Painful Bowel Movements: Fissures, Hemorrhoids, or Polyps?

Is pain during bowel movements a sign of anal fissure?

Hello, doctor.
I have both internal and external moles, and I have coexisted with them peacefully for a long time.
However, after experiencing constipation and passing hard stools, I now have sharp pain during each bowel movement, and there is blood in my stool.
Additionally, there seems to be something resembling hemorrhoids that protrudes, and I have to push it back in with my hand, which is also painful.
Could you please tell me if this is an anal fissure, hemorrhoids, or possibly a papilloma?

Ms. Wu, 30~39 year old female. Ask Date: 2022/09/21

Dr. Zhang Shuhao reply Surgery

Pain during or after bowel movements that feels like a knife cutting is a typical symptom of anal fissures.
This is caused by tension in the sphincter muscle or excessive straining during defecation, leading to a tear.
Some anal fissures may be accompanied by symptoms such as anal skin tags, ulcers, or anal papilla hyperplasia, and may also coexist with hemorrhoids.
A definitive diagnosis requires an examination by a physician in an outpatient setting.
At home, one can start with warm sitz baths, use topical ointments, and take oral anti-inflammatory pain relievers.
Increasing fluid intake and dietary fiber can also help with bowel movements.
Acute anal fissures may improve within about a week.

Reply Date: 2022/09/21

More Info

Based on your description, it sounds like you are experiencing significant discomfort during bowel movements, which could be attributed to several conditions, including anal fissures, hemorrhoids, or possibly even polyps. Let’s break down these possibilities to help you understand your symptoms better.

Anal Fissures
Anal fissures are small tears in the lining of the anus, often caused by passing hard stools. The sharp, knife-like pain you describe during bowel movements is characteristic of fissures. They can also lead to bleeding, which might explain the blood you see on your stool or toilet paper. Fissures can be quite painful, especially if they become chronic, and they may cause a spasm of the anal sphincter, leading to further pain and difficulty with bowel movements.

Hemorrhoids
Hemorrhoids are swollen veins in the lower rectum and anus. They can be internal (inside the rectum) or external (under the skin around the anus). Symptoms of hemorrhoids can include pain, discomfort, itching, and bleeding during bowel movements. If you notice a lump or "something coming out" during bowel movements, it could be a thrombosed hemorrhoid, which occurs when a blood clot forms in an external hemorrhoid, causing significant pain and swelling.

Polyps
While less likely given your symptoms, polyps are growths on the lining of the colon or rectum that can sometimes cause bleeding. They are usually asymptomatic but can lead to complications if they become large or if there are multiple polyps.

Diagnosis and Treatment
To determine the exact cause of your symptoms, a thorough examination by a healthcare professional is essential. This may include a physical examination, possibly a digital rectal exam, and other diagnostic tests such as a colonoscopy if necessary.

1. For Anal Fissures: Treatment often includes dietary changes to ensure softer stools (increased fiber and hydration), topical anesthetics, and sometimes medications to relax the anal sphincter. In chronic cases, surgical options may be considered.

2. For Hemorrhoids: Conservative treatment includes warm sitz baths, topical treatments, and dietary adjustments. If they are severe or thrombosed, procedures such as rubber band ligation or surgical removal may be necessary.

3. For Polyps: If polyps are found, they are typically removed during a colonoscopy and sent for biopsy to rule out cancer.

Lifestyle Modifications
Regardless of the diagnosis, certain lifestyle changes can help alleviate symptoms:
- Increase Fiber Intake: Aim for a diet rich in fruits, vegetables, and whole grains to soften stools.

- Stay Hydrated: Drink plenty of water throughout the day.

- Avoid Straining: Try not to strain during bowel movements, as this can exacerbate fissures and hemorrhoids.

- Regular Exercise: Physical activity can help promote regular bowel movements.

When to Seek Help
If your symptoms persist, worsen, or if you experience significant bleeding, it is crucial to seek medical attention promptly. A healthcare provider can offer a definitive diagnosis and appropriate treatment plan tailored to your specific condition.

In summary, while your symptoms could indicate anal fissures or hemorrhoids, a proper evaluation by a healthcare professional is necessary to determine the exact cause and appropriate treatment. Don't hesitate to reach out to a specialist, such as a gastroenterologist or a colorectal surgeon, for further evaluation and management.

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