Anal Pain: Causes, Symptoms, and Treatment Options

Anal pain

Hello Doctor, last June I experienced pain during bowel movements, and there was fresh blood on my stool and on the toilet paper, so I consulted a gastroenterologist.
After examination, the doctor diagnosed me with internal hemorrhoids and prescribed suppositories.
After using them regularly, I did not have significant issues.
However, in April and October of this year, I encountered the same symptoms.
I used ointments and suppositories on my own, which mostly improved my condition.
A few days ago, I felt pain again, so I quickly applied ointment and used a water-based lubricant.
There was no bleeding, just anal pain.
Additionally, sometimes my bowel movements are smooth, but I still feel discomfort in the anal area.
Is this simply a case of anal fissures accompanying internal hemorrhoids? Thank you.
(The day before the bleeding, I felt pain during bowel movements but no blood; the next day, there was blood.
In April and October, I had thrombosed hemorrhoids, but soaking in warm water and applying ointment resolved them quickly.)

EA, 20~29 year old female. Ask Date: 2015/11/20

Dr. Ke Fangxu reply Surgery

This situation is likely a higher possibility of anal fissure combined with hemorrhoidal bleeding.
An anal fissure itself can cause mild bleeding and pain; as long as there is no further bleeding, it should not be a concern.
It is recommended to avoid constipation during this period and to shorten the time spent on bowel movements.
Additionally, taking warm sitz baths can effectively alleviate symptoms.
Over-the-counter hemorrhoid suppositories can also be used.
However, if bleeding persists, it is best to consult a physician for evaluation.

Reply Date: 2015/11/20

More Info

Anal pain can be a distressing symptom that often leads individuals to seek medical advice. Based on your description, it appears that you have been experiencing recurrent issues related to anal pain, bleeding during bowel movements, and discomfort associated with your previous diagnosis of internal hemorrhoids. Let's break down the potential causes, symptoms, and treatment options for your condition.

Causes of Anal Pain
1. Hemorrhoids: Internal hemorrhoids are swollen veins inside the rectum that can cause pain, discomfort, and bleeding during bowel movements. They are often exacerbated by straining during defecation, constipation, or prolonged sitting.

2. Anal Fissures: These are small tears in the lining of the anus that can occur due to passing hard stools. They typically cause sharp pain during and after bowel movements and may be associated with bleeding.

3. Thrombosed Hemorrhoids: This occurs when a blood clot forms in an external hemorrhoid, leading to severe pain and swelling. You mentioned experiencing thrombosed hemorrhoids in the past, which can recur.

4. Other Conditions: While less common, conditions such as anal abscesses, infections, or inflammatory bowel disease can also cause anal pain and discomfort.

Symptoms
From your description, the symptoms you are experiencing include:
- Pain during bowel movements.

- Bright red blood on the stool or toilet paper.

- Discomfort in the anal area, even when not having a bowel movement.

- Occasional relief with topical treatments such as ointments and suppositories.

Treatment Options
1. Topical Treatments: Over-the-counter creams and ointments containing hydrocortisone or witch hazel can help reduce inflammation and soothe the area. You mentioned using a water-based lubricant, which can also help ease discomfort during bowel movements.

2. Sitz Baths: Soaking in warm water for 10-15 minutes several times a day can help relieve pain and promote healing.

3. Dietary Changes: Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools and reduce straining during bowel movements. Staying hydrated is also crucial.

4. Stool Softeners: Over-the-counter stool softeners can be beneficial if you are experiencing constipation, making bowel movements easier and less painful.

5. Medical Intervention: If symptoms persist or worsen, it may be necessary to revisit your healthcare provider. They may recommend further evaluation, including a physical examination or possibly a colonoscopy, to rule out other underlying conditions.

6. Surgical Options: In cases where conservative treatments fail, surgical options such as hemorrhoidectomy or rubber band ligation may be considered for persistent hemorrhoids.

Conclusion
Given your history of internal hemorrhoids and the recurrence of symptoms, it is likely that your current discomfort may be related to either hemorrhoids or anal fissures. While self-care measures can provide relief, it is essential to monitor your symptoms closely. If you experience significant pain, prolonged bleeding, or changes in bowel habits, it is advisable to consult a healthcare professional for a comprehensive evaluation and tailored treatment plan. Remember, maintaining a healthy diet and lifestyle can significantly impact your bowel health and help prevent future episodes.

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