Occasional Rectal Pain and Nighttime Urgency: A Surgical Perspective

Occasional brief sharp pain in the buttocks and being awakened at night by the urge to defecate?

I am currently 33 years old, and my bowel habits have been to have a bowel movement every two to three days since high school.
Although I eat some vegetables, I don't consume them in large amounts, which often results in hard stools.
Sometimes, I experience a tearing sensation when using the restroom.
I used to have a habit of excessive cleaning; if I felt I hadn't cleaned thoroughly, I would wipe until it was completely clean, which occasionally led to blood on the toilet paper.
I have gradually changed this habit, and I no longer see blood when wiping, but sometimes when my stools are hard, I still notice a bit of fresh blood.
Currently, I feel a very mild soreness above the anus that occasionally flares up, but it mainly occurs when I am standing still.
This symptom has persisted for about a month, although the frequency has decreased recently.
Another issue is that I rarely wake up at night due to the urge to defecate; it has happened twice in the past six months.
I have been taking medication for gastroesophageal reflux (mosapride, Nexium, and gastric mucosal protective agents) for about two days.

Yesterday, after taking mosapride to promote motility, I had a bowel movement that was relatively soft but of normal color.
However, since I was at work and trying to finish quickly, my stool ended up being somewhat flattened (possibly due to straining) and came out in several small segments.
Last night, I went to bed at 12:30 AM and was awakened by the urge to defecate around 3:30 AM.
After tossing and turning for about five minutes, the urge subsided.
I was awakened again around 6:00 AM, and when I relaxed, it turned out to be just a small gas release.
I suddenly thought that if there were any growths, it could also cause a sense of urgency, but I don't experience this issue during the day.
Could this problem possibly be due to hemorrhoids or the medication? Before starting the medication, my stool color was consistently a yellow-brown, with a smooth surface or slightly hard consistency, about the thickness of a ten-dollar coin, and the shape was generally intact, measuring around 20 centimeters in length.
I only noticed blood when wiping if the stool was particularly hard.

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

Dr. Zhang Shuhao reply Surgery

Pain deep in the upper buttocks is commonly caused by piriformis syndrome and gluteal myofascial pain, often related to prolonged sitting and poor posture.
Physical therapy from a rehabilitation specialist can help improve these conditions.
Medications that promote intestinal motility may increase the urge to defecate; if urgency persists after discontinuing the medication, a rectal examination should be considered.
This can be done using a sigmoidoscope or anoscope to check for any lesions.
If the results are normal, a gradual adjustment of gastrointestinal medications can be made to alleviate symptoms.

Reply Date: 2024/05/30

More Info

Understanding occasional rectal pain and nighttime urgency can be complex, especially in the context of your surgical history and current medication regimen. Based on your description, it seems that you are experiencing a combination of symptoms that could be attributed to several factors, including dietary habits, bowel habits, and possibly the effects of medications.

Firstly, the infrequent bowel movements you mentioned (every two to three days) can lead to hard stools, which may cause discomfort and even minor anal fissures, especially if you have a history of excessive cleaning that could irritate the anal area. The presence of blood on toilet paper, particularly after hard stools, is often indicative of small tears in the anal mucosa or hemorrhoids. These conditions can lead to intermittent pain, especially when standing or during bowel movements.

The occasional rectal pain you experience, particularly when standing, may be related to increased pressure in the pelvic area or tension in the anal sphincter. This discomfort can be exacerbated by prolonged sitting or standing, as these positions can increase strain on the pelvic floor muscles. It’s also worth noting that if you have developed a habit of straining during bowel movements, this can lead to further irritation and discomfort.

Regarding the nighttime urgency you mentioned, it is not uncommon for individuals to experience a sudden urge to defecate during the night, especially if they have had a recent change in bowel habits or dietary intake. The medications you are currently taking, such as mosapride and Nexium, can influence gastrointestinal motility. Mosapride is a prokinetic agent that enhances gastrointestinal motility, which may lead to more frequent bowel movements or a sense of urgency, particularly if taken close to bedtime.
The fact that you have experienced this urgency only a couple of times in the past six months suggests that it may not be a chronic issue but rather an occasional side effect of your medication or dietary habits. The sensation of needing to defecate, followed by a release of gas, can also be attributed to the gastrointestinal tract's natural response to movement and pressure changes.

To address your concerns, here are some recommendations:
1. Dietary Adjustments: Increasing your fiber intake can help soften stools and promote regular bowel movements. Incorporate more fruits, vegetables, and whole grains into your diet. Staying hydrated is also crucial, as adequate fluid intake can prevent constipation.

2. Bowel Habits: Try to establish a regular bowel routine. Setting aside time each day to sit on the toilet, even if you don’t feel the urge, can help train your body to have more regular bowel movements.

3. Medication Review: Consult with your healthcare provider regarding your current medications. If you suspect that mosapride or any other medication is contributing to your symptoms, a review may be necessary to adjust dosages or explore alternatives.

4. Pelvic Floor Exercises: Engaging in pelvic floor exercises can help strengthen the muscles in that area, potentially reducing discomfort and improving bowel control.

5. Medical Evaluation: If symptoms persist or worsen, it is essential to follow up with your healthcare provider. They may recommend further evaluation, such as a rectal examination, to rule out conditions like hemorrhoids, fissures, or other underlying issues.

In summary, while your symptoms may be related to dietary habits and the effects of medication, it is crucial to monitor your condition and seek medical advice if necessary. Maintaining a healthy diet, establishing regular bowel habits, and consulting with your healthcare provider can help alleviate your symptoms and improve your overall gastrointestinal health.

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