Mild Anal Pain During Bowel Movements: Causes and Solutions

Mild anal pain during bowel movements?

Hello Dr.
Ke: For over a month, I have occasionally experienced slight pain on the right side of my anus during bowel movements, without any bleeding.
When the discomfort is more severe, I feel a mild burning sensation and a swollen foreign body sensation after defecation, along with occasional itching.
However, these symptoms disappear after a night's sleep, and the mild pain during bowel movements lasts about two days before resolving.
It seems that there is a hemorrhoid located in that area, confirmed as a grade II internal hemorrhoid by a physician's examination.
This situation has occurred about three times, and I have used a hemorrhoidal suppository each time.
There is no pain when pressing on the outside of the anus, and there are no hard lumps or swelling.
Two weeks ago, I consulted a proctologist about hemorrhoid surgery, but the examination did not indicate any issues with that specific point.
I would like to ask Dr.
Ke if grade II internal hemorrhoids can cause symptoms like mine.
Since I do not have a strong feeling of heaviness or incomplete bowel movements, could it possibly be anal gland inflammation or cryptitis? Thank you for taking the time to respond amidst your busy schedule.

Zhou, 20~29 year old female. Ask Date: 2023/07/06

Dr. Ke Fangxu reply Surgery

Based on your description, it seems more like the typical symptoms of an anal fissure, which include pain during bowel movements accompanied by slight bleeding.
The pain usually lasts for several days, sometimes exceeding a week.
The common causes are often constipation or diarrhea.
The fundamental treatment is to improve bowel habits, along with warm sitz baths.
Warm sitz baths can help alleviate pain, maintain cleanliness, and promote blood circulation.
You can also purchase hemorrhoid suppositories over the counter.
Anal abscess or anal fistula typically presents with severe pain or fever and does not last for such an extended period, so it seems less likely in this case.

Reply Date: 2023/07/06

More Info

Mild anal pain during bowel movements can be a common issue, and your symptoms suggest a few potential causes. Given that you have been diagnosed with a second-degree internal hemorrhoid, it is quite possible that this is the primary source of your discomfort. Internal hemorrhoids can cause pain, especially during bowel movements, and may lead to sensations of burning, swelling, or a feeling of a foreign body in the anal area.

Understanding Internal Hemorrhoids
Internal hemorrhoids are swollen veins located inside the rectum. They are classified into degrees based on their severity:
- First-degree: Hemorrhoids that do not prolapse (protrude) outside the anal canal.

- Second-degree: Hemorrhoids that protrude outside the anal canal during bowel movements but retract back inside afterward.

- Third-degree: Hemorrhoids that protrude outside the anal canal and need to be pushed back in manually.

- Fourth-degree: Hemorrhoids that are permanently prolapsed and cannot be pushed back in.

Your description of mild pain, burning sensation, and swelling after bowel movements aligns with the symptoms of second-degree internal hemorrhoids. The fact that these symptoms resolve after a short period and do not involve bleeding is also consistent with this diagnosis.

Other Possible Causes
While your symptoms are likely related to the internal hemorrhoid, there are other conditions that could cause similar symptoms:
1. Anal Fissures: Small tears in the lining of the anus can occur, especially if you have hard stools. They can cause sharp pain during and after bowel movements, along with a burning sensation.

2. Anal Abscess or Fistula: An abscess is a collection of pus that can cause pain and swelling, while a fistula is an abnormal connection between the anal canal and the skin. These conditions can lead to discomfort and may require medical intervention.

3. Proctitis: Inflammation of the lining of the rectum can cause pain and discomfort, often accompanied by other symptoms like diarrhea or rectal bleeding.

4. Anal Warts: Caused by the human papillomavirus (HPV), these can lead to discomfort and may be mistaken for hemorrhoids.

5. Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause anal pain, especially if there are lesions or inflammation in the anal area.

Recommendations
1. Dietary Adjustments: Ensure you are consuming a high-fiber diet to prevent constipation and straining during bowel movements. This can help reduce the pressure on hemorrhoids and alleviate symptoms.

2. Hydration: Drink plenty of fluids to help keep stools soft.

3. Topical Treatments: Over-the-counter hemorrhoid creams or suppositories can provide relief from pain and inflammation.

4. Warm Baths: Soaking in warm water can help soothe anal discomfort and promote relaxation of the anal muscles.

5. Consultation with a Specialist: Since you have already consulted with a proctologist, it may be beneficial to follow up if symptoms persist or worsen. They may recommend further evaluation or treatment options, including surgical interventions if necessary.

6. Monitor Symptoms: Keep track of your symptoms, including their frequency and severity, and report any changes to your healthcare provider.

In conclusion, while your symptoms are likely related to your second-degree internal hemorrhoid, it is essential to consider other potential causes. Maintaining a healthy lifestyle, monitoring your symptoms, and consulting with your healthcare provider will help manage your condition effectively. If symptoms persist or worsen, further evaluation may be necessary to rule out other underlying issues.

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