Pain Near the Anus: Causes and When to Seek Help - Family Medicine

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Understanding pain near the anus can be a complex issue, as it can stem from various causes, including hemorrhoids, anal fissures, or even infections. Based on your description, it sounds like you may be experiencing symptoms related to hemorrhoids or an anal fissure, especially given the history of constipation and the pain you feel when straining during bowel movements.

Hemorrhoids are swollen veins in the lower rectum and anus that can cause discomfort, pain, and sometimes bleeding. They can be internal or external. External hemorrhoids can be felt as a lump near the anus and can be painful, especially when sitting or during bowel movements. Internal hemorrhoids, while usually not painful, can cause bleeding and discomfort if they prolapse.

Anal fissures, on the other hand, are small tears in the lining of the anus, often caused by passing hard or large stools. They can lead to sharp pain during and after bowel movements and may cause a small amount of bleeding. The pain associated with fissures can be quite severe and may lead to a cycle of constipation, as individuals may avoid bowel movements due to the pain.

Given that you mentioned a "small round thing" near the anus that is painful to touch, it is essential to consider the possibility of thrombosed hemorrhoids, which occur when a blood clot forms in an external hemorrhoid, leading to significant pain and swelling.

In your case, since you are experiencing pain, especially when straining, and have noticed a change in your bowel habits (constipation), it would be advisable to seek medical attention. You should consider visiting a gastroenterologist or a colorectal surgeon. These specialists can provide a thorough examination, which may include a visual inspection and possibly a digital rectal exam to assess the condition of the anal area and determine the exact cause of your symptoms.

In the meantime, here are some general recommendations to help alleviate your symptoms:
1. Increase Fiber Intake: Eating a diet high in fiber can help soften stools and make them easier to pass, reducing the strain during bowel movements. Foods rich in fiber include fruits, vegetables, whole grains, and legumes.

2. Stay Hydrated: Drinking plenty of water can also help prevent constipation.

3. Warm Sitz Baths: Soaking in warm water for 10-15 minutes several times a day can help soothe the area and relieve discomfort.

4. Over-the-Counter Treatments: You may consider using over-the-counter creams or ointments designed for hemorrhoids, which can help reduce pain and inflammation.

5. Avoid Straining: Try to avoid straining during bowel movements, as this can worsen your symptoms.

6. Regular Bowel Habits: Establishing a regular schedule for bowel movements can help prevent constipation.

If your symptoms persist or worsen, or if you notice any bleeding, it is crucial to seek medical attention promptly. Early intervention can help prevent complications and improve your quality of life. Remember, while it can be uncomfortable to discuss issues related to the anal area, healthcare providers are trained to handle these situations with professionalism and care.