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Anal pain (proctalgia) | nidirect

Anal pain (pain in the bottom) can be distressing. But is often just the result of a minor, treatable condition. Many common causes of anal pain will improve with self-care treatments. See your GP if your pain is severe, doesn’t improve after a few days or you have rectal bleeding.

Common causes of anal pain

Anal fissures

An anal fissure is a small tear in the skin of the anus.

Symptoms of an anal fissure can include:

  • a severe, sharp pain when doing a poo
  • a burning or gnawing pain that lasts several hours after doing a poo
  • rectal bleeding – you may notice a small amount of blood on the toilet paper after you wipe

Anal fissures can be very painful, but many heal on their own in a few weeks.

Increasing the amount of fibre in your diet, drinking plenty of fluids and taking laxatives and over-the-counter painkillers can help.

If the pain continues, your GP will advise on the appropriate treatment.

Haemorrhoids (piles)

Haemorrhoids (piles) are swellings containing enlarged blood vessels that are found inside or around the bottom.

They can be caused by straining on the toilet as a result of prolonged constipation, or other things that increase the pressure in your tummy.

In many cases, haemorrhoids don’t cause symptoms. When symptoms do occur, they may include:

  • bleeding after doing a poo
  • an itchy bottom
  • feeling like there’s a lump in or around your anus
  • soreness and redness around your anus
  • anal pain, if the blood supply to the haemorrhoid becomes blocked or interrupted – for example, by a blood clot

The symptoms often pass after a few days. Increasing the amount of fibre in your diet, drinking plenty of fluids and taking laxatives and over-the-counter painkillers can help.

If the blood supply to the haemorrhoid has been blocked by a clot, a simple procedure can be carried out to remove the clot under local anaesthetic (where the area is numbed).

Anal fistulas and abscesses

An anal fistula is a small tunnel that develops between the end of the bowel and the skin near the anus. It’s usually caused by an infection near the anus resulting in a collection of pus (an abscess).

Symptoms of an anal fistula or abscess can include:

  • a constant, throbbing pain that may be worse when you sit down
  • skin irritation around the anus
  • passing pus or blood when you poo
  • swelling and redness around your anus
  • a high temperature (fever)

Your GP may prescribe antibiotics if an abscess is picked up early on.

If it persists, it may need to be drained in hospital, possibly under general anaesthetic (while you’re asleep).

If a fistula develops, surgery will usually be needed because they rarely heal by themselves.

Less common causes of anal pain

Less common causes of anal pain include:

  • proctalgia fugax – a condition that causes episodes of sudden, severe anal pain that last for a few minutes at a time; medication that relaxes the muscles in the pelvis may help
  • levator ani syndrome – an aching or pressure sensation in and around the anus that may be constant or last for hours or days at a time; treatment to relax the muscles in the pelvis may help
  • an inflammatory bowel disease such as Crohn’s disease – other symptoms can include tummy cramps, bloody diarrhoea and weight loss; treatments are available to help relieve the symptoms
  • an infection – such as a fungal infection or rectal sexually transmitted infection (STI)
  • a bone-related problem – such as coccydynia (tailbone pain) or pain that spreads from your lower back, pelvis or hips, caused by arthritis or bone tumours
  • a urinary tract problem – such as prostatitis (inflammation or infection of the prostate gland)
  • cancer of the anus or lower rectum – this can have similar symptoms of haemorrhoids and anal fissures, but is much rarer 

When to get medical advice

Many common causes of anal pain will improve with simple self-care treatments, so you don’t always need to see your GP.

But it’s a good idea to see your GP if:

  • your pain is severe
  • your pain doesn’t improve after a few days
  • you also experience rectal bleeding

Don’t feel embarrassed to see your GP. Anal pain is a common problem that they’re used to seeing. Your GP can try to work out what the problem is and give you treatment advice.

They’ll probably ask to see your bottom. They may carry out a rectal examination (where they will gently put a gloved finger into your bottom) to check for any abnormalities.

If the cause is not immediately obvious, they may refer you to a specialist for advice and further tests.

More useful links

The information on this page has been adapted from original content from the NHS website.

For further information see terms and conditions.

Causes, When to See a Doctor, Treatment

Rectal pain is a common experience. While some cases are due to a chronic and/or serious medical condition, most are not. Nevertheless, the pain can be intense, worrying, and impact your quality of life.

This article reviews the many causes of rectal pain and the various treatments used to manage them, including self-care strategies, medications, and complementary options. You’ll also learn when you need to seek medical attention.

Symptoms

Depending on the underlying cause, rectal pain may be described as burning, stinging, aching, throbbing, or stabbing.

Rectal pain is also often accompanied by other symptoms, such as:

  • Bleeding
  • Irritation, itchiness, or swelling of the skin around the anus
  • Feeling like you cannot fully empty your bowels of stool (tenesmus)
  • Diarrhea or constipation
  • Passage of mucus

When to Seek Medical Attention

It’s important to seek medical attention right away if you are experiencing:

  • Severe or worsening rectal pain
  • Rectal pain accompanied by fever, chills, or anal discharge
  • Significant rectal bleeding, especially if you feel dizzy or lightheaded

Schedule a doctor’s appointment or call your doctor if you are experiencing:

  • Rectal pain that is persistent and not improving with at-home measures
  • Rectal pain accompanied by a change in bowel habits or mild bleeding
  • Unintended weight loss or unusual fatigue

Causes

Your rectum begins at the end of your large intestines (colon) and ends at your anus. When stool reaches your rectum from your colon, you will feel an urge to have a bowel movement. Stool moves through your rectum and out of your body through your anus.

Due to the proximity and collaboration of the rectum and anus, “rectal pain” may be due to a problem within your rectum or your anus.

While not an exhaustive list, here are some conditions that cause rectal/anal pain. Some are more concerning than others, but luckily, many can be managed at home.

Verywell / Nusha Ashjaee

Hemorrhoids

Hemorrhoids are swollen or enlarged veins in the rectum. They are estimated to affect over half of all American adults. They are more common in pregnancy, older people, those who sit for prolonged periods of time, and those who strain during bowel movements.

Hemorrhoids are a common cause of bright red blood after a bowel movement. Besides bleeding, patients commonly report itching around their anal area or discomfort during a bowel movement or when sitting.

If a blood clot forms inside a hemorrhoid—what’s called a thrombosed hemorrhoid—sudden, severe rectal/anal pain may develop.

Anal Fissure

An anal fissure is a small tear in the skin at the opening of the anus where stool comes out. It usually occurs from excessive straining and stretching of the anal canal when passing a large or hard stool.

Once an anal fissure develops, the internal anal sphincter (the muscle that controls the anal opening) often goes into spasm, making it even more difficult to pass stools.

The pain of an anal fissure occurs with every bowel movement and is often very severe, sharp, and/or “ripping” in nature. A dull, throbbing pain may then take over and last for several minutes to hours.

If you have an anal fissure, you may also see a small amount of bright red blood in your stool or on toilet paper when you wipe.

Fecal Impaction

Fecal impaction occurs when hardened, dry stool gets lodged in the rectum causing pain, among other symptoms, like stool leakage and bloating.

Fecal impaction results from chronic constipation, oftentimes in older individuals who are unable to sense the urge to have a bowel movement. Limited fluid intake, a low-fiber diet, and an inactive lifestyle also tend to contribute.

Levator Ani Syndrome

Levator ani syndrome is characterized by episodes of aching or pressure-like pain high up in the rectum. The episodes last 30 minutes or longer.

This syndrome is more common in women, especially those between 30 and 60 years of age.

While the precise cause remains unknown, some research suggests the attacks may be triggered by stress, sex, bowel movements, sitting for long periods of time, and childbirth.

Proctalgia Fugax

Proctalgia fugax causes recurrent, sudden attacks of cramping, spasming, gnawing, or stabbing pain in the rectum unrelated to bowel movements. The attacks last around 15 minutes on average and may be triggered by stressful life events or anxiety.

Proctalgia fugax may occur at any age in men or women, but it is rare before puberty.

Anal Fistula

An anal fistula is an abnormal connection that forms between the anal canal and the skin of your buttocks. Most patients with an anal fistula have a history of a collection of pus called a perianal abscess that was previously drained.

Symptoms of an anal fistula may include pain, anal swelling, skin irritation around the anus, fever and chills, and drainage of pus near the anal opening.

Perianal Hematoma

A perianal hematoma is a collection of blood that develops around the anus. It is sometimes mistaken for an external hemorrhoid.

Perianal hematomas are extremely painful and caused by some sort of trauma or injury that makes the veins in your anal area suddenly break open. For example, this may occur because of straining during a bowel movement, lifting heavy weights, or forceful coughing.

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a general term for two disorders: Crohn’s disease and ulcerative colitis. Both cause chronic inflammation (pain and swelling) of the digestive system.

Crohn’s disease affects your digestive tract, anywhere from your mouth to your anus. Symptoms may include diarrhea, crampy abdominal pain, rectal soreness and fullness, tiredness, fever, and weight loss.

Ulcerative colitis nearly always involves the rectum and lower colon, although the entire colon may be affected. Symptoms may include bleeding, diarrhea, cramping abdominal pain, and rectal soreness.

Proctitis

Proctitis refers to inflammation of the lining of the rectum. Besides soreness and a sensation of rectal fullness, other symptoms of proctitis include bloody bowel movements, diarrhea, abdominal cramping, and passing mucus.

Inflammatory bowel disease is a common cause of proctitis, as are sexually transmitted diseases passed through anal sex, including gonorrhea, chlamydia, syphilis, herpes, and HIV.

Other causes of proctitis include trauma (e.g., insertion of objects into the anus), cancer radiation therapy, and foodborne illnesses, including salmonella and shigella.

Antibiotics, too, may cause proctitis by killing helpful bacteria in the rectum and allowing harmful bacteria to grow.

Solitary Rectal Ulcer Syndrome

This is an uncommon and poorly understood disorder characterized by redness or sores in the mucosal lining of the rectum.

Symptoms of this disorder include rectal bleeding and pain, pelvic fullness, tenesmus, straining during bowel movements, and the passage of mucus.

While the precise cause remains unknown, experts suspect it may stem from chronic constipation. An uncoordinated rectal muscle problem or another condition called rectal prolapse (when the rectum protrudes through the anus) are also possible causes.

Cancer

While not common, anal or rectal cancer may be the source of your pain.

Bleeding is often the first sign of anal cancer. Other possible rectal or anal cancer symptoms include:

  • Itching or a lump at the anal opening
  • Anal discharge
  • Fecal incontinence
  • Swollen lymph nodes in the area or groin region
  • A change in bowel habits
  • Unusual fatigue
  • Unintended weight loss

Recap

Both temporary and chronic conditions can cause rectal pain. These include hemorrhoids, fecal impaction, and IBS. Cancer is rarely the cause, but it is a possibility. Any concerning symptoms should be evaluated by your doctor.

