Buttock Pain and Stool Shape Changes: A Gastrointestinal Perspective

Stool shape and dull pain in the buttocks?

Hello, Doctor.
I've been experiencing some issues for the past two months.
About two months ago, I started having a dull pain in my buttocks.
It's not constant; it occurs intermittently for a second or two.
The pain is not located at the anal area but rather in the groin area on both sides.
Pressing on this area does not trigger the pain.
Occasionally, I wake up at night due to the pain (about once or twice every two weeks).
Unlike during the day, the pain at night is not very intense; it feels more like soreness, with a sensation of fullness in my buttocks, similar to the urge to pass gas.

About three weeks ago, I noticed blood at the end of my stool on one or two occasions.
After bowel movements, I would see blood when wiping.
I instinctively thought it was a hemorrhoid flare-up, so I purchased ointment and suppositories, along with warm sitz baths.
After about four to five days, I stopped seeing blood in my stools, but the dull pain in my buttocks persists.
Recently, I've also felt uncomfortable sitting, as if my buttocks are sore.
Last night, the pain returned, and applying the hemorrhoid ointment did not help.
I took a muscle relaxant to try to ease the tension, and the pain disappeared within a few minutes.
Could it be a muscle strain? However, during the day, taking medication does not seem to help.
Worried that the dull pain might be related to my rectum, I have been monitoring my bowel movements over the past two months.
Last month, my stools were mostly formed, but this month they have become softer and not in a long shape, but rather in segments like sausages.
The color has remained yellow-brown, with no significant changes (except for those two instances of bleeding from hemorrhoids).
This week, I noticed that I first pass a normal-sized stool, followed by smaller, flatter stools.
However, it doesn't feel like constipation; I can complete a bowel movement within five minutes without straining too hard.
I am unsure what could be causing the change in the shape of my stools (they resemble a crescent shape).
Could it be something in my intestines, or is it due to straining during bowel movements? If there were something growing in my intestines, it shouldn't develop to the point of affecting stool shape in just two months, right? My bowel movement frequency used to be every two to three days (with harder stools, which could lead to anal fissures).
Recently, I've increased my vegetable intake and probiotics, so now I go every one to two days.

Aside from the two issues I've mentioned, I have not experienced diarrhea or bloating, my appetite is normal, my weight has not decreased, and I feel generally well.
However, the combination of the buttock pain and the occasional flat stools has made me increasingly worried.
I have scheduled a colonoscopy with a gastroenterologist, but due to long wait times at the hospital, the earliest appointment is at the end of August, which means I have to wait two months.
This has made it difficult for me to relax.
Given my age (33 years) and the absence of a family history of colorectal cancer, is it possible that there is something growing in my rectum? Or could it simply be a recurrence of hemorrhoids combined with my own anxiety? I apologize for the lengthy message.

WW, 30~39 year old female. Ask Date: 2024/07/02

Dr. Ke Fangxu reply Surgery

At the age of 34, the likelihood of developing colorectal cancer is not zero, but generally speaking, it is relatively low.
Based on your description, it seems more like symptoms of hemorrhoidal swelling or anal fissure pain.
It is advisable to maintain a light diet and a good lifestyle routine, while avoiding spicy, irritating, and greasy foods.
Increasing your intake of dietary fiber from plant sources can also be beneficial.
Since you have already scheduled a colonoscopy, it is best to wait for that examination.
In the meantime, you may consider using rectal suppositories or topical ointments, and taking warm sitz baths can also provide relief.

Reply Date: 2024/07/02

More Info

Based on your detailed description of symptoms, it seems you are experiencing a combination of issues that may be related to your gastrointestinal health, particularly concerning your rectum and possibly your colon. Your symptoms include intermittent dull pain in the buttock area, occasional rectal bleeding, changes in stool consistency, and a feeling of discomfort in the pelvic region.
Firstly, the dull pain you are experiencing in the buttock area, particularly near the groin, could be related to several factors. One possibility is muscle strain or tension, especially if you have been sitting for prolonged periods or engaging in activities that may have led to muscle fatigue. The fact that the pain subsides after taking a muscle relaxant suggests that muscle tension could be a contributing factor. However, it’s also important to consider other potential causes, such as nerve irritation or issues related to the pelvic floor.

The rectal bleeding you mentioned, especially if it was noted at the end of a bowel movement, could indeed be indicative of hemorrhoids (commonly referred to as piles). Hemorrhoids can cause bleeding, especially during bowel movements, and they can also lead to discomfort or a feeling of fullness in the rectal area. The fact that you have used topical treatments and experienced a cessation of bleeding is a positive sign, but it does not completely rule out the possibility of other conditions.

Regarding the changes in your stool, the transition from well-formed stools to softer, segmented stools could be attributed to dietary changes, particularly the increase in fiber from vegetables and probiotics. A diet high in fiber typically leads to softer stools, which can sometimes appear in various shapes. The presence of flat or thin stools can be concerning, as it may suggest a narrowing of the rectal passage, potentially due to an obstruction or mass. However, it is essential to note that stool shape can vary widely based on diet and hydration levels.

Given your family history of colorectal cancer, it is understandable that you are feeling anxious about these symptoms. While your age (33 years) and lack of a direct family history of colorectal cancer may lower your risk, it is still crucial to take any changes in bowel habits and rectal symptoms seriously. The fact that you have scheduled a colonoscopy is an excellent step toward understanding the underlying cause of your symptoms. This procedure will allow for a direct examination of the colon and rectum, and any abnormalities can be biopsied if necessary.

In the meantime, it is advisable to maintain a balanced diet rich in fiber, stay hydrated, and continue with any prescribed treatments for hemorrhoids. Additionally, managing stress and anxiety is crucial, as these can exacerbate gastrointestinal symptoms. Engaging in relaxation techniques, regular physical activity, and ensuring adequate rest can help alleviate some discomfort.

In summary, while your symptoms may be related to benign conditions such as hemorrhoids or muscle tension, it is essential to follow through with your scheduled colonoscopy to rule out any serious conditions. Keep track of your symptoms, and do not hesitate to reach out to your healthcare provider if you notice any significant changes or worsening of your condition. Your proactive approach to your health is commendable, and addressing these concerns with a specialist will provide you with the clarity and peace of mind you seek.

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