Anal Pain and Discomfort: Possible Causes and Solutions

Pain in the buttocks accompanied by slight swelling?

My usual bowel habit is to have a bowel movement every two to three days, which has been the case since high school.
Although I do eat some vegetables, I don't consume them in large quantities, so my stools are often hard, and sometimes I experience a tearing sensation during bowel movements.
I have a habit of excessive cleaning; if I feel that I haven't cleaned thoroughly, I will wipe until it's completely clean, which has occasionally resulted in blood on the toilet paper.
I have slowly been changing this habit, but sometimes when my stools are hard, I still notice a little fresh blood.
Therefore, I believe I have a history of anal fissures and hemorrhoids.
Regarding the symptoms mentioned in the title, they have been present for about two to three weeks.
Currently, I feel a very slight aching sensation occasionally just above the anus, along with a mild feeling similar to the urge to defecate, which feels like anal distension.
The initial onset was at the end of April after a series of international flights (I traveled abroad twice in April), but the early symptoms felt more like a blockage in the rectum, especially at night.
However, if I have a bowel movement that day, the urge diminishes significantly, leaving mostly just the aching sensation.
This discomfort mostly occurs when I am standing still or sitting/lying down.
I have been wondering if there might be something growing in the rectum, so I have been monitoring my bowel movements during this time.
The frequency has remained the same as before, with stool color being a light brownish-yellow, about the thickness of a ten-dollar coin, and generally well-formed (sometimes it comes out in two pieces).
The length of each bowel movement is approximately 20 centimeters, and there is no blood when wiping unless the stool is particularly hard.
Considering the timing of the onset, it may be due to poor posture during the flights causing pressure.
Now, three weeks after returning home, I have been standing and moving around a lot at work due to my job, but interestingly, I don't experience symptoms while at work.
However, during my usual rest or when getting up in the morning, I often find myself distracted by this aching and distension sensation.
My bowel movements remain normal, but there was one instance when the stool was harder, and the bidet spray caused some irritation, resulting in a small amount of mucus, which was the same color as the stool.
I do not experience diarrhea or bloating, and occasionally I pass non-smelly gas.

Could this aching and distension sensation be caused by anal fissures or hemorrhoids? Thank you.

WEI, 30~39 year old female. Ask Date: 2024/05/18

Dr. Lin Minghui reply Gastroenterology and Hepatology

Prolonged sitting or standing can lead to varicose veins and hemorrhoids.
It is recommended to eat more fruits and vegetables, drink plenty of water, establish good bowel habits, avoid prolonged sitting or standing, and engage in moderate exercise.
If there are concerns about growths in the rectum, it is advisable to follow up with a colorectal specialist.
Wishing you good health!

Reply Date: 2024/05/18

More Info

Understanding anal pain and discomfort can be quite complex, as it can stem from various causes, including but not limited to hemorrhoids, anal fissures, and even muscle tension or nerve-related issues. Based on your description, it seems likely that you may be experiencing symptoms related to both anal fissures and hemorrhoids, especially considering your history of hard stools and the occasional presence of blood on toilet paper.

Possible Causes
1. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. Symptoms typically include sharp pain during bowel movements and sometimes bleeding. Given your mention of a "cutting" sensation and the presence of blood, this could very well be a contributing factor.

2. Hemorrhoids: These are swollen veins in the lower rectum and anus that can cause discomfort, itching, and bleeding. They can be internal or external, and symptoms can include a feeling of fullness or pressure in the anal area, which might explain the "bulging" sensation you described.

3. Constipation: Your bowel habits, with infrequent and hard stools, can lead to both fissures and hemorrhoids. The strain during bowel movements can exacerbate these conditions.

4. Muscle Tension: Sometimes, the muscles around the anus can become tense, leading to discomfort. This can be exacerbated by prolonged sitting or poor posture, such as when traveling on airplanes.

5. Nerve-related Issues: Conditions affecting the nerves in the pelvic area can also lead to sensations of pain or discomfort, although this is less common.

Solutions and Recommendations
1. Dietary Changes: Increasing your fiber intake can help soften your stools and make bowel movements easier. Aim for a diet rich in fruits, vegetables, whole grains, and plenty of fluids. You might also consider fiber supplements if dietary changes alone are insufficient.

2. Hydration: Ensure you are drinking enough water throughout the day. Proper hydration is crucial for maintaining softer stools.

3. Regular Bowel Habits: Try to establish a routine for bowel movements. This can help reduce the strain associated with constipation. Do not ignore the urge to go, as this can lead to harder stools.

4. Warm Baths: Soaking in warm water can help relieve discomfort and promote healing if you have fissures or hemorrhoids. This can also help relax the anal muscles.

5. Over-the-Counter Treatments: There are various topical treatments available for hemorrhoids that can provide relief from itching and discomfort. These include creams or ointments containing hydrocortisone or witch hazel.

6. Avoid Straining: When using the bathroom, try to relax and avoid straining. If you find yourself straining frequently, consider using a stool softener or laxative under the guidance of a healthcare provider.

7. Consult a Healthcare Provider: If your symptoms persist or worsen, it is essential to consult a healthcare professional. They can perform a thorough examination to rule out any serious conditions and provide tailored treatment options.

8. Pelvic Floor Exercises: If muscle tension is suspected, pelvic floor exercises may help relieve discomfort. These exercises can strengthen the pelvic muscles and improve overall function.

Conclusion
While your symptoms may suggest anal fissures or hemorrhoids, it is crucial to consult a healthcare provider for an accurate diagnosis and appropriate treatment. Self-care measures, including dietary changes and proper hydration, can significantly alleviate your symptoms. However, persistent or severe symptoms warrant professional evaluation to rule out any underlying conditions. Remember, taking care of your digestive health is vital for overall well-being, and addressing these issues early can prevent more significant problems down the line.

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