Diagnosis

A primary care doctor, gastroenterologist, or colorectal surgeon is often involved in the diagnosis and management of rectal pain.

In addition to a medical history and physical exam, your doctor may perform various tests and procedures, such as:

  • Blood tests: A complete blood count may be ordered to check for anemia or infection.
  • Imaging tests: An abdominal X-ray or computed tomography (CT) of the abdomen may be ordered to evaluate for masses, enlarged lymph nodes, or stool.
  • Digital rectal exam: During this exam, the doctor will insert a gloved, lubricated finger into your rectum to check for blood, discharge, or abnormal masses.
  • Anoscopy: A doctor will insert a thin, rigid tool with a light on the end of it a few centimeters into your anus to examine the inside of your anus/rectum. A tissue sample (biopsy) may also be taken.
  • Sigmoidoscopy/colonoscopy: During this procedure, a long, thin instrument with a tiny video camera attached to it is inserted through your rectum and manipulated up into your large intestine. Biopsies may also be taken.

Treatment

As you probably expect, the treatment of rectal pain depends on the underlying diagnosis.

Self-Care Strategies

In many cases, various self-care strategies can be used to manage your pain.

For example, taking sitz baths two or three times a day for 15 minutes can help soothe pain associated with hemorrhoids, anal fissures, perianal hematomas, levator ani syndrome, and proctalgia fugax. Sitz baths work by improving blood flow and relaxing the muscles that surround your anus. They are available in most drugstores and online.

A diet rich in fiber is also appropriate for these conditions. It can soften stool, making bowel movement less painful. It can help manage solitary rectal ulcer syndrome and prevent recurrent fecal impaction as well.

Aim for 20 to 35 grams of fiber per day.

Medications

Certain causes of rectal pain can be managed well with over-the-counter or prescription medications.

Pain Relievers

Different types of medications may be recommended for the relief of rectal pain, such as:

Stool Softeners or Laxatives

Stool softeners such as Colace (docusate) help soften hard stools and alleviate constipation. They are often used to manage hemorrhoids, anal fissures, and perianal hematomas.

Laxatives may also be recommended for easing constipation, especially in patients with fecal impaction, anal fissures, or solitary rectal ulcer syndrome.

Antibiotics/Antivirals

For bacteria-related sources of rectal pain, such as proctitis from gonorrhea or chlamydia, antibiotics will be given. Antivirals will be given for proctitis related to an infection with herpes or HIV.

Steroids and Immunosuppressants

Inflammatory bowel disease may be treated with steroids and/or immunosuppressants in order to slow the progression of the disease.

Complementary Therapies

A combination of therapies is often used to treat chronic anal pain caused by levator ani syndrome, proctalgia fugax, and, sometimes, solitary rectal ulcer syndrome.

Such therapies may include:

  • Biofeedback: Monitoring equipment is used to measure bodily functions, and a practitioner teaches you how to change them based on the results
  • Sacral nerve stimulation: Electrical impulses are transmitted through a device to affect nerves that control the rectum
  • Physical therapy and massage
  • Botox injections

Procedures/Surgery

The treatment of fecal impaction may require an enema either at home or in a doctor’s office. For severe cases, manual removal of the hard stool may be warranted.

Other medical therapies or office-based procedures may also be considered. For example, with rubber-band ligation, the blood supply to a hemorrhoid is cut off, forcing it to shrink. Surgery may be indicated for severe cases of proctitis caused by IBD or hemorrhoids that cannot be treated any other way.

Surgery is also often indicated to repair an anal fistula, treat anal/rectal cancer, and for patients with solitary rectal ulcer syndrome who suffer from rectal prolapse.

Recap

There are numerous ways to treat your rectal pain, depending on the underlying diagnosis. Therapies may include taking sitz baths or using medications, like pain relievers or stool softeners. Sometimes, an office-based or surgical procedure is needed.

Summary

There are many potential causes of rectal pain including hemorrhoids, an anal fissure, inflammation from IBD, an infection, or trauma. Cancer is also a cause, albeit a much less common one.

Rectal pain is often easily diagnosed and managed, and at-home treatments may be all that’s needed. Still, if you are unsure why you are experiencing rectal pain, it is severe or not improving, or you have other worrisome symptoms like bleeding or fever, see your doctor.

A Word From Verywell

You may feel hesitant to talk about rectal pain, even with a physician. It may help to remember that the issue is common and that your doctor’s sole concern is making sure you are well.

Once a diagnosis is reached, a suitable and effective treatment plan can be established—perhaps one that will address the cause of your rectal pain once and for all. And in the rare instance that your pain is due to cancer or a chronic condition like IBD, early treatment is key. The sooner you are evaluated, the better.

Digestive Diseases: Rectal & Colon Diseases

Overview

Many Americans have difficulty moving their bowels. Many things contribute to this problem, including diet and activity level. Other causes are unknown.

This article will describe some of the more common bowel problems.

Anatomy and physiology

The large bowel consists of the colon (5 feet long) and the rectum (8 inches long). (Many times the rectum is referred to as the opening where stool emerges, but that is actually the anus.) The rectum is just upstream from the anus, and the large bowel is connected to the small bowel.

Anatomy of the large bowel (colon).

The colon’s main function is to process the 3 pints of liquid stool it receives each day into a manageable amount of solid stool, ready for elimination. The rectum coordinates this process. Normally, a person can pass up to 200 grams of solid stool daily. However, there is a lot of variation in the amount of stool a healthy person passes, and can vary from 3 times a day to 3 times per week.

Functional disorders

Functional disorders are conditions in which the bowel looks normal but doesn’t work properly. These are the most common problems affecting the colon and rectum. The direct cause is frequently unknown.

Constipation

Constipation is defined as small, hard, difficult, or infrequent stools. Constipation may be caused by:

  • Inadequate “roughage” or fiber in the diet
  • Not drinking enough fluids
  • Poor habits, especially delaying using the toilet
  • Movement problems in the large bowel, including slow or uncoordinated movement

A person who is constipated may strain during a bowel movement, or just pass very hard stool. Passage of hard stool may lead to anal problems such as fissures (painful cracks in the anal tissue lining) or hemorrhoids.

Irritable bowel syndrome (sensitive colon; spastic colon)

Irritable or sensitive bowel is a condition in which the colon muscle contracts (tightens) in an abnormal fashion, which may lead to several problems. Some patients have diarrhea, others have constipation, and others alternate between constipation and diarrhea. The abnormal contraction can lead to high pressure that builds up in the colon, causing abdominal cramps, gas, bloating, and sometimes extreme urgency (need to go the bathroom).

Treatment includes avoiding foods that make the problems worse, tailoring diet to the particular symptoms, managing stress, and medications.

Structural disorders

Structural disorders are those in which there is something abnormal that may need to be removed, altered, or repaired by an operation. These may include removing a portion of the colon for diverticulitis or for a cancer.

Anal disorders

Internal hemorrhoids

Internal hemorrhoids are normal blood vessels that line the inside of the anal opening. We are born with them. They are thought to be the fine-tuning mechanism that allows us to contain gas and avoid passing it until we it is socially acceptable. When internal hemorrhoids become enlarged as a result of straining or pregnancy, they may become irritated and start to bleed. Occasionally, internal hemorrhoids can become large enough to bulge outside the anal opening.

Hemorrhoids are swollen and inflamed veins around the anus or the lower rectum.

Traditional care for internal hemorrhoids has included improving bowel habits, using elastic bands to pull the hemorrhoids back into the rectum, or removing them surgically. Devices that use sound waves can discover exactly where the excessive blood flow is occurring into these vessels and allow the doctor to specifically tie off the area. Another treatment is the stapled hemorrhoidectomy, in which a special device is used to pull the hemorrhoid tissue back into the body and staple it in place.

External hemorrhoids

External hemorrhoids are veins that lie just under the skin on the outside of the anus. Usually, they do not cause any symptoms. Occasionally, a blood clot can form and can be very painful. These are not dangerous blood clots that can travel to other organs. The biggest concern they raise is pain. Many times this will get better on its own. Sometimes, the clot is removed under local anesthesia in the doctor’s office.

Anal fissure

An anal fissure is a split or tear in the lining of the anus that occurs after trauma. This can happen as a result of a hard stool or even diarrhea.

An anal fissure causes bleeding and intense burning pain after bowel movements. The pain is caused by spasms of the sphincter muscle, which is exposed to air by this tear. The pain with bowel movements has been described as the feeling of passing razor blades.

Fissures are the anal problem that is misdiagnosed most commonly. They are frequently mistaken for hemorrhoids.

Fissures often heal on their own. If they don’t improve, your doctor can recommend an ointment or medication that will relieve the pain. In certain cases, surgery may be recommended if the tear does not heal because of excessive sphincter spasm.

An anal fissure is a split or tear in the lining of the anus. A perianal abscess is a pocket of pus that results from a blocked, infected anal gland.

Perianal abscess

The anal region has tiny glands on the inside of the anus that open and probably help with the passage of stool. When one of these glands becomes blocked, an infection may develop and there may be an abscess (a pocket of pus). Treatment includes draining the abscess, usually under local anesthesia in the doctor’s office.

Fistula-in-ano

In about 50% of cases after a perianal abscess has been drained, a tunnel develops from the gland on the inside of the anus to the skin around the anus. This is called a fistula-in-ano. Fistulas drain mucous fluid onto the skin and blood. They rarely heal on their own and usually need surgery.

Other perianal infections

Hair in the region between the anal area and the tailbone can burrow under the surface and cause an infection called pilonidal disease. It may present as abscess in this area just below the tailbone, or as small draining openings. Usually surgery is needed to treat this problem.

Sexually transmitted diseases that can affect the anus include herpes, AIDS, chlamydia, and gonorrhea. Anal warts are small growths on the anal skin that look like tiny pink cauliflowers and are caused by a virus (HPV).

Colon and rectal disorders

Diverticular disease

Colonic diverticula are little out-pouchings or sacs in the bowel lining that occur when the lining gets pushed through weak spots in the muscle of the bowel wall. They usually appear in the sigmoid colon, where the large bowel exerts the highest pressure.

Colonic diverticula are small out-pouchings or sacs that push through weak spots in the muscle layers of the colon wall.

Diverticular disease is very common in Western societies and may be due to low-fiber Western diets. Diverticula rarely cause symptoms unless one of the sacs gets blocked and infected. This is called diverticulitis and occurs in about 10% of people with diverticula. There is occasionally bleeding in this area.

