Occasional Rectal Pain: When to Seek Medical Attention

Pain on the inside of the anus?

Hello, Dr.
Ke.
Occasionally, when sitting or standing, I suddenly feel a slight pain deep inside the anus (on the inner side of the anal opening).
However, it goes away shortly after.
For about three to four days, I noticed a very small amount of blood on the toilet paper after wiping (just a tiny bit, not easily noticeable unless closely examined, about the size of 2mm).
Many people I know (elders, pharmacists, nurses) suggested that it might be due to a minor tear or excessive heat in the body.
It has been over six months since I last experienced bleeding during bowel movements.
I only occasionally feel pain when sitting or standing (sometimes once a day or once every four to five days), and then it disappears after a few seconds.
Doctor, what could this possibly be? Should I go to the hospital for a rectal examination?

Niming, 20~29 year old female. Ask Date: 2016/02/14

Dr. Ke Fangxu reply Surgery

Based on your description, it seems to be an anal fissure.
The typical symptoms include pain during bowel movements accompanied by slight bleeding.
The primary cause of anal fissures is usually hard stools; however, diarrhea, frequent bowel movements, or prolonged straining can also lead to fissures.
It is recommended to improve bowel habits and to take warm sitz baths to alleviate symptoms.
Topical ointments and suppositories can also be used for treatment.
If symptoms persist for more than a week without improvement, it is advisable to consult a physician to identify the underlying issue.
A rectoscopy may not be necessary at this stage; it is best to have the physician perform a digital rectal examination first.

Reply Date: 2016/02/14

More Info

Understanding occasional rectal pain can be concerning, especially when accompanied by symptoms such as minor bleeding. Based on your description, it seems you have experienced intermittent pain in the rectal area, along with occasional blood on toilet paper after wiping. While these symptoms can sometimes be benign, they warrant careful consideration and possibly further evaluation.

The pain you describe, particularly if it is localized and transient, could be related to several conditions. Common causes of rectal pain include hemorrhoids, anal fissures, or even muscle spasms in the anal region. Hemorrhoids are swollen veins in the lower rectum or anus that can cause discomfort, especially during bowel movements. They can also lead to minor bleeding, which might explain the blood you noticed on the toilet paper. Anal fissures, on the other hand, are small tears in the lining of the anus, often caused by passing hard stools, which can also result in pain and bleeding.

Given that you mentioned the pain is occasional and resolves quickly, it might suggest a less severe issue, such as a minor fissure or irritation. However, the presence of blood, even if it is minimal, should not be overlooked. While many people may experience similar symptoms without serious underlying issues, it is essential to rule out more serious conditions, such as inflammatory bowel disease, infections, or even polyps or tumors, especially if the symptoms persist or worsen.

In your case, since you have experienced these symptoms intermittently over an extended period (six months), it would be prudent to seek medical attention. A healthcare provider can perform a thorough examination, which may include a digital rectal exam and possibly a sigmoidoscopy or colonoscopy if deemed necessary. These procedures allow for a direct view of the rectum and lower colon, helping to identify any abnormalities.

It is also important to consider lifestyle factors that may contribute to your symptoms. For instance, dietary habits, hydration levels, and bowel habits can significantly impact rectal health. Ensuring a diet rich in fiber, staying hydrated, and maintaining regular bowel movements can help prevent issues like hemorrhoids and fissures.

In summary, while your symptoms may not indicate a severe condition, the presence of rectal pain and blood should prompt a visit to a healthcare professional. They can provide a proper diagnosis and recommend appropriate treatment options, which may include dietary changes, topical treatments, or further interventions if necessary. It is always better to err on the side of caution when it comes to health concerns, especially those involving potential bleeding.

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