagnosed by several colorectal specialists as mild internal hemorrhoids and a small external hemorrhoid.
I have undergone ligation surgery, a flexible sigmoidoscopy, and an MRI of the lower abdomen.
The results showed no tumors other than uterine fibroids.
However, the anal pain has not been resolved, especially when sitting, which exacerbates the pain.
Standing provides slight relief, and bowel movements are mostly painless unless the stool is particularly hard.
It does not affect my sleep at night, but upon waking, the symptoms reappear as soon as I sit down, characterized by a sensation similar to skin abrasion, a feeling of anal tightness, and a mild foreign body sensation.
There is no pain upon pressing the anal area.
Previously, doctors have advised me not to over-clean and suggested using petroleum jelly to massage the anal area for relaxation.
Dr.
Ke, what insights do you have regarding this situation?

Joi, 50~59 year old female. Ask Date: 2022/01/19

Dr. Ke Fangxu reply Surgery

If a colonoscopy has not been performed, it is advisable to schedule an examination of the entire colon to check for any issues.
If the colon is found to be normal, at this age, it is also possible that the pain could be due to sacral nerve pain or pelvic pain syndrome.
You may consider consulting with an obstetrician-gynecologist or a neurologist for further evaluation.
Oral pain relievers or medications for neuropathic pain may also be beneficial.

Reply Date: 2022/01/19

More Info

Understanding anal pain, particularly in the context of hemorrhoids, requires a comprehensive approach that considers both the physical and psychological aspects of the condition. Hemorrhoids, which can be internal or external, are swollen veins in the rectal area that can cause discomfort, pain, and bleeding. Your experience with anal pain, especially after undergoing various diagnostic procedures and treatments, suggests that there may be multiple factors contributing to your symptoms.

Firstly, it is essential to understand that hemorrhoids can cause pain, particularly when sitting, due to increased pressure in the anal region. The pain you describe as a "burning" or "abrasive" sensation could be attributed to the irritation of the anal mucosa or the presence of hemorrhoids themselves. The fact that your pain is lessened when standing and is exacerbated by sitting indicates that posture plays a significant role in your discomfort.
In your case, the previous treatments, including the ligation of hemorrhoids and the advice to avoid excessive cleaning, are standard recommendations. Over-cleaning can lead to irritation and exacerbate symptoms. The suggestion to use petroleum jelly (Vaseline) for anal massage is aimed at providing lubrication and reducing friction, which can help alleviate discomfort during bowel movements.

Given that your pain is primarily associated with sitting and is not significantly affecting your sleep or bowel movements, it may be beneficial to explore additional treatment options. Here are some recommendations:
1. Dietary Adjustments: Ensure that your diet is high in fiber to prevent constipation and hard stools, which can aggravate hemorrhoids. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Staying well-hydrated is also crucial.

2. Sitz Baths: Taking warm sitz baths can help soothe the anal area and reduce pain. This practice can promote blood flow and healing while providing relief from discomfort.

3. Topical Treatments: Over-the-counter creams or ointments containing hydrocortisone or witch hazel can reduce inflammation and provide symptomatic relief.

4. Pain Management: If pain persists, consider discussing the use of oral pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), with your healthcare provider.

5. Physical Therapy: In some cases, pelvic floor physical therapy can help address muscle tension and improve symptoms related to anal pain.

6. Follow-Up with Specialists: If your symptoms continue to be bothersome, it may be worth consulting a colorectal specialist who can provide a more in-depth evaluation and explore other potential causes of your pain, such as anal fissures or muscle spasms.

7. Mind-Body Approaches: Stress and anxiety can exacerbate pain perception. Techniques such as mindfulness, relaxation exercises, or cognitive behavioral therapy may help manage the psychological aspects of chronic pain.

In summary, while hemorrhoids are a common cause of anal pain, your ongoing symptoms suggest that a multifaceted approach may be necessary. By addressing dietary habits, utilizing topical treatments, and considering physical therapy, you may find relief from your discomfort. Always consult with your healthcare provider before making any changes to your treatment plan to ensure that it aligns with your specific health needs.

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