About half the patients who have complications of their diverticula will need surgery.

Polyps and cancer

Cancer of the colon and rectum is a major health problem in America today. It occurs when the cells in the lining of the large bowel grow and divide in an uncontrolled manner. Many factors contribute to this loss of control, including the environment, our diet, and genetics (what we inherit from our parents).

The first abnormality in the bowel in colon cancer is a polyp, a small growth that may look like a mushroom protruding from the lining tissue of the large bowel. There are many types of polyps, and not all are the type that turn into cancer. However, removing these polyps before they develop severe changes and grow can prevent the progression to cancer.

Polyps are small abnormal growths that protrude from the tissue lining the colon or rectum.

When cancer develops, it must be removed by surgery. Chemotherapy may be recommended for cancer of the colon or rectum. Certain cancers of the rectum may require radiation treatment.

With prompt, expert treatment, most people can be cured of colorectal cancer. Although people may worry about having to wear a colostomy bag on the abdomen to collect stool, very few people need a permanent colostomy bag.

Because colorectal cancer comes from polyps, a colonoscopy procedure can prevent colorectal cancer by finding and removing polyps. People at greater risk for colorectal cancer include those who have had polyps or cancers in the past, or those who have a family history of colorectal cancer.

Colitis

Colitis is a group of conditions that cause inflammation of the large bowel.

Colitis is an inflammation of the inner lining of the colon.

There are several types of colitis, including:

  • Infectious colitis (due to an infection that attacks the large bowel)
  • Ischemic colitis (caused by not enough blood going to the colon)
  • Radiation colitis (after radiation therapy, usually for prostate, rectal, or gynecological cancer)
  • Ulcerative colitis
  • Crohn’s disease

Colitis causes diarrhea, rectal bleeding, abdominal cramps, and urgency (increased need to go to the bathroom). Treatment depends on the diagnosis, which is made by colonoscopy and biopsy (removal of cells or tissue for examination under a microscope).

Summary

Many diseases of the colon and rectum can be prevented or treated by seeking prompt medical care. People who have symptoms of any of these conditions should consult their doctor.

Most importantly, colon cancer is a preventable disease. The most important risk factor is having a direct family member who had colon cancer. Ask your doctor when you need an evaluation (usually a colonoscopy) to look for polyps. For people with no family history and no symptoms, the current recommendation is that everyone should have their first colonoscopy at age 45.

A Common Cause of Anal Pain

Perm J. 2007 Fall; 11(4): 62–65.

Herman Villalba, MD, (left) is a resident in the Department of Surgery, Los Angeles Medical Center in California. E-mail: [email protected]Sabrina Villalba, MD, (center) is a resident in the Department of Family Medicine, Los Angeles Medical Center in California. E-mail: [email protected]Maher A Abbas, MD, FACS, FASCRS, (right) is an Assistant Clinical Professor of Surgery at the University of California, Los Angeles; Chief of Colon and Rectal Surgery and Education Chair in the Department of Surgery at the Los Angeles Medical Center. E-mail: [email protected] article has been cited by other articles in PMC.

Vignette

A patient presents with severe anal pain, lasting hours after each bowel movement. She notices some intermittent bleeding with defecation. She comes to the office with the presumed diagnosis of hemorrhoids. Are her symptoms consistent with hemorrhoidal disease, or does she have another disorder?

Introduction

Benign anorectal disorders are common and increasing in incidence. The decreasing intake in dietary fiber over the 20th century and into the 21st has contributed to a steady rise in preventable anorectal disorders. It is estimated that 20% of the American public has such benign conditions.1 Although hemorrhoids represent the most common benign anorectal disorder, anal pain is most often secondary to an acute or chronic anal fissure and not hemorrhoidal disease.1–14

Pathophysiology and Presentation

An anal fissure is a tear or a cut in the anoderm (). Constipation and passage of hard stools is often the cause of an anal fissure, although diarrhea can also contribute to its development. Most anal fissures are located in the midline and are posterior more frequently than anterior. Anterior fissures are seen more often in women. Most fissures heal spontaneously, but some persist. It is believed that the decreased blood flow to the midline portion of the anus contributes to a relatively ischemic milieu that becomes more profound secondary to the associated sphincter spasm noted in the majority of patients with anal fissure.8,10 The anal spasm is a defense mechanism to prevent further stretching of the anal canal and worsening of the tear. A vicious cycle ensues whereby the anal spasm exacerbates the ischemia and prevents the fissure from healing, which in turn sustains the anal spasm to prevent further tearing. Once this cycle sets in, the likelihood of spontaneous healing decreases and the edges of the fissures become more fibrosed, leading to a chronic fissure.

Some fissures can be minimally symptomatic, but most patients present with severe pain, bleeding, or itching. The pain can be localized to the anus but can radiate to the buttocks, upper posterior thighs, or lower back. Often the pain is triggered by a bowel movement, can last for hours, and can be severe. Bleeding is usually not significant. Most patients with fissures have a history of constipation.

Evaluation

The diagnosis of anal fissure is often made on the basis of the patient’s medical history. Several anorectal disorders can present with severe anal pain; anal fissure is the most common cause of pain with or after defecation (). Anal examination can confirm the diagnosis at the initial visit but is often limited by the patient’s discomfort. The patient is usually examined in the prone position. A gentle spreading of the buttocks can reveal the fissure in some patients. If the patient is too apprehensive and in much discomfort, the examination should be aborted. The patient is treated for the presumed diagnosis of anal fissure and a complete examination is deferred to the next visit, usually three or four weeks later. If the fissure is not visualized, lidocaine 2% jelly is used to locally anesthetize the anal opening so that a gentle digital examination can be attempted. Anal spasm is often present. Posterior or anterior midline tenderness can be elicited with gentle palpation. If the patient tolerates the digital examination, then anoscopy can be performed. In addition to direct visualization of the fissure, the clinician may note a sentinel pile or tag just distal to the fissure and a hypertrophied anal papilla just proximal to it (). The exposed white fibers of the internal sphincter muscle can be seen in the center of chronic fissures. The clinician should be ready to abort the examination at any time if the patient has severe pain. Under such circumstance, carrying out the examination causes needless suffering and often cannot be completed despite the perseverance of the examiner. If there are findings suspicious for other disorders, such as draining pus from anal opening, swelling and erythema of the perianal area, or a mass, then the patient should undergo an examination under anesthesia.

Table 1

It is important to note that benign fissures are located in the posterior or anterior midline. Fissures located in the lateral quadrants are referred to as atypical fissures or ulcers and are often secondary to other conditions (). Atypical fissures can be multiple, deep, wide; have irregular margins; and may present with purulent drainage from the anus. Atypical fissures warrant a complete medical workup and often require an examination under anesthesia, with biopsies and cultures.

Table 2

Atypical causes of anal fissure or ulcer

Treatment Options

More than 90% of fissures heal spontaneously. Symptomatic fissures warrant treatment. Conservative management is the first line of therapy. Increasing dietary fiber and water intake should be coupled with fiber supplementation. Psyllium-based products are our preferred fiber supplement. For patients who cannot tolerate psyllium because of excess gas or bloating, other fiber products are available (). Ideally the adult diet should contain 25 to 35 g of fiber daily (). In addition to increasing dietary fiber, patients should begin fiber supplementation once a day (ie, 6 g psyllium), and if that is tolerated, their dosage should be increased to twice a day within a week. Patients should drink at least two glasses of water or fluids each time they take a fiber supplement dose. A laxative, such as two tablespoons milk of magnesia once or twice a day, is added for patients with persistent constipation despite increased fiber intake. Stool softeners such as docusate can also be added to the fiber regimen. A sitz bath in warm water once or twice a day for ten minutes may offer some relief. Lidocaine 2% jelly is prescribed to reduce pain as needed before and after bowel movements. Steroid-based creams and hemorrhoidal ointments are usually not effective. Ointments such as nitroglycerin 0.2% to 0.3%, diltiazem 2%, and nifedipine 0.03% can heal symptomatic fissures; their reported success rate is between 30% and 70%.2–4,7–11 Most of these medications must be compounded as an ointment preparation by a pharmacy. Gel or liquid preparations are not as effective because of a shorter duration of action. Furthermore, they are cumbersome to use and do not adhere to the anal area as well as ointments do. Diltiazem 2%, applied three times daily and five minutes prior to a bowel movement, is our ointment of choice and has a higher rate of fissure healing than nitroglycerin does and can heal fissures that have been unsuccessfully treated with nitroglycerin.10 Headache is a common side effect with nitroglycerin, experienced by up to 50% of patients.8 About 10% of patients using diltiazem ointment will experience itching.10 Patients should wear a glove or a finger cot to apply the medication. The relaxation of sphincter tone induced by diltiazem, nitroglycerin, and nifedipine can relieve the pain within a few days, but complete healing may take up to two months. Patients should be reassessed at one month; if there is persistent fissure but decreased symptoms, the ointment should be continued for another month.

Table 3

Table 4

Patients in whom medical therapy fails may be candidates for surgical intervention. The timing of intervention depends on the initial response to conservative therapy and on symptom severity. Patients with severe anal pain can be offered surgical intervention if no improvement is seen within a week. Injection of botulinum toxin type A into the internal sphincter can lead to symptomatic relief and healing of some fissures. Overall, it is safe and rarely causes any degree of incontinence. The paralysis that it causes occurs within hours of injection, reaches its peak within a week, and can last between one and three months.8 However, in many patients the relief is temporary and long-term fissure recurrence is common, often making additional injections necessary.8 Furthermore, botulinum is expensive; the cost of 100 units is $558 at our institution. Because of these reasons, we do not offer injection as a sole treatment. However, for a subgroup of patients with fissures refractory to medical therapy who are at risk of incontinence or are reluctant to undergo the gold standard surgical treatment of lateral internal sphincterotomy (LIS), we have combined injection of botulinum with fissurectomy. Debridement of the fibrotic edges of a chronic fissure can stimulate healing when combined with fissurectomy.11 Typically we inject 60 to 80 units of botulinum toxin type A into the internal sphincter muscle; we have seen complete fissure resolution in many patients.

The most effective surgical treatment of chronic anal fissure is LIS (). LIS can heal more than 90% of fissures refractory to medical therapy within eight weeks and is associated with a very low recurrence rate of less than 10%.7 LIS involves cutting a small portion of the distal aspect of the internal sphincter muscle (). The internal sphincter muscle contributes to baseline and resting continence. Spasm of this muscle results in severe anal pain and constricts blood flow to the fissure area. Releasing a portion of the muscle yields rapid symptomatic relief and heals the fissure. Overall, the procedure is safe and can be done under local anesthesia with intravenous sedation in most patients. The complication rate is low.7,12–14 A subgroup of patients may experience transient and temporary gas incontinence. In rare cases, the incontinence can be more severe or permanent. A careful evaluation of the patient’s baseline continence level is important before deciding on surgery. If the patient has any pre-existing degree of incontinence, it is best to consider injection of botulinum toxin type A with fissurectomy or, alternatively, a flap procedure to cover the fissure.

