Anal Pain: Causes, Treatments, and When to Seek Help

Q: Anal Pain: Causes, Treatments, and When to Seek Help

Hello： In response to your question, the common causes of anal pain and bleeding are hemorrhoids, anal fissures, and rectal cancer. <br>The possibility of rectal cancer can be ruled out since a digital rectal examination and anoscopy have already been performed. <br>Hemorrhoids a

Anal pain or discomfort?

Hello Doctor: I used to suffer from constipation frequently, and two years ago, I experienced burning pain and bleeding during bowel movements.
After seeing a doctor, I discovered I had both internal and external hemorrhoids, as well as anal ulcers.
After applying ointment for a while, I improved.
This April, I started experiencing constipation again, accompanied by pain and bleeding during bowel movements, but after applying ointment, it improved for a while.
By May, I was no longer bleeding during bowel movements, but I noticed a painful area at the lower right and lower left of the anal opening that felt like it was chafed, especially when urine touched it, causing a stinging sensation.
After showering or during normal activities, it feels uncomfortable and painful; applying ointment provides temporary relief, but the pain returns if I stop using it.
Yesterday, I visited a surgeon who performed a digital exam and anoscopy, stating that there was nothing significant, just harder stools.
However, when I asked about the pain in the lower left and lower right of the anal opening, the doctor mentioned it might be due to chafing and suggested using ointment.
I would like to ask the doctor: 1.
The lower right and lower left of the anal opening are painful, but the doctor said there was nothing significant.
Could this pain be related to previous anal fissures? I find that the ointment only provides temporary relief; am I applying it to the wrong area? Should I be applying it both internally and externally? 2.
The doctor only mentioned hemorrhoids this time; does that mean the anal fissures have healed? However, during the anoscopy, I felt a tearing pain inside the anus.
Could it be that the previous fissure was aggravated? Or is this sensation normal? Thank you, Doctor, for taking the time to respond.

Xiao Xiao, 20~29 year old female. Ask Date: 2013/06/21

Dr. Ke Fangxu reply Surgery

Hello: In response to your question, the common causes of anal pain and bleeding are hemorrhoids, anal fissures, and rectal cancer.
The possibility of rectal cancer can be ruled out since a digital rectal examination and anoscopy have already been performed.
Hemorrhoids and anal fissures often occur together, presenting similar symptoms and having similar underlying causes, with no significant differences in treatment.
If there is anal pain without noticeable bleeding, the likelihood of an anal fissure is greater.
In addition to topical medications, warm sitz baths can provide significant therapeutic effects.
Furthermore, because the fissure is located internally, topical ointments may not be very effective; therefore, considering the use of rectal suppositories for treatment could be beneficial.
Additionally, the causes of anal fissures are often related to bowel movements; both constipation and diarrhea can lead to fissures.
To prevent recurrence in the future, developing good bowel habits is essential.

Reply Date: 2013/06/21

More Info

Anal pain can be a distressing and uncomfortable experience, often linked to various underlying conditions. Based on your description, it seems you have a history of constipation, hemorrhoids, and anal fissures, which can all contribute to the pain and discomfort you are experiencing. Let's break down your concerns and provide some insights into the potential causes, treatments, and when to seek further medical help.

1. Understanding the Pain
The pain you are feeling in the lower right and left areas around the anus could indeed be related to previous anal fissures. An anal fissure is a small tear in the lining of the anus, often caused by passing hard stools. When you mentioned that you have experienced bleeding and burning pain during bowel movements, it aligns with the symptoms of an anal fissure. Even if the fissure appears to have healed, the area can remain sensitive, especially if you are experiencing constipation again, leading to harder stools that may cause irritation.

The fact that you feel pain when urine touches the area suggests that the skin may be sensitive or possibly irritated. This could be due to residual inflammation or skin breakdown from previous fissures or hemorrhoids. The use of topical ointments can provide temporary relief by soothing the area, but if the underlying issue, such as constipation, is not addressed, the pain may persist.

2. Treatment Options
Here are some recommendations for managing your symptoms:
- Dietary Changes: Increasing your fiber intake can help soften stools and reduce the strain during bowel movements. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Additionally, staying well-hydrated is crucial.

- Topical Treatments: While you are currently using a topical ointment, ensure that it is appropriate for both internal and external use if you are experiencing pain in both areas. Some ointments are specifically designed for anal fissures and may contain ingredients like lidocaine for pain relief or hydrocortisone to reduce inflammation.

- Warm Sitz Baths: Taking warm baths can help soothe the anal area and promote relaxation of the sphincter muscles, which may alleviate pain.

- Avoid Straining: When using the bathroom, try to avoid straining, as this can exacerbate fissures and hemorrhoids. If you find it difficult to pass stools, consider using a stool softener or a gentle laxative after consulting with your healthcare provider.

3. When to Seek Further Help
While your recent examination by a surgeon did not reveal any significant issues, if your pain persists or worsens, it may be worthwhile to seek a second opinion or consult a specialist, such as a gastroenterologist or a colorectal surgeon. Here are some signs that warrant further evaluation:
- Persistent or worsening pain that does not improve with home treatments.

- New symptoms such as significant bleeding, changes in bowel habits, or any unusual discharge.

- Signs of infection, such as fever or increased redness and swelling around the anal area.

Conclusion
In summary, the pain you are experiencing could be related to your history of anal fissures and hemorrhoids, exacerbated by constipation. Addressing dietary habits, using appropriate topical treatments, and practicing good bowel habits can help alleviate your symptoms. However, if the pain continues or you have concerns about your condition, do not hesitate to seek further medical advice. Your comfort and health are paramount, and a healthcare professional can provide tailored guidance based on your specific situation.

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