Deep Anal Pain: Causes, Diagnosis, and Treatment Options

Deep anal pain?

Hello Dr.
Ke, I have been experiencing deep anal pain for three months.
Last October, during a digital examination, the doctor found a small lump and diagnosed it as an internal hemorrhoid.
However, I have been feeling a persistent burning sensation deep in the anal area, and the pain seems to be spreading.
I consulted another doctor who performed a digital examination and diagnosed it as a stage II internal hemorrhoid.
Due to my pregnancy, I did not undergo an anal endoscopy, and after giving birth, I saw a different doctor who, after a digital examination, indicated that the hemorrhoid was not located that high up, but rather in the rectum, and arranged for an MRI.
I would like to ask you, Dr.
Ke, I have never experienced any bleeding or discharge, and there are no hard lumps near the anus.
However, deep pressure from the perineum towards the rectum causes pain.
I am unsure if this is due to bone inflammation or something else, as my gynecologist suggested it could likely be pubic bone inflammation.
Additionally, I have a history of coccyx injury, so pressing on my coccyx post-delivery is painful, and I am also experiencing pain from external hemorrhoids.
Is it sufficient to just have the MRI, or do I need to undergo other diagnostic tests? I hope you can provide me with some advice.

Dian Dian, 20~29 year old female. Ask Date: 2016/01/29

Dr. Ke Fangxu reply Surgery

The pubic bone is located in the front and the coccyx is in the back.
To determine the reference for the pain, it is important to assess the location of the pain.
It is recommended that you first complete an MRI examination, and then based on the results, consider whether additional tests such as a colonoscopy or other examinations are necessary.

Reply Date: 2016/01/29

More Info

Deep anal pain can be a complex issue, often stemming from various underlying causes. Given your symptoms and history, it’s essential to approach this condition with a comprehensive understanding of potential diagnoses and treatment options.

Possible Causes of Deep Anal Pain
1. Internal Hemorrhoids: These are swollen veins in the rectum that can cause pain, especially if they become thrombosed or inflamed. Your description of an "internal mass" could correlate with this condition.

2. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. They can lead to significant pain, especially during bowel movements.

3. Abscess or Fistula: An anal abscess is a collection of pus that can cause deep pain and swelling. If it drains, it may form a fistula, which can also be painful.

4. Pelvic Floor Dysfunction: Given your history of tailbone injury and pregnancy, pelvic floor issues could contribute to pain. This includes muscle spasms or tension in the pelvic floor muscles.

5. Coccydynia: Pain in the tailbone area can radiate and cause discomfort in the anal region, especially if there was a prior injury.

6. Inflammatory Conditions: Conditions like Crohn's disease or ulcerative colitis can cause deep anal pain due to inflammation in the gastrointestinal tract.

7. Infections: Infections in the anal area, including sexually transmitted infections, can lead to pain and discomfort.

Diagnostic Approach
Given that you have already undergone a digital rectal examination and are scheduled for an MRI, this is a good start. The MRI can provide detailed images of the soft tissues in the pelvic area, helping to identify any abnormalities such as abscesses, tumors, or significant inflammation.

In addition to the MRI, consider the following diagnostic options:
- Anoscopy or Sigmoidoscopy: These procedures allow direct visualization of the anal canal and rectum, which can help diagnose hemorrhoids, fissures, or other lesions.

- Pelvic Ultrasound: This can be useful in assessing pelvic floor issues or any masses that may not be visible on MRI.

- Blood Tests: To rule out infections or inflammatory markers that could indicate underlying conditions.

Treatment Options
1. Medications: Depending on the diagnosis, treatments may include topical anesthetics for pain relief, anti-inflammatory medications, or stool softeners to ease bowel movements.

2. Sitz Baths: Warm sitz baths can help alleviate pain and promote healing in cases of hemorrhoids or fissures.

3. Physical Therapy: If pelvic floor dysfunction is suspected, pelvic floor physical therapy can be beneficial in addressing muscle tension and improving function.

4. Surgical Options: If hemorrhoids are severe or if there is an abscess or fistula, surgical intervention may be necessary.

5. Follow-Up Care: Regular follow-ups with your healthcare provider are crucial to monitor your condition and adjust treatment as necessary.

Conclusion
In summary, deep anal pain can arise from various causes, and a thorough diagnostic approach is essential to identify the underlying issue. The MRI will provide valuable information, but additional tests may be warranted based on your symptoms. Treatment will depend on the specific diagnosis but may include medications, lifestyle changes, and possibly surgical options. It’s important to communicate openly with your healthcare provider about your symptoms and concerns to ensure you receive the appropriate care.

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