Lateral internal sphincterotomy.

Lateral internal sphincterotomy.

Releasing a portion of the muscle yields rapid symptomatic relief and heals the fissure.

Conclusion

Anal fissure is the most common cause of severe anal pain and bleeding seen in the primary care setting, in urgent care and surgical clinics, and in Emergency Departments. Most fissures heal spontaneously, but conservative management with ointment and fiber supplementation will relieve the pain and promote healing of those that do not. Surgical intervention is reserved for patients in whom conservative treatment fails.

Acknowledgments

Katharine O’Moore-Klopf of KOK Edit provided editorial assistance.

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Suggested Reading

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Why it hurts when you poop, and when to get help – National

Pooping should never be painful.

Health experts say it’s quite common for people to feel pain in their anal area when passing a stool. But besides feeling pain, irregular pooping should also be considered a red flag, said gastroenterologist Dr. Talia Zenlea of Women’s College Hospital in Toronto.

“Regularity doesn’t matter… you don’t get a gold star of having one form of poop,” she told Global News. “Some people say, ‘What is normal?’ It doesn’t matter how often you go or don’t go, as long as it isn’t bothersome.”

She said “normal poop” can be considered going two times a day or once a week — it all depends on the individual. “If you went from one stool a week to one stool a day, I would be more worried about that,” she continued, adding that people’s pooping routine comes down to a variety of factors including genetics, diets or even how much they exercise.

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READ MORE: Everything you need to know about healthy pooping

Experts have also said “normal poop” may come down to looking at the smell, type and colour.

General internal medicine specialist Dr. Seema Marwaha of Toronto added that although we all poop, it’s still quite taboo to talk about pooping patterns or even pain to your doctor.

“In the past people had long-term relationships with their doctors and were more willing to to talk about their personal issues,” she explained. “But now we have a culture in younger people where they don’t have regular medical followups and when they see a doctor, it’s in an emergency setting or walk-in.”

She also added we rely too much on what we find online, often diagnosing ourselves before we even see a doctor. A quick search on “pain while pooping” can lead to articles about irritable bowel syndrome or cancer, which are rarer.

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Below, both experts help us determine the most common reasons why pooping can be a painful experience.

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Constipation

Constipation is common across all age groups and something that causes many symptoms. Marwaha said doctors often define it two ways. “One is that it’s a decrease in frequency in bowel movements, going less than three times a week,” she explained. “But we also use the second definition of passing a stool that is hard, even though that is not the medical definition.”

Often the terms are used interchangeably, but any type of irregularity from your unique pattern can be a cause of pain when you poop.

READ MORE: Could you be a poop donor? Here’s why clinics are looking

Zenlea added constipation can also become chronic, where people shift back and forth between constant diarrhea to normal stools. “I would speak to an expert if there are bothersome symptoms like pain, bloating and definitely if there is blood.”

Diet

Diet can also play a role in making your poop irregular, and while it may not cause pain, it could lead to constipation or frequent bowel movements, which could eventually be painful to pass gas or stools.

“Certain [things] high in fibre, caffeine and alcohol can make stool looser, as well as greasy food,” Zenlea said. She adds people with food intolerance like dairy or gluten may also experience irregular bowel movements.

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Hemorrhoids

Hemorrhoids are also very common and some research suggests three in four adults will experience hemorrhoids at some point in their lifetime, Marwaha added.

“You have blood vessels that supply and drain blood from the anus and rectum and they are kind of exposed,” she explained. adding they are sensitive to pressure or strain.

READ MORE: What the colour of your pee says about your health

“When the walls of the blood vessels are stretched, they become painful… you can probably see it or feel it when you wipe.”

A rectal exam can help determine whether or not you have hemorrhoids, but Marwaha said it is often the result of passing blood when you poop. “People that do activities that cause increased pressure in that area, like heavy weightlifters who squat or pregnant women [are at higher risk].”

Trauma or anal fissure

An anal fissure is a small tear in the lining of the anus and it is very common in young children and adults. “This is also pressure based, after a long period of time you can get hemorrhoids,” she continued.

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During childbirth, anal fissures are common or even after anal intercourse, which is considered trauma. And while they can be mild and go away on their own, if they are causing pain when you poop, talk to a doctor.

[email protected]




© 2018 Global News, a division of Corus Entertainment Inc.

Easing the strain: put your feet up for constipation

In this guest blog, pelvic physiotherapist and comedian Elaine Miller tells us what we need to know to avoid constipation and when the going gets tough. This is the third blog in our new series Evidence for Everyday Health Choices.

Constipation is a miserable condition which can worsen co-morbidities like low back pain, muscle tone problems in people with neurological conditions and confusion in people with dementia. It is therefore a condition that needs to be understood and managed – but there is a dearth of research to guide us.

One of the main issues is encouraging people to seek help. Many people are simply too embarrassed to see their GP about bowel problems, which is a problem because one of the signs of colon cancer is a disruption in habits which lasts for longer than three weeks.

Therefore, I don’t discourage poo talk from my children, not even in front of Grandma (though, I draw the line at “Last Christmas, I went for a poo, and the very next day, I flushed it away. This year, to save diarrhoea, I’ll eat up my grains and fibre…” <proud mum>). The children’s continence charity ERIC has excellent resources for parents and for professionals in health and education, to try and normalise toilet talk.

What is normal?

Normal bowel function is:

  • When you first feel the urge to poo you can hold on long enough to get to a toilet without accident.
  • You do a poo within a minute of sitting on the toilet, it doesn’t hurt, and you don’t have to strain.
  • You completely empty your bowel, you don’t have to go back again, or have a feeling of some “left”.
  • It is normal for you to feel an urge to poo within about half an hour of eating.  This is the gastrocolic reflex and is what prompts people to want to go to the toilet in the morning. People’s normal pattern can range from several times a day to several times a week – it’s a good idea to pay attention to what your bowel habit is.

Here’s how it works

The indigestible parts of our food pass into the colon, which absorbs water and electrolytes. The large intestine is full of bacteria which change the food remnants into faeces. The time it takes for food to pass from one end of the digestive tract to the other is called “bowel transit time”, one to three days on average, and 90% of that time is spent in the bowel. A slow bowel transit time means the faeces spends longer in the large intestine becomes dehydrated and more difficult to pass.

The stool travels from the colon into the rectum, through the internal sphincter muscle and then through the external sphincter muscle on its way out of the anus. The internal sphincter muscle automatically relaxes the top of the anal canal, triggering nerves to signal that you need to go. The external sphincter is under voluntary control and can push the stool back out of the anal canal if there is nowhere suitable for us to go to the toilet. However, repeated withholding can cause constipation, particularly in children – it’s best to move your bowels when you feel the first urge.

Poo position

You can help reduce the stress on the tissues and reduce straining by squatting to pass a bowel movement. This position encourages the pelvic floor to relax. This can be mimicked on a Western style toilet by raising the feet on a low stool. A stool stool, if you will.

Sitting with hips at 90 degrees means the puborectalis muscle is not relaxed, which means the kink in the upper rectum does not straighten out. Raising the feet, so that the hips are flexed beyond 90 degrees straightens out where the colon and rectum join and allows poo to pass more easily. You can use a couple of toilet rolls to rest your feet on, or a children’s kick stool, or buy a specially made stool stool. Leaning on the elbows and making a “moo” (or other) sound reduces the urge to strain.

Physiotherapists commonly teach people to imagine they are widening their waist and pushing their tummy forward, like a barrel or like Shrek, and asking them to pay attention to their anus as they do so. Lean forwards and rest elbows on knees, almost like the crash position on an aeroplane. The anal sphincter should relax, and this basic biofeedback can be very helpful, and can save the person from assuming the recovery position post-poo. A motion-less position…

Why is straining bad?

Straining increases your intra-abdominal pressure and causes congestion of the soft tissues. So, you are more likely to develop piles, prolapse or vaginal varicose veins.   Cases of people fainting or having heart attacks when straining are well known. Ask Elvis.

Also, we know that a full bowel can irritate a bladder – many cases of incontinence are related to constipation. In my experience, deal with the bowel first.

What about diet?

Government guidelines published last year say we should aim for 30g a day of fibre. NHS Choices has some suggestions here for how you can get more fibre into your diet. Increase daily fibre gradually (5g a day) to avoid bloating. And, remember to drink plenty of water.

Bowel diary

It’s a good idea to keep a bowel diary, or, to make the obvious joke, a log log. Note down when you poo, whether there was any straining or leaking of gas or faecal matter and what the poo was like, as measured by the Bristol Stool Scale, a simple medical tool used to classify poo and monitor bowel health and function. Types 1-2 indicate constipation; types 3-4 are ideal; types 5-7 indicate diarrhoea or urgency.

Adjust diet and fluid intake with the aim to be a 3-4 if you are prone to diarrhoea, a 4-5 if you are prone to constipation.

Massage

The first record of abdominal massage as a treatmentSomething done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. More for chronicA health condition marked by long duration, by frequent recurrence over a long time, and often by slowly progressing seriousness. For example, rheumatoid arthritis. More constipation was in 1870. Interest has resurfaced and we know it can help move stool along and relieve cramping or bloating symptoms. Many non-randomizedA non-randomised study is any quantitative study estimating the effectiveness of an intervention (harm or benefit) that does not use randomisation to allocate people to comparison groups. More studies have suggested that it is an effective interventionA treatment, procedure or programme of health care that has the potential to change the course of events of a healthcare condition. Examples include  a drug, surgery, exercise or counselling.   More for constipation and has no known side effects. A Cochrane Review on abdominal massage for chronic constipation is currently being prepared.

People can learn to self massage to good effect – and what mammal doesn’t like the idea of a tummy rub? Start on the right side by the hip bone. Rub in a circular motion up the right side to the rib cage, across the abdomen to the left side and then down to the left hip bone and across the pelvis to the umbilicus. Always massage in a clockwise direction as this is the direction of digestion.

Medication

Best get advice from your GP or pharmacist. For instance, we don’t want people buying themselves over-the-counter bulk forming laxatives if they have chronic constipation. If you are already bunged up, you don’t need any more volume.

