Rectal Discomfort: Symptoms and Possible Causes

Hello, Dr. Chang. I have been experiencing discomfort in the anal area since September 3rd until today?

On September 3rd, I experienced a sensation where I felt like I couldn't fully empty my bowels, even though I had already passed some stool.
Suddenly, I had a feeling similar to having very hard stool that wouldn't come out.
The difference was that with hard stool, I could gradually push it out, and it could still be broken off.
However, this time, I couldn't break it off or push it out, and it felt like something was firmly gripping my anus, making it impossible to pass.
This sensation has persisted until now.
Over the past few days, I have still been able to pass stool, mostly well-formed, but when it drops into the toilet, it breaks apart.

One day, a couple of days ago, I felt the urge to go in the evening, but the stool that came out was in smaller pieces, and I still felt the urge afterward.
It was the same feeling as on September 3rd; I sat on the toilet for nearly 30 minutes before giving up.
When I returned to a seated position, I felt a sensation of heaviness in my lower abdomen.
I looked it up, but it didn't seem like a typical case of urgency with heaviness; it was just a feeling of heaviness without urgency, as if something was pressing against my anus.
However, the next day, I woke up and was able to pass a normal amount of stool, which was hard at the front and softer at the back, but not very loose, more like fragmented.
The hard pieces still broke apart in the toilet, and the feeling of heaviness was not as intense, but it was still present.
I attempted to exert pressure with my anus and took a picture with my phone, which showed what appeared to be some kind of growth or possibly hemorrhoids.
When I touched it, it felt soft, smooth, and somewhat elastic.
There seemed to be another one in the photo, but it wasn't as prominent.
It didn't hurt when I touched it, but I had a similar sensation before that I hadn't paid much attention to.
It seemed to retract back.

Whenever I have diarrhea or pass very hard stool, I experience pain and a burning sensation around my anus.
When I wipe with toilet paper, there is sometimes a little blood, and later, it turns into itching around the anus.
Sometimes at night, I pass gas frequently, and once while eating, I accidentally released liquid stool.
I went to the bathroom and had diarrhea, which turned the toilet water yellow.

I've looked into many possibilities, and while some symptoms seem to match, I don't have the typical urgency with heaviness; it's just a feeling of heaviness unless I exert myself while using the toilet, which gives me the sensation of rectal prolapse with stool coming out.
Normally, when sitting, it feels like my anus is constantly tightening, as if there is stool inside, but nothing comes out when I go to the bathroom.
However, when I stand or sit properly (not cross-legged or squatting), or take a shower, that feeling diminishes or is barely noticeable.
Currently, it feels more like hemorrhoids or possibly rectal prolapse.
I'm not sure if there is stool stuck inside causing constipation, but if that were the case, it seems unlikely since I can still pass stool.

Mr. Chen, 30~39 year old female. Ask Date: 2022/09/06

Dr. Zhang Shuhao reply Surgery

The photo appears to show a prolapsed hemorrhoid, which can cause a persistent sensation of foreign body in the anal area and may lead to the feeling of incomplete bowel movements when swollen.
It is recommended to start with warm sitz baths, gently pushing the hemorrhoid back during the bath.
Additionally, increasing fluid intake and dietary fiber can help with bowel movements.
If there are concerns, it is advisable to visit a colorectal specialist for an examination of the anal and rectal area.

Reply Date: 2022/09/06

More Info

Understanding rectal discomfort can be complex, as it may stem from various causes, including hemorrhoids, anal fissures, rectal prolapse, or even functional bowel disorders. Based on your description, it seems you are experiencing a combination of symptoms that could indicate one or more of these conditions.

Symptoms and Possible Causes
1. Hard Stool and Difficulty Passing: The sensation of having hard stool that feels stuck can often be attributed to constipation. Constipation occurs when bowel movements become infrequent or difficult to pass. This can lead to straining during bowel movements, which may cause discomfort and a feeling of incomplete evacuation.
2. Rectal Pressure and Discomfort: The feeling of pressure in the rectum, especially after a bowel movement, can be indicative of rectal prolapse or hemorrhoids. In rectal prolapse, part of the rectum protrudes through the anus, which can create a sensation of fullness or pressure. Hemorrhoids, which are swollen veins in the rectal area, can also cause similar sensations, along with pain, itching, and sometimes bleeding.

3. Presence of Soft, Smooth Mass: You mentioned noticing a soft, smooth mass around the anus. This could potentially be a hemorrhoid or a skin tag, which are common in individuals who have experienced straining or irritation in the anal area. Hemorrhoids can be internal or external, and while they are generally not serious, they can cause significant discomfort.

4. Bleeding and Burning Sensation: The presence of blood on toilet paper and a burning sensation after bowel movements are classic signs of hemorrhoids or anal fissures. Anal fissures are small tears in the lining of the anus that can occur due to passing hard stools. They can be quite painful and may cause bleeding during bowel movements.

5. Bowel Movement Irregularities: The alternating patterns of hard and loose stools, along with the urgency and incomplete evacuation feelings, may suggest a functional bowel disorder, such as irritable bowel syndrome (IBS). IBS can cause a range of symptoms, including abdominal pain, bloating, and changes in bowel habits.

Recommendations for Management
1. Dietary Changes: Increasing fiber intake can help soften stools and promote regular bowel movements. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Additionally, staying hydrated is crucial, as adequate fluid intake can prevent constipation.

2. Over-the-Counter Treatments: If hemorrhoids are suspected, over-the-counter creams or ointments can provide relief from itching and discomfort. Stool softeners or mild laxatives may also be beneficial if constipation is an issue.

3. Warm Sitz Baths: Taking warm baths can help soothe the anal area and reduce discomfort associated with hemorrhoids or anal fissures.

4. Avoid Straining: When using the bathroom, try to avoid straining, as this can exacerbate hemorrhoids and lead to further complications. If you feel the urge to go, respond promptly to avoid hardening of the stool.

5. Consult a Healthcare Provider: Given the complexity of your symptoms, it is advisable to consult a healthcare provider for a thorough evaluation. They may perform a physical examination and possibly recommend further diagnostic tests, such as a colonoscopy, to rule out any serious conditions.

6. Follow-Up: If symptoms persist or worsen, follow-up appointments are essential to monitor the situation and adjust treatment as necessary.

In conclusion, while your symptoms may suggest common conditions like hemorrhoids or constipation, it is crucial to seek medical advice for an accurate diagnosis and appropriate management. Early intervention can help alleviate discomfort and prevent potential complications.

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