Anal Issues: Causes of Pain, Discomfort, and Treatment Options

Anal issues

Hello, Dr.
Ke.
I discovered I had two internal hemorrhoids and one external hemorrhoid during an examination at a nearby clinic around July or August of this year.
Initially, I underwent a ligation procedure for the two internal hemorrhoids, while the external hemorrhoid was not treated.
In early November, I experienced anal pain after straining to pass hard stools.
This lasted for about a week, and I did not visit the hospital for a check-up due to my menstrual period.
Recently, I have been experiencing a persistent burning sensation in my anus, along with occasional itching.
When I went for a check-up, the doctor found a small internal hemorrhoid and performed another ligation.
He also mentioned that there was scar tissue from an anal fissure beneath the external hemorrhoid (approximately 0.5 cm) and a small polyp nearby.
After treatment, I still feel a burning sensation in my anus, and during anal contractions, I feel a foreign body sensation, along with a hard lump that can be pushed back in.
This is very uncomfortable.

I have a few questions:
1.
Why do I continue to experience a burning sensation? The doctor suggested that removing the external hemorrhoid and the scar tissue might alleviate the symptoms.
Is the burning sensation related to the external hemorrhoid and scar tissue? In your opinion, would removing the external hemorrhoid resolve this issue? My external hemorrhoid is quite small, so I am unsure why it causes such significant discomfort.

2.
Could this be caused by an anal fistula or an anal abscess? Is there such a thing as a hidden fistula, where the opening is covered by skin, making it difficult to diagnose? Could this be causing the ongoing anal swelling?
3.
If an anal abscess does not form a hard lump under the skin, is it undetectable? Is it only characterized by swelling?
4.
Is the foreign body sensation due to a prolapsed internal hemorrhoid? However, since I have already had most of my internal hemorrhoids ligated, is it still possible for there to be a prolapse? I am very concerned that I will continue to feel this way after surgery.
I apologize for the lengthy message, and I appreciate your help! Thank you.

Niming, 30~39 year old female. Ask Date: 2012/11/20

Dr. Ke Fangxu reply Surgery

A burning sensation is not necessarily caused by hemorrhoids resulting from treatment; the hemorrhoids themselves can also lead to abnormal sensations in the anal area.
However, this does not pose a threat to life.
It is recommended to use topical ointments for treatment.
If it causes significant distress, surgical intervention may be considered, but it may not improve the burning sensation in the anal area.

Anal abscesses typically present with symptoms of infection, leading to severe pain and fever.
Anal fistulas may also cause these symptoms, but there is usually an open wound on the skin surface that does not heal.
Hemorrhoids can potentially cause these symptoms as well, and hemorrhoid ligation does not eliminate internal hemorrhoids; it merely controls bleeding.
A definitive diagnosis still requires examination by a physician.

Reply Date: 2012/11/20

More Info

Hello! Thank you for reaching out with your concerns regarding anal issues, which can indeed be quite distressing. Based on your description, it seems you are experiencing a range of symptoms related to hemorrhoids and possibly other anal conditions. Let’s break down your questions and concerns.

1. Burning Sensation and External Hemorrhoids
The burning sensation you are experiencing could be related to several factors, including the presence of external hemorrhoids, scar tissue from previous surgeries, or even anal fissures. Hemorrhoids can cause discomfort due to inflammation and irritation, especially if there is straining during bowel movements. The scar tissue from a fissure can also contribute to discomfort, as it may not stretch as well as normal tissue, leading to pain or a burning sensation during bowel movements.

Removing the external hemorrhoid and any associated scar tissue may help alleviate these symptoms. However, it’s essential to have a thorough examination by a healthcare professional to determine the exact cause of your discomfort. If the external hemorrhoid is small, it may not seem significant, but even small hemorrhoids can cause discomfort, especially if they become thrombosed (clotted).

2. Anal Fistula or Abscess
Regarding your question about anal fistulas or abscesses, these conditions can indeed cause persistent discomfort and swelling. An anal fistula is an abnormal connection between the anal canal and the skin, which can occur after an abscess. If the opening of the fistula is covered by skin, it can be challenging to diagnose, leading to ongoing symptoms.
If you suspect you might have a fistula, it’s crucial to consult with a colorectal specialist who can perform an examination, possibly including imaging studies, to determine if a fistula is present.

3. Diagnosis of Anal Abscess
An anal abscess may not always present as a hard lump; it can sometimes just cause swelling and discomfort. If there is no visible external abscess, it may still be present internally. Symptoms of an abscess can include localized pain, swelling, and sometimes fever. If you have persistent pain and swelling, it’s advisable to seek medical attention for a thorough evaluation.

4. Sensation of a Foreign Body
The sensation of a foreign body in the anal area could be due to several reasons. It could be related to residual internal hemorrhoids, especially if they were not entirely removed during your previous procedures. Even after ligation, some tissue may remain, which can still cause discomfort.
If you are experiencing this sensation, it’s essential to communicate this with your healthcare provider. They may recommend further evaluation, possibly including an anoscopy, to visualize the anal canal and rectum directly.

Conclusion
In summary, your symptoms of burning, discomfort, and the sensation of a foreign body can be interconnected and may stem from your history of hemorrhoids and any associated treatments. It is crucial to follow up with your healthcare provider for a comprehensive evaluation. They may suggest treatments ranging from dietary changes, topical treatments, or possibly further surgical interventions if necessary.

Remember, managing bowel habits, such as avoiding straining and ensuring soft stools, can significantly help alleviate symptoms. Increasing fiber intake, staying hydrated, and possibly using stool softeners can be beneficial.

Please don’t hesitate to reach out to your healthcare provider with these concerns, as they can provide tailored advice and treatment options based on your specific situation. Wishing you relief and good health!

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