Pregnancy, childbirth and bowels

Pregnancy is particularly challenging because the growing uterus squashes the colon and the hormonal changes make it sluggish. Many pregnant women are prescribed iron supplements which increase the riskA way of expressing the chance of an event taking place, expressed as the number of events divided by the total number of observations or people. It can be stated as ‘the chance of falling were one in four’ (1/4 = 25%). This measure is good no matter the incidence of events i.e. common or infrequent. More of constipation. Fear of post-delivery pain from tear or episiotomy sites can cause anxiety around bowel movements.

These issues are often missed in antenatal appointments and classes because of time constraints. It is very important, however, that women get good information about good bowel management – particularly if she has had a tear or episiotomy. You are going to nurse that first postnatal poo along and have to resist the urge to put a bonnet on it and give it a name…(ask me how I know).

Worry and discomfort are going to have a negative impact on maternal happiness and breastfeeding. Improved education might reduce the need for medication in this populationThe group of people being studied. Populations may be defined by any characteristics e.g. where they live, age group, certain diseases. More. Toilet straining places stress on pelvic tissues and is associated with vaginal prolapse, rectal prolapse and piles. None of which are remotely funny.

What does the research say?

Not an awful lot. Much of the research is poor quality and little of it includes the Bristol Stool Chart, measures of pain or quality of life.

This Cochrane Review on interventions for treating constipation in pregnancy compared bulk forming with stimulant laxatives in pregnant women. DataData is the information collected through research. More was poor but they concluded there was evidence that increasing fibre formed a better stool. The review states there is a need for further randomizedRandomization is the process of randomly dividing into groups the people taking part in a trial. One group (the intervention group) will be given the intervention being tested (for example a drug, surgery, or exercise) and compared with a group which does not receive the intervention (the control group).   More controlled trialsA trial in which a group (the ‘intervention group’) is given a intervention being tested (for example a drug, surgery, or exercise) is compared with a group which does not receive the intervention (the ‘control group’). More (RCTs) in different settings with a range of types of laxative and measurements of pain as well as stools.

There’s a lack of evidence on how best to prevent or treat constipation after childbirth.

A Cochrane ReviewCochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. More published in 2015 evaluated effectiveness and safety of interventions for preventing postpartum (after childbirth) constipation.* They included five trialsClinical trials are research studies involving people who use healthcare services. They often compare a new or different treatment with the best treatment currently available. This is to test whether the new or different treatment is safe, effective and any better than what is currently used. No matter how promising a new treatment may appear during tests in a laboratory, it must go through clinical trials before its benefits and risks can really be known. More, and, again, reporting was poor and none of the trials included pain, straining, incidenceThe number of new occurrences of something in a population over a particular period of time, e.g. the number of cases of a disease in a country over one year. More of constipation or quality of life. All trials did measure time to first bowel movement. They did not, however, record what the woman’s normal, pre-delivery pattern was. They recommended future trials should include behavioural and educational interventions and measure pain, straining and quality of life as well as time to first post-natal bowel movement.

Another Cochrane review by the same team, looked at interventions for treating post-partum constipation. They excluded nine studies on the basis that they did not meet the inclusion criteria. They recommended rigorous and well conducted large RCTs.

There are some studies looking at adults with neurological problems, who often have problems with faecal incontinence or constipation. There are lots of papers examining the cause of neurogenic bowel disorders, but, few looking at the management of them. A Cochrane Review on this included twenty trials, mostly poor quality, but they suggest that a good bowel routine (using laxatives, suppositories, enemas, diet, exercise and digital evacuation) is important and should  be based on the needs of the individual. Massage and even one education session with a nurse may help reduce constipation, but more and better research is needed before we can say that with confidence. The reviewers commented that there was “remarkably little research on this common problem” and repeated the call for more, good, randomized studies.

Until that happens, we will all just have to continue trial and error. With our knees above our hips.

Top bowel tips

  • drink plenty of water
  • avoid caffeine
  • eat fibre
  • exercise
  • go when you feel the first urge
  • after breakfast, sit on the toilet for 15-20 minutes and wait for the ejection reflex- which does exactly what it says
  • take your time on the toilet
  • raise feet on a stool, lean forwards
  • don’t hold breath, ssss, grrrr, or moo
  • do a pelvic floor contraction when the bowel movement is done to encourage complete closing
  • congratulate yourself on releasing the poo hostage

Editor’s note: This is the third of our daily posts this week to launch our new series Evidence for Everyday Health Choices. You can read more about it here. Join in the conversation on Twitter where you can find Elaine Miller @GussieGrips and us @CochraneUK #EEHealthChoices. 

*The Cochrane Review Interventions for preventing postpartum constipation was updated in August 2020, with no studies added and no change to the conclusions.

The featured image and the image of mother and baby have been purchased for Evidently Cochrane from istock.com and may not be reproduced. The sitting man and log log are Elaine’s work so do ask her if you want to use them.

References (pdf)

Page last updated 06 August 2020

Rectal pain pressure | Cancer Chat

Not in the slightest – happy to share!

So, after a 48 stomach flu with explosive diarrhea, my bowels were, for about two or three weeks, mostly mushy although my diet was shocking as I was so stressed. I think I had one formed stool in three weeks and was over the moon!

I had a DRE and that was fine, but I don’t take 100% comfort from that as I don’t think a finger can reach the upper part of the rectum?

Anyway, I started adding more fibre into my diet and my stools gradually become more solid, with one explosive moment in between. At the moment, I obsess over every movement and examine it afterwards which isn’t good for your mental health! So, sometimes I will have what I consider a thin stool (the width of my thumb) and I’ll panic, then the next day I’ll have a normal, solid, number 4 Holy Grail on the Bristol Scale chart and think ‘well if it’s a tumour, stools wouldn’t get bigger only more narrow’ and tumours don’t move up and down in size so if the stool size is varied then it must not be a tumour, but that comforting thought lasts about ten minutes! So right now my stools could be anything, thinner, fatter, sometimes loose, then sometimes I’ll pass a rock hard stool the size of a mini Swiss Roll. All over the place basically!

I’ve never had any bleeding either in the stool or on the paper. 

In terms of the pressure in the rectum, it’s hard to describe. It comes goes. I just feel like something is there if that makes sense? Sometimes it feels relieved when I pass gas. Other times it’s non existent. Other times it feels like I want to have a movement, but not urgently so that I rush to the toilet and nothing happens. It’s just a dull, pressure sensation.

I also get mild scrotum and lower back pain (I had a back MRI and it was largely fine, no sign of anything nasty) it can be slightly painful to ejaculate (sorry to be graphic!) and I urinate a tremendous amount. Blood and stool tests both normal. 

No weight loss, loss of appetite or fatigue in any way, although my stress levels are absurdly high and spending six hours a day, all day, on Google, is my norm. 

In the course of any given day I can write myself as terminal rectal cancer to having IBS to having IBS with prostatitis to anything!

I will add that if my stress is focused on something ie my back, my stool, rectal pressure etc the symptoms seem worse. Psychological maybe? As soon as I had the MRI on my back, I stopped thinking about it and the pain greatly diminished. 

I’ve paid privately to get a colonoscopy tomorrow (I had one just shy of five years ago and not even a polyp was found so if it’s cancer it must be aggressive, in my rationale anyway) so I will, of course, let you know! 

90,000 Pain in the anus | Articles of the medical center Medklinik

The need for this article has been long overdue. She directly asks herself to the page. The topic of pain in the anus is so relevant, so necessary that there is no point in being silent further. Let’s get down to the topic.

But, dear readers, this article is of an overview, thesis nature. Its purpose is to guide the patient in his actions. I recommend everyone who is interested in their health issues in this area to read thematic articles that reflect the essence of the problem in more detail.

There are many different causes that can cause pain in the anus.

First, let’s isolate the cause of pain in the anus that is not directly related to the anus (anal canal and rectum).

There is such a medical term – proctalgia . It translates literally as pain in the rectum. This pain is associated with problems in the nervous system. It occurs with ostechondrosis of the spine, intervertebral hernias, after stress.Most often, such pain is associated with the tension of the muscle that lifts the anus.

In fact, this is some analogue of radiculitis and it is treated in the same way. When starting the treatment of proctalgia, it is necessary to exclude the presence of other diseases. Examination by a proctologist is mandatory.

Another recurring variant of pain in the anus, weakly associated with the anus itself, is coccygodynia – pain in the coccyx. It can intensify when walking, pressure on the tailbone.This disease has many causes, both neurological and various others. Often in the history of coccygodynia, injuries to the coccyx region are noted, sometimes even its fractures. Almost always, with pain in the coccyx, there was a previous fall on the bottom.

What to do with coccygodynia? In any case, treatment begins after examination by a proctologist. The doctor may prescribe an additional X-ray of the coccyx, recommend examination by other specialists, for example, a neurologist.Treatment is mainly focused on physiotherapy. Some doctors carry out blockades and recommend removal of the tailbone, but such manipulations do not significantly alleviate the patient’s condition.

Now you can get closer to the problems directly related to the anal canal and the anus.

The first place in terms of frequency of occurrence is hemorrhoids ! And there is no getting away from it. According to a study conducted by WHO, about 85% of the population periodically experience problems associated with hemorrhoids.

Just a few words about the essence of the disease. With the development of the human embryo, the veins of the hemorrhoidal plexuses are laid in the lower rectum. Under the influence of some factors, the veins of these plexuses expand and form first internal and then external hemorrhoids. Unfortunately, hemorrhoids can bother not only an adult, but also a child.

Dear readers, please note that hemorrhoids develop gradually. And you can never notice the onset of the disease.Once you find discomfort in the anus, a feeling of incomplete emptying after stool, a slight itching in the anus. In most cases, these are the initial manifestations of hemorrhoids! Uncomplicated hemorrhoids don’t hurt!

Hemorrhoids can hurt in the following cases:

  1. Thrombosis of the external hemorrhoid. In the veins of the external hemorrhoidal plexus, blood coagulates, a thrombus and inflammation occur. It all starts to hurt. The greater the thrombosis, the stronger the pain.
  2. Prolapse of internal hemorrhoids. The nodes begin to fall out after stool at the third degree. The disease progresses: “bumps” then fall out when walking and a little effort. First they set themselves, then you need to set them with your hands. The pain during prolapse is usually mild, after reduction it goes away.
  3. Prolapse and thrombosis of internal hemorrhoids. The situation is serious, it hurts very badly, and requires urgent medical attention and qualified help.

Medicines in the treatment of hemorrhoids are necessary only to relieve inflammation.Unfortunately, drug treatment of hemorrhoids does not lead to the disappearance of the disease. Hemorrhoids should be removed. Removal methods are different and correspond to different stages of the disease. We will not consider them here.

The second place among the treated patients is currently sphincteritis . He pushed back the anal fissure, which is now in third place. Let me explain the essence of such a disease as sphincteritis – an inflammation of the structures of the anal canal.I will explain the details and details in another article (I will write a little later).

