Painful Bowel Movements: Causes and Treatments

Recurrent sharp pain and bleeding during bowel movements?

I had been taking weight loss pills for 2-3 years, which led to constipation.
Recently, when I had a bowel movement, my stool seemed very hard, and the moment I exerted myself, it felt like I was being cut with a knife, causing intense pain and a lot of fresh blood.
I went to see a doctor, who said that my stool was too hard and that it had caused a tear, leading to bleeding.
I underwent three rubber band ligation procedures for internal hemorrhoids, but I still experience sharp pain at the moment of passing stool, along with fresh blood.
What further treatment do I need? Out of nearly ten bowel movements, only occasionally do I not feel sharp pain; otherwise, every time I have a bowel movement, the moment the stool is about to come out is extremely painful, and there is a lot of blood.
Could this not be an internal hemorrhoid issue? Could it be a chronic anal fissure instead? How can I completely resolve this problem? I'm really becoming increasingly fearful of having bowel movements; each time is incredibly painful.
Although the pain is only at the moment of passing stool, it is so intense that it takes my breath away.

Zhang, 30~39 year old female. Ask Date: 2023/01/23

Dr. Yu Mingchang reply Surgery

There is a higher possibility of anal fissures, so it is advisable to consult a colorectal specialist.

Reply Date: 2023/01/23

More Info

Understanding painful bowel movements can be quite complex, especially when there are underlying issues such as chronic constipation, hemorrhoids, or anal fissures. Based on your description, it seems you have been experiencing significant pain during bowel movements, accompanied by fresh blood. This is a concerning symptom that warrants further exploration.

Firstly, the long-term use of weight loss medications can lead to various gastrointestinal issues, including constipation. When stool becomes hard and difficult to pass, it can cause trauma to the anal canal, leading to conditions such as anal fissures or exacerbating hemorrhoids. An anal fissure is a small tear in the lining of the anus, which can be extremely painful, especially during bowel movements. The pain you describe, akin to being cut by a knife, aligns with the typical experience of someone suffering from an anal fissure.

You mentioned that you have undergone three procedures for hemorrhoid ligation, which indicates that hemorrhoids have been a concern. While hemorrhoids can cause bleeding and discomfort, the sharp pain you are experiencing may suggest that there is more than just hemorrhoids at play. It is possible that you are dealing with both hemorrhoids and anal fissures simultaneously, which can complicate the healing process.

To address your concerns, here are several steps you can take:
1. Dietary Changes: Increasing your fiber intake is crucial. A diet rich in fruits, vegetables, whole grains, and legumes can help soften the stool and make bowel movements easier. Aim for at least 25-30 grams of fiber per day. Additionally, staying well-hydrated by drinking plenty of water can also aid in preventing constipation.

2. Stool Softeners and Laxatives: Over-the-counter stool softeners can help ease the passage of hard stools. If necessary, a mild laxative may be used occasionally to relieve constipation. However, it is essential to consult with your healthcare provider before starting any new medication.

3. Sitz Baths: Taking warm sitz baths can help soothe the anal area and promote healing. Soaking in warm water for about 15-20 minutes several times a day can provide relief from pain and discomfort.

4. Topical Treatments: Applying topical anesthetics or hydrocortisone creams can help reduce pain and inflammation in the anal area. If you have fissures, your doctor may prescribe medications to promote healing.

5. Follow-Up with a Specialist: Given the persistence of your symptoms, it may be beneficial to consult a gastroenterologist or a colorectal surgeon. They can perform a thorough examination to determine if there are any other underlying issues, such as chronic anal fissures or other conditions that may require different treatment approaches.

6. Consideration of Surgical Options: If conservative treatments do not provide relief, surgical options may be considered. For chronic anal fissures, procedures such as lateral internal sphincterotomy can be effective in relieving pain and promoting healing.

7. Behavioral Modifications: Avoid straining during bowel movements, as this can exacerbate pain and lead to further injury. Establishing a regular bowel routine and responding promptly to the urge to defecate can also help.

In conclusion, the pain you are experiencing during bowel movements is likely due to a combination of factors, including hard stools, potential anal fissures, and possibly hemorrhoids. It is crucial to address these issues comprehensively to prevent further complications and improve your quality of life. Do not hesitate to seek further medical advice to explore all available treatment options and ensure you receive the appropriate care for your condition.

Similar Q&A

Painful Bowel Movements: Causes and Solutions for Discomfort

I've been experiencing pain during bowel movements these past few days, which I didn't have before. Additionally, there was a time when my stool had a sticky, transparent mucus, and I noticed some blood on the toilet paper after wiping, although it wasn't a lot. Wh...

Dr. Lin Minghui reply Gastroenterology and Hepatology
Hello, pain during bowel movements and rectal bleeding may be caused by anal fissures, hemorrhoids, and other reasons. It is recommended to drink plenty of water and consume a high-fiber diet to develop good bowel habits. Hemorrhoids are varicosities of the hemorrhoidal veins, an...

Understanding Painful Bowel Movements: When to Seek Medical Attention

Hello doctor, I have been experiencing sharp pain and bleeding during bowel movements recently. I would like to know if this could be a sign of a serious illness. Additionally, I have been feeling some gastrointestinal discomfort and have had slight difficulty breathing. I'm...

Dr. Ke Fangxu reply Surgery
Based on your description, it seems to be an anal fissure. The typical symptoms include pain during bowel movements accompanied by slight bleeding. The primary cause of anal fissures is usually hard stools; however, diarrhea, frequent bowel movements, or prolonged straining can a...

Understanding Anal Pain During Bowel Movements: Causes and Solutions

Current Condition: Since around the age of 20, I have experienced a slight stabbing pain during bowel movements, located at the 12 o'clock position, which has gradually worsened over the years. In recent years, the pain has become sharp, akin to being cut with a knife (clenc...

Dr. Ke Fangxu reply Surgery
1. Cannot be ruled out. 2. A personal examination is necessary to make a determination; online consultations may not be conclusive. 3. It is likely not primarily related to body size. 4. First, consider whether surgery can truly address your concerns; if the surgery exacerbates t...

Understanding Painful Bowel Movements: Causes and Solutions

Hello Doctor, I have been experiencing constipation and bloating for several years. Since last year, I often feel sharp pain during bowel movements, and sometimes my stools are very hard. After using the restroom, I still feel pain around the anus. Recently, I have noticed that m...

Dr. Ke Fangxu reply Surgery
At the age of 23, the likelihood of developing colorectal cancer is not zero, but generally speaking, it is extremely low. Based on your description, it seems more like hemorrhoidal bleeding. It is recommended to maintain a light diet and good lifestyle habits, while avoiding spi...