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

Anal swelling and pain?

Hello, doctor.
I had constipation for about three to four days, and after having a bowel movement on January 27th (the stool was normal in shape but slightly green, as I had eaten a lot of sweet potato leaves in the previous days), I experienced anal pain and was unsure if I had completely emptied my bowels (the pain persisted).
That evening, I felt discomfort after returning home.
The next day, January 28th, after waking up and having a bowel movement (the color and shape were normal but the amount was small), I started to feel pain throughout the day.
At that time, I suspected an anal fissure and only did warm sitz baths at home, which provided slight relief.
On the 29th, I woke up to pain again, and my bowel movement was similar to the previous day.
I was still very swollen and in pain, whether standing or sitting.
Sometimes I felt the urge to have a bowel movement but couldn't pass anything while sitting on the toilet; it felt like something was swollen and blocking the anus, with a high internal pressure sensation.
That evening, I felt a bit chilly, and when I went to the outpatient clinic, it was already full.
I bought an ointment nearby, but it did not improve my condition.
That night, I had a fever (my whole body felt hot and I was cold) and took some antipyretics at home.
The next day, January 30th, I visited an anal clinic in Banqiao.
The doctor examined my anus and said everything looked normal.
After a digital rectal exam, he mentioned that there were ulcers deeper inside, and their small clinic could not handle it, so he advised me to go to the emergency room.
That evening, I went to the emergency room at Taipei Mackay Memorial Hospital.
After blood tests, it was confirmed that I had an infection and inflammation.
I was admitted for observation and received antibiotics throughout the night.
After receiving pain relief medication, my discomfort significantly improved.
During the night of January 30th to the morning of January 31st, three different emergency physicians performed digital rectal exams but all said there were no significant issues inside the anus (the first physician asked if I wanted a CT scan).
When I was discharged the next day, I did not continue my follow-up at Mackay since I was returning to southern Taiwan.
I received the prescribed antibiotics and pain medication.
That afternoon, I took the high-speed rail back to the south, but I still experienced anal pain and woke up two to three times at night due to pain, trying to use the restroom but unable to pass stool.
This morning, February 1st, I went to Kaohsiung Medical University for a consultation.
The doctor there listened to my description and suggested I continue taking the medication prescribed by Mackay without performing a digital rectal exam.
After observing the anal area and pressing on several spots, he asked me to do another blood test and urinalysis, and to return on Wednesday for the results.
He mentioned that surgery was not necessary and that the internal wounds would heal on their own.
However, the doctor from the first clinic suggested that surgery might be needed, and online information indicates that anal abscesses can only be resolved through surgery.
Now it seems they are only advising me to manage it with antibiotics? Today, the pain relief medication has improved my condition compared to the previous day, but I still experience swelling and pain, although walking is not as painful.
I am very worried that if the internal abscess is not treated, it could lead to cancer risk or develop into a fistula.
I know this is a bit complicated, but thank you, doctor.

Hsu Hong-yao, 20~29 year old female. Ask Date: 2016/02/01

Dr. Ke Fangxu reply Surgery

Superficial anal abscesses are relatively easy to diagnose, but deep abscesses are not as straightforward.
If localization cannot be achieved through external examination, surgical intervention becomes challenging.
Therefore, it is recommended to use antibiotic treatment; if successful, surgery may not be necessary.
Otherwise, waiting for the abscess to mature can facilitate localization, which is also the reason for suggesting a computed tomography (CT) scan.
If symptoms have already improved, this can be considered a sign of effective antibiotic treatment.
It is advisable to have a physician evaluate whether continued antibiotic therapy is necessary.
An abscess itself does not have the potential for malignant transformation, but whether it develops into a fistula will require further observation.

Reply Date: 2016/02/01

More Info

Anal pain can be a distressing and uncomfortable experience, and understanding its causes, treatments, and when to seek medical help is crucial for effective management. Based on your description, it seems you have been experiencing significant discomfort following a period of constipation, which can lead to various complications, including anal fissures or infections.

Causes of Anal Pain
1. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. Symptoms typically include sharp pain during and after bowel movements, and sometimes bleeding.

2. Hemorrhoids: Swollen blood vessels in the rectal area can cause pain, itching, and bleeding. They can be internal or external and are often exacerbated by straining during bowel movements.

3. Abscesses: An anal abscess is a collection of pus that can develop due to infection, often resulting in severe pain, swelling, and sometimes fever. The pain can be constant and may worsen with sitting or during bowel movements.

4. Infections: Bacterial infections can lead to inflammation and pain in the anal region. This can occur after trauma or due to poor hygiene.

5. Other Conditions: Conditions such as inflammatory bowel disease (IBD), sexually transmitted infections (STIs), or even certain cancers can manifest as anal pain.

Treatment Options
1. Medications: Over-the-counter pain relievers such as acetaminophen or ibuprofen can help manage pain. Topical treatments, including anesthetic creams or ointments, may provide localized relief.

2. Warm Sitz Baths: Soaking in warm water can help soothe the area and promote healing. This is particularly effective for anal fissures and hemorrhoids.

3. Dietary Changes: Increasing fiber intake can help soften stools and reduce straining during bowel movements, which is crucial for preventing further injury.

4. Antibiotics: If an infection is present, antibiotics may be necessary to treat the underlying cause.

5. Surgical Intervention: In cases of severe abscesses or persistent fissures that do not respond to conservative treatment, surgical options may be considered. This could involve drainage of an abscess or surgical repair of a fissure.

When to Seek Help
You should seek medical attention if:
- Pain persists despite treatment.

- You experience fever or chills, which may indicate a systemic infection.

- There is significant bleeding from the anus.

- You notice changes in bowel habits or stool consistency.

- You have concerns about the possibility of a more serious condition, such as cancer.

Concerns About Cancer and Complications
It is understandable to be concerned about the potential for serious conditions, especially after experiencing significant pain and discomfort. However, the likelihood of anal pain leading to cancer is relatively low, particularly if the pain is associated with more common issues like fissures or hemorrhoids. Regular follow-ups with your healthcare provider are essential to monitor your condition and ensure appropriate treatment.

In your case, it seems that the initial assessments did not reveal any immediate surgical needs, and the recommendation to continue with antibiotics and pain management is a common approach. If symptoms persist or worsen, it would be prudent to seek a second opinion or request further diagnostic tests, such as imaging studies or a referral to a specialist, such as a gastroenterologist or a colorectal surgeon.

In conclusion, while anal pain can be alarming, many causes are treatable with conservative measures. Maintaining open communication with your healthcare provider and following their recommendations will be key to managing your symptoms effectively. If you have any further concerns or if your symptoms change, do not hesitate to seek medical advice.

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