Sphincteritis by itself occurs quite rarely. This requires severe digestive disorders: pancreatitis, gastric ulcer and duodenal ulcer, long-term and persistent gastritis and duodenitis, stool disorders after taking antibiotics, irritable bowel syndrome, severe dysbiosis, infectious diseases and some other pathological conditions. Perhaps we can say that the priest with such diseases does not bother often and severe pains are also not often.With successful treatment of the underlying disease, sphincteritis most often disappears.

But! There is one important BUT. All of the above is true if the patient does not have hemorrhoidal disease! Hemorrhoids are an “interesting” sore. Even doctors rarely pay attention to the very essence of the pathogenesis (development) of this disease. Hemorrhoids lead to hemodynamic disturbances (blood stasis) in the anal canal and nearby organs. This is especially pronounced with a sedentary lifestyle. And as a result of these stagnant phenomena in the anus, many patients experience inflammation of the anal canal – sphincteritis – even without any digestive disorders.This inflammation is wavy in nature – it periodically increases and decreases under the influence of many factors.

That is, hemorrhoids by themselves tend to lead to inflammation of the anal canal and the appearance of pain, itching, discomfort and other unpleasant sensations. And if a stool disorder also joins (I described the most common reasons above), then the situation arises quite serious. And therefore, dear readers, you already understand that treating sphincteritis without removing hemorrhoids (if any) is not very promising.So we treat them together, and sometimes in turn.

We get to such an “interesting” disease as anal fissure, which also causes pain in the anus. Why did I put the word interesting in quotation marks? Because a crack in the anus is difficult to treat. Fissure is currently the third most common disease causing pain in the anus.

The fissure is characterized by pain during bowel movements and some time after it. At first, the pain is mild, there may be a slight discharge of blood.Over time, the pain intensifies, it can last for several hours. The discharge of blood is often reduced. Increased pain is associated with the development of scarring around the crack and inflammation. Sentinel tubercles appear outside and inside. These are signs of the transition of an acute anal fissure into a chronic stage.

Chronic anal fissure usually does not heal with conservative (drug) treatment. Medical manipulations are required. Here the dependence is simple: the older the crack, the more difficult the manipulation.

A very important point in the treatment of anal fissures: most often they appear in the pathologically altered anal canal against the background of other diseases (hemorrhoids, sphincteritis). It is difficult to treat such cracks.

Cryptitis – inflammation of the crypt (exit of the anal gland into the rectum). Cryptitis pain is intense, associated with stool, sometimes there is mucous or purulent discharge from the anus. The disease is relatively rare and can be treated conservatively. I put cryptite in fourth place only because cryptite can lead to the next, more common problem.

Paraproctitis and rectal fistula . Diseases are not rare, but not so common. Acute paraproctitis is the initial stage in the development of chronic paraproctitis (rectal fistula).

The essence of acute paraproctitis is perfectly described in the book “Fundamentals of Coloproctology” – “acute inflammation of the peri-rectal tissue caused by the spread of the inflammatory process from the anal crypts and anal glands.” Simply put, pus accumulates in the anal glands. There are a lot of him and he is very “evil”.This pus must be released before it causes big trouble.

So dear patients, if you have swelling, induration, fever up to 38 degrees and above, pain in your anus, then go to a hospital where there is a proctology. We’ll have to do the operation urgently!

How to distinguish acute paraproctitis from thrombosis of the external hemorrhoidal node to a non-specialist? It’s complicated. There is a high temperature – go to the hospital!

Rectal fistula .Almost always – the next stage in the development of acute paraproctitis. The fistula itself does not cause pain, it is a pathological course between the rectum and the surface of the body near the anus (sometimes far enough). It happens that the fistula closes for a while (months, years), and then again suppurates and behaves like acute paraproctitis. Only the inflammation is not so strong and the pain is less. Fistulas are treated only promptly in a hospital. Subcutaneous fistulas can be opened on an outpatient basis.

Epithelial coccygeal passage or pilonidal sinus .In fact, this is a narrow cavity in the region of the sacrum and coccyx, formed when embryonic development is disturbed. You can live your whole life with this move and not know about it. If it becomes inflamed, then pain occurs in the anus. But it hurts mainly in the coccyx area, there is also a swelling there. In case of acute inflammation, it is urgent to open it. For chronic inflammation – elective surgery in the proctology department.

Stenosis (narrowing) of the anal canal . The essence of the problem is that the anus narrows and it is difficult to pass fecal masses.It goes without saying that when you have a bowel movement, especially if the stool is hard, it can be painful. This condition can be after surgery on the anus, inflammation (sphincteritis, anal fissure), with cancer of the anal canal. Children have congenital narrowing. We’re talking about adults.

In case of inflammation of the anal canal, anal fissure – treatment of the corresponding disease. With cancer of the anal canal, treatment by an oncologist is necessary, timely diagnosis is very important.

Trauma (rupture) of the anal canal .Most often as a result of an accident or sexual activity. The patient’s actions depend on the intensity of the pain syndrome: the more it hurts, the faster you seek help. For minor pain, when there is a tear in the skin covering the anal canal (in fact, an acute anal fissure) – outpatient treatment. In case of significant ruptures (rupture of the sphincter and even levators) – urgent surgical intervention in the department of proctology.

Anal cancer . The onset of the disease proceeds with symptoms such as discomfort, mucus, blood, anal itching.That is, the symptoms are common with various diseases of the rectum and anal canal, therefore early diagnosis is of primary importance in the treatment of the disease.

Some other diseases can also be accompanied by pain in the anus or near it: prostatitis, cysts, teratomas, osteomyelitis and some others. Description of these problems is beyond the scope of this article.

Yours faithfully, Ilyin Vitaly Arkadievich , proctologist, candidate of medical sciences

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90,000 Pain in the anus – causes, symptoms and treatment

The emergence of acute or dull aching pain is always an alarming signal that indicates tissue damage or inflammation. Pain in the anus can have a sharp spasmodic character and spread to the lower abdomen or back, coccyx and perineum, or be not very pronounced, but still cause discomfort and discomfort. If painful attacks recur for several days, we recommend not to hesitate – it is best to consult a doctor for diagnostics and appropriate treatment.

OUR ADVANTAGES

High professionalism

Head of the department – d.MD, professor. Certified specialists with more than 10-30 years of experience.

The latest equipment

In 2014, new imported equipment was purchased for the operating room and diagnostic rooms

Comfortable living conditions

The department has been renovated, all wards with their own bathroom

Delicate problem

To a delicate problem – an individual delicate approach

Causes of pain in the anus

  • Anal fissures.In this case, painful sensations are often localized precisely in the region of the anus. They can lead to constipation or vice versa – diarrhea, as well as damage to the wall of the anal canal.
  • Acute hemorrhoids. One of the common problems, as evidenced by the discomfort and pain in the rectum. They arise due to the development of thrombosis and inflammation in the hemorrhoids. At the same time, the pain syndrome is not always pronounced, it can be chronic, or vice versa – be acute, causing severe torment.
  • Infringement of the hemorrhoid. It may be accompanied by severe pain, constipation and swelling of this area, and fever.
  • Acute proctitis. The pains are pronounced stabbing and cutting, accompanied by an increase in temperature and general malaise. This disease is an inflammation of the mucous membranes of the rectum.
  • Paraproctitis. The process of purulent fusion of the cellulose surrounding the rectum. If inactive, the process is propagated to other departments. This is an emergency requiring immediate hospitalization and urgent surgery.

Symptoms

  • The symptomatology of pain depends on the cause of its occurrence and the stage of the disease – often unpleasant sensations appear suddenly, and are largely associated with the act of defecation.
  • A painful attack can be of different intensity: from mild discomfort and itching to sharp stabbing and cutting spasms.
  • The duration of the spasms can last from a few minutes to several hours.
  • Many patients complain of bouts of pain in the middle of the night, resulting in disturbed sleep.
  • Often, pain in the anus can be of a somatic nature, arising from stress, prolonged depression and increased nervousness.
  • Exacerbations of chronic ailments are also often accompanied by constipation, increased pain when trying to defecate, as well as the appearance of bloody or purulent discharge in the feces.

Diagnostics

For the timely identification of the causes of pain and inflammation, it is necessary to consult with a coloproctologist if unpleasant sensations appear in the anus and rectum.Based on the stated symptoms, you will be assigned the necessary medical examination, which will include: physical diagnosis, examination of the anal area and gentle rectal palpation. If necessary, sigmoidoscopy is performed. Also, discomfort may indicate diseases of other organs, therefore, at the consultation, it is recommended to undergo the necessary examination and pass the necessary tests.

Treatment of pain in the anus

The appointment of treatment directly depends on the identified causes of the appearance of unpleasant sensations, as well as the stage of proctalgia.The primary form has no background in the form of chronic diseases of the rectum or genitourinary system, the secondary one occurs against the background of acute hemorrhoids, tumors, anal fissures and various inflammatory processes. Therefore, the method of treatment is determined individually in accordance with the diagnosis made – it can be physical or drug therapy, blockade. In order to eliminate the cause and alleviate the patient’s condition, it is necessary to accurately diagnose and only then can the necessary, effective treatment be prescribed.This can only be done by an experienced coloproctologist.

Department of Coloproctology (812) 912-35-16, + 7-921-912-35-16

PATIENT REVIEWS

How long I went to the doctors before coming here, no one could make a correct diagnosis for me. And only here, thanks to the experience and professionalism of the head of the department, they were finally able to determine the cause of the pain and prescribe adequate treatment, the results of which were not long in coming.

Roman Vasiliev 03/17/2017

I was worried about pain and itching in the anus. Later, there was blood on toilet paper. After research by the proctologist, it turned out that there are two cracks. I thought I needed an operation, but they prescribed treatment, which quickly began to help. Now I don’t remember this problem.

Leonid Zhiganov 10.11.2016

If I had known earlier that hemorrhoids can be cured so quickly and practically painlessly in the first coloproctology department, I would, of course, have applied earlier.But as they say, better late than never. The operation was performed here with the help of a laser, so I had a minimal rehabilitation period, I practically did not feel pain. I am very satisfied, I recommend it to everyone!

Elena Kryventsova 09/26/2016

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OUR SPECIALISTS

Shakaya Yakov Illarionovich

Coloproctologist of the highest category, work experience over 35 years.

Maltsev Nikolay Pavlovich

coloproctologist, work experience over 7 years.

Vlasova Tatiana Anatolievna

Senior Nurse of the Coloproctology Department.

Alekseeva Elena Grigorievna

guard nurse of the department of coloproctology

Bogatyr Alexandra Sergeevna

guard nurse of the department of coloproctology

Bukshtynova Irina Sergeevna

guard nurse of the department of coloproctology

Gayshun Elena Mikhailovna

Post nurse of the department of coloproctology

90,000 Which doctor should I contact for pain in the anus

Moscow proctologists – latest reviews

The reception went well, neatly and calmly.I liked everything, I will recommend a specialist. As a result, I received a consultation, the necessary appointments, treatment and prevention. Andrey Ilyich is 100 percent professional. I was pleased with the reception.

Mehman,

August 16, 2021

The services of this field must be used carefully…
The doctor seemed good to her 4 stars for cheating. I looked and prescribed some kind of treatment. Accepts only adults .. came with a child to another doctor who looks at children .. but for some reason they sent us to this doctor. At the exit from the clinic, as expected, our doctor was looking for us .. and he was told in front of me that we didn’t wait for him .. I didn’t expect such a scam from the clinic ..

Moderation,

August 18, 2021

The doctor is friendly, experienced and professional.Zemfira Uzeirovna examined, told about the risks, carried out the procedure carefully, sent the material for analysis and research.

Lyudmila,

August 12, 2021

A wonderful doctor.There was ear inflammation from the piercing. The doctor took off the jewelry, prescribed the necessary treatment, gave recommendations. I was pleased with the reception. I will make an appointment with this specialist again.

Lina,

August 13, 2021

The doctor is good, sympathetic, good-natured.At the reception there was a painstaking examination. Gave a referral to a gastroenterologist. Communicates well with the patient. I don’t know if I’ll apply again. I’m not sure about the recommendation of this specialist either.

Helena,

August 18, 2021

The doctor did everything quickly and professionally.Ekaterina Vladimirovna was attentive, explained everything in detail. She performed the operation and issued prescriptions for further treatment.

Dmitriy,

August 15, 2021

The doctor is competent, the appointment went well and I have already made an appointment for the next appointment.The doctor was attentive, explained everything to me clearly. The doctor helped me in solving my problem. I would recommend it to my friends.

Margarita,

August 15, 2021

The doctor first of all reassured me, said that everything was fine and there was nothing to be afraid of.I wrote out recommendations that need to be done further. The doctor is competent, calm, I liked it.

Yuliya,

August 13, 2021

A very competent, sensitive doctor.Gave detailed recommendations. Reassured that nothing serious. He answered all my questions. He prescribed the necessary medications. The doctor helped solve my problem. I was pleased with the reception.

Maksim,

August 17, 2021

Everything went perfectly.A very good doctor, attentive and tidy. All recommendations were given on the case, he helped to solve my problem. I recommend the specialist to my friends and acquaintances, I will also apply myself if necessary.

Anonymous,

August 15, 2021

Show 10 reviews of 10,001 90,000 reasons, complaints, diagnostics and treatment methods on the website of the clinic “Alfa-Health Center”

Inflammation of the hemorrhoids formed as a result of the expansion of the veins of the anus, the prolapse of the nodes outward.Symptoms are sharp pain, which increases with bowel movements, periodic bleeding.

Most people over 50 suffer from hemorrhoids. The three main clusters of vascular tissue are normally located in the submucosal layer of the anal canal. These plexuses can fill with blood to protect the anal canal during bowel movements. With age and with the appearance of various concomitant diseases, the supporting muscle plate of the submucosal layer is destroyed, which leads to stretching of the veins and the appearance of nodes.These nodes are often thrombosed and ulcerated. Sedentary work and food poor in fiber predispose to constipation, which is manifested by too much stretching of the intestinal wall during bowel movements; from this, hemorrhoids protrude more strongly into the intestinal lumen.

External and internal hemorrhoids differ in the location of the nodes relative to the rectal-anal line, although the external and internal nodes can merge into a single conglomerate. There are four stages of hemorrhoids. At the first stage, the nodes protrude into the anal canal, but do not fall out.At the second stage, the nodes fall out, but they adjust on their own. On the third, the knots that have fallen out have to be adjusted by hand, on the fourth, the knots that have fallen out cannot be adjusted. Staging is important for the choice of treatment.

External hemorrhoids

External hemorrhoids are manifested by the secretion of mucus and a small amount of blood from the anus. Mucus begins to flow when the knot interferes with the closure of the anus. In this case, anal itching may occur. External hemorrhoids are prone to thrombosis.This is an extremely painful condition, and thrombosis often develops after constipation.

As a rule, with external hemorrhoids, it is enough to improve the consistency and increase the volume of feces with the help of a diet. In addition, hygiene rules have been developed. For example, the patient is advised to take a sitz bath, not to sit for a long time and not to push during bowel movements. In acute thrombosis within 2-3 days from the onset of the disease, hemorrhoids can be excised under local anesthesia.

General recommendations for patients with hemorrhoids are as follows:

  • Drink plenty of fluids.Drink at least 6-8 glasses of water or juice daily; you should not drink tea, coffee and carbonated drinks
  • Eat fruits and vegetables at least 4-5 times a day
  • Take fiber (such as plantain seed) 1 tablespoon, diluted in a glass of water, 1-2 times a day. Take sodium docusate 50-100 mg 1-2 times a day.
  • Take a sitz or regular bath with warm water twice a day. Do not lather the perianal area as this may irritate.
  • After a bowel movement, do not rub or scratch the perianal area, but gently blot it with toilet paper. After a sitz bath or bowel movement, apply a cotton swab to your anus. Change cotton wool after bath and bowel movement
  • Don’t sit on the toilet; don’t read in the restroom
  • Avoid or minimize the use of narcotic analgesics (such as codeine or oxycodone / paracetamol), as these drugs can cause constipation
  • Don’t sit for long periods.Lie down frequently with a pillow under your thighs to raise the perianal region

Internal hemorrhoids

As a rule, internal hemorrhoids are not as painful as external ones. Internal hemorrhoids are manifested by bleeding and prolapse of nodes. Just as with external hemorrhoids, in the first and second stages of the disease, it is usually enough to eat right, regularly empty the intestines and observe hygiene rules. If this does not help, more sophisticated treatments are used.

Surgical treatment is required in less than 10% of patients with clinical manifestations of hemorrhoids. For internal hemorrhoids of the first, second and sometimes third stages, cryotherapy, diathermocoagulation, laser coagulation, infrared photocoagulation, sclerotherapy and ligation with rubber rings are used; none of the methods has clear advantages.

Hemorrhoidectomy is performed for hemorrhoids of the third and fourth stages, with the ineffectiveness of conservative treatment at earlier stages and with mixed hemorrhoids (if there are both external and internal nodes).The operation can be performed on an outpatient basis.

90,000 Constipation: what is it, causes, treatment

What is constipation?

Constipation, according to doctors, is of several types. The first is sharp. And it is more familiar to most of us, it is determined by a simple time frame – if you have no stool for 2 or 3 days. The second type is much more serious, and its
usually called “chronic”. It is also easy to determine: bowel cleansing usually occurs less than three times a week; when visiting the toilet, you often have to strain a lot, and, finally, after you have done everything,
all the same, there may be a feeling of incompleteness of the process – incomplete cleansing of the intestines.The duration of these symptoms in chronic constipation is usually at least 3 months 1 .

Constipation is an extremely delicate problem, and it is somehow not accepted to talk about it in the company of friends. In other words, you can ask for advice on treating a runny nose or headache, but hardly about difficulties with stool. This leads more often
all to the fact that many leave constipation without special attention, considering it a temporary problem that “will soon pass.” As modern research shows, constipation can reduce quality of life as much as serious chronic
cardiovascular disease or diabetes mellitus 1.2 .At the same time, the prevalence of constipation is high – it is believed that every fifth inhabitant of our country suffers from this intestinal dysfunction 3 .

How to identify constipation in children?

Children’s intestines work differently from adult intestines. Children have a different schedule of stool frequency, and it is important to take it into account if you suddenly decide to give your child an independent diagnosis of constipation. Look at
data from this table 5 to know for sure.

table below – can be shown in a simple and understandable table format.

age bowel movements per week number of bowel movements per day
0 – 3 months breastfeeding 5-40 2.9
artificial feeding 5-20 2.0
6 – 12 months 5-28 1.8
1-3 years 4-21 1.4
4 years and older 3-14 1

What are the causes of constipation?

Proof that constipation is not an ordinary phenomenon, like a runny nose, is the huge amount of information that a doctor collects to help a patient with similar problems.Hence, there are many reasons, the symptom of which
are secondary constipation. Here are just some of them:

  • Intestinal tumor that may obstruct the passage of intestinal contents.
  • Diseases of the anal region and rectum that cause pain in the stool. The pain leads to the fact that a person is simply afraid to go to the toilet often.
  • Certain neurological diseases, such as Parkinson’s disease.
  • Mental disorders such as depression or anorexia.
  • Taking a number of drugs – antidepressants, opioid analgesics 1 .

Separately, two causes of constipation can be distinguished directly related to the state of the intestines

  • Antibiotic therapy. Some antibiotics can inhibit the normal flora of the gastrointestinal tract, which negatively affects the digestion of food. Beneficial bacteria (lactobacilli, bifidobacteria, colibacteria, etc.) are necessary to maintain normal microflora – its violation can lead to a delay in food digestion.They are needed to maintain an acidic environment within the intestines, which inhibits the growth of fungi and disease-causing bacteria. Violations of peristalsis and retention of feces are also often associated with changes in the intestinal microflora against the background of antibiotic therapy. 1, 7
  • Dysbacteriosis or dysbiosis. This is a temporary or permanent imbalance in the microflora inside the intestine. Its development can be associated with many diseases, and not necessarily the gastrointestinal tract. Dysbacteriosis can develop with chronic fatigue syndrome, stress, depression; with long-term or chronic diseases of any organ or system; with violations of immunity; due to a decrease in the general defenses of the body.Improper diet, hypovitaminosis, taking certain medications can also cause dysbiosis. 1, 8, 9

However, you should not immediately look for all these frightening signs of constipation. Most often, we suffer from a “plug” in the intestines for more mundane reasons. Due to improper diet or temporary impairment of bowel function, do not
associated with other diseases 1 . And also because of psychological discomfort when using the toilet, for example, in public places or during travel and business trips.Such constipation is usually called functional (primary).

Children also have “their own” reasons for constipation. For example, introducing new foods into the diet: especially feed formulas and products based on cow’s or goat’s milk. Also, children may experience problems when starting to attend the nursery.
or kindergarten – the child may be uncomfortable in a new environment, where it is terribly uncomfortable to perform a delicate process. All this makes the child endure home, leading to the appearance of the usual constipation.Accustoming to
a pot can also lead to disruption of the intestines, so it should take place in a calm manner, without conflicts 5 .

What does the doctor prescribe for constipation?

The doctor may prescribe different examinations (X-ray of the abdominal cavity, defecography, assessment of the intestinal transit rate) or refer to another specialist for consultation to determine the cause of constipation 1 . If you find yourself
If the connection between the prescribed studies and your complaints is not clear, then you do not need to be shy – ask your doctor a question.

How to deal with constipation without medication?

Generally, non-drug treatments for constipation work best with children. Some of them are associated with overcoming the psychological barrier that a child may have in connection with going to the toilet. In no way worth it
scold the child or somehow hint to him that constipation seems to you a terrible or unacceptable thing. The main thing, as Carlson said, is calmness. First of all, you need to explain to the child the importance of regular visits to the toilet.For this
you can start asking him to sit on the potty or toilet immediately after eating. It is important that the child has a good support for the legs. It is also important to talk with other parents and teachers about setting up a toilet in kindergarten or
manger. Especially if other children there also face a similar problem 5 .

Another effective non-drug method is dietary change, and it can be applied not only to children, but also to adults. First, remove products that, like heavy trucks on the highway, inhibit intestinal movement: strong tea and coffee, pureed food,
semolina and rice porridge, radish, jelly.Along with this, start eating foods rich in dietary fiber, they, like racing cars, will increase the speed of passage in the intestines. The movement of food through the intestines is also accelerated by sour fruits,
sweet and savory foods, vegetable fats 5 . And you need to eat them regularly, on schedule. For adults, the average amount of dietary fiber per day is 20-25 grams 1 . It is important to remember that such products cannot
there is “dry water” – water is important, 2 liters per 25 grams of dietary fiber.If you don’t drink, the symptoms of constipation can only get worse.

Which foods are rich in dietary fiber

5.6 ?

It can be shown in the form of a simple plate, where, next to the names of the products, their beautiful pictures.

Product Amount of dietary fiber in 100 grams of product (in grams)
Melon 1-2
Rye bread 1-2
Carrot 1-1.9
Bread with bran 2-3
Strawberry 4.5
Wheat bran 8.2
Wheat bran 14

What medications can help with constipation?

If preventive measures have not helped much, then laxatives may be used in the treatment of functional constipation…. For example, osmotic laxatives – medicines containing polyethylene glycol or lactulose. How these drugs work
based on the fact that they become a kind of dams – they hold fluid in the intestinal lumen. This leads to an increase in the volume of feces and an acceleration of its movement through the intestines 1 .

Another group of laxatives is stimulants. Among this group of drugs, the drug Guttalax stands out, the active ingredient of which is sodium picosulfate.Guttalax is available in the form of drops as well as tablets, which makes it easy to pick up
dose to achieve optimal stool frequency. If Guttalax is taken before bedtime, then physiological relief should come in the morning, when you habitually go to the toilet.

Also, Guttalax, as prescribed by a doctor, can be given to children with constipation from the first days of life, as well as used by pregnant women in the second or third trimester 4 . All of these methods can help solve the delicate problem of constipation.You need to be prepared for the fact that
treatment will require a lot of attention to detail both on the part of the doctor and the patient and his loved ones. But later, you can quote with a smile the lines that history ascribes to Alexander Pushkin: “Blessed is he who has
a chair without coercion, that all the food is to his liking and all the pleasures are available. ”

90,000 what, where and why it hurts

After being expelled from paradise, a person acquired the ability to independently reproduce his own kind, and a woman had to give birth to children in pain… Pain during childbirth and pain after childbirth doctors refer to the category of inevitable. Even after almost painless childbirth, which is carried out under epidural anesthesia, women experience pain in the postpartum period.

Most often, pulling pains after childbirth in the lumbar region and lower back are associated with displacement of the hip joints, as well as with the manifestation of those changes in the sacrococcygeal spine that occur throughout pregnancy and during childbirth.

Causes of pain after childbirth

We will consider typical pain after childbirth and their most common causes, although, of course, there are many clinical cases where the symptoms of pain after childbirth are individual. For example, long-term severe headaches after childbirth torment women in labor who have undergone regional epidural (spinal) anesthesia, in which an anesthetic drug is injected into the spine at the border of the lumbar and sacral regions.A severe headache lasting the first three days after childbirth (with a veil before the eyes and nausea) may also be a sign of preeclampsia – if the expectant mother had a persistent increase in blood pressure in the second and third trimester of pregnancy.

Chest pain after childbirth, more precisely, chest pain with shortness of breath and cough, may indicate an infectious lung disease, but these are also symptoms of pulmonary embolism (a blood clot entering the pulmonary artery). Leg pain after childbirth – in the calves of the legs – can be a sign of life-threatening deep vein thrombosis, which causes skin redness, swelling, and fever.And severe pain after childbirth in the abdomen can be a sign of inflammation of the uterus at the site of attachment of the placenta.

However, the typical causes of pain after childbirth are associated with the fact that during the birth of a child, the birth canal is subjected to strong mechanical stress, which is often traumatic.

Abdominal pain after childbirth

The hormones that are produced during pregnancy relax the ligaments and muscles. This is necessary for the normal development of the fetus, and for the entire period of bearing the child, the size of the uterus increases 25 times.After childbirth, the uterus begins to return to its “pre-pregnant” state. And pain in the lower abdomen after childbirth, which many women in labor define as pain in the uterus after childbirth, are associated with a reduction in the size of the uterus.

These pains are most often cramping and intensify with breastfeeding. All this is absolutely normal. The fact is that the hormone oxytocin, which is produced in large quantities by the hypothalamus of the woman who gave birth, enters the bloodstream and stimulates the contraction of the smooth muscles of the uterus.7-10 days after the birth of the child, similar pains in the uterus after childbirth disappear by themselves.

The fundus of the uterus after childbirth is located approximately at the level of the navel. During the postpartum period, that is, in 6-8 weeks, the uterus contracts to its previous size. But in women who had a large belly during pregnancy, the muscle tone of the peritoneum can be weakened, which often becomes the cause of an umbilical hernia. It is she who provokes pain in the navel after childbirth. To solve this problem, you should see a gynecologist who observed the pregnancy.

By the way, stomach pain after childbirth, as well as pain in the intestines after childbirth, can occur due to constipation, which affects many women in labor. In addition, the pain of this localization may bother those who have chronic gastrointestinal diseases: in the postpartum period, they may worsen. So you can’t do without the advice of a specialist.

Pain in the spine after childbirth

As doctors note, the reason that different women feel differently after childbirth largely depends on how their body copes with the change or drop in the level of hormones that were produced during the period of gestation.

After childbirth and the exit of the placenta, the production of certain hormones stops abruptly. For example, the hormone relaxin is almost completely stopped, which during pregnancy helps to increase the elasticity of the muscles and relax the ligaments of the pubic joint of the pelvic bones. But this hormone does not return to the normal level in the body of a woman in labor immediately, but about five months after childbirth.

Therefore, the entire musculoskeletal system of a woman after childbirth passes to normal functioning gradually.And some stages of this process cause symptoms of pain after childbirth.

Pain in the spine after childbirth is associated with the fact that relaxin, by relaxing the abdominal muscles during pregnancy, weakens the ligaments around the spine. It is the increased instability of the spine during pregnancy and even some displacement of the vertebrae that leads to pulling back pain after childbirth. Joint pain after childbirth has the same cause, including wrist pain after childbirth, leg pain after childbirth, and knee pain after childbirth.

Low back pain after childbirth

Lower back pain after childbirth is partly due to overstrain of the quadratus lumbar muscle, which is located in the posterior abdominal wall and connects the ilium, ribs, and transverse processes of the lumbar vertebrae. With its excessive contractions or with prolonged static loads, pains in the lower back and in the entire back begin to be felt.

In addition, during pregnancy, the abdominal muscles stretch and lengthen, and the muscles in the lumbar spine, which are responsible for tilting and straightening the trunk and for the stability of the lower spine, become shorter.And it also causes lower back pain after childbirth. Sprains in the pubic joint, spine, and pelvic floor muscles are also causes of discomfort and pain in the lumbar region.

Pelvic pain after childbirth: pain in the sacrum and coccyx

Pain in the sacrum and coccyx after childbirth is usually not distinguished by women and pain in the coccyx is mistaken for pain in the sacrum. Meanwhile, the coccygeal bone consists of several fused rudimentary vertebrae, and the sacrum is a large triangular bone that sits at the base of the spine, just above the coccyx.Together, the tailbone and sacrum make up the lower, immobile spine.

Ligaments run from the anterior and posterior surfaces of the sacrum to the pelvic bones, which firmly hold the bones of the pelvic ring. But during pregnancy – literally from the very beginning – the woman’s musculoskeletal system begins to prepare for childbirth. How?

First, the vertebrae of the lumbar spine deviate backward from the axis of the spine. Secondly, the lower limbs begin to move away from the iliac bones, and the hip heads even protrude from the acetabulum.Third, the bones of the pubic and sacroiliac joints diverge slightly. Finally, the arch of the coccyx bend changes, and the usually motionless bone of the sacrum moves slightly posteriorly. All these changes in the area of ​​the pelvic bones are provided by nature and allow the child to leave the mother’s womb.

If the baby is large or his presentation is incorrect, or if the birth was too fast, then pain in the sacrum after childbirth and pain in the tailbone after childbirth appears due to excessive pressure on the joints in the pelvic region.They provoke pain in the pelvis after childbirth and overstretching of these joints in the event of a forced manual release of the passage for the baby’s head during childbirth.

The more the sacrococcygeal joint was overloaded, the stronger and longer the pain in the pelvis after childbirth and the longer the recovery process will be.

Often, in complaints of pain in the sacral zone, women in labor specify that this is pain during bowel movements after childbirth. Indeed, the pain of this localization can become stronger in the case of enlargement of the sigmoid colon with the accumulation of feces or in the acute phase of chronic colitis, which is a complication of postpartum constipation.How to get rid of constipation in the postpartum period, we will tell you a little later.

Pubic pain after childbirth

Under the influence of hormones, which “signal” to all systems of the mother’s body about the end of the childbirth process, the mechanism of postpartum recovery is triggered. And usually immediately after childbirth, the pubic articulation (symphysis) is restored, the bones of which diverge slightly during pregnancy.

If everything is normal, then the process of restoring the usual anatomical position of this joint goes on without tangible consequences.

But if a woman who has given birth complains of pubic pain after childbirth, then the cartilage connecting the pubic bones is injured due to overstretching of the pelvic floor (which occurs when the head is extended from the baby’s womb). In this case, a violation of the symmetry of the right and left pubic bones is likely. Doctors diagnose this pathology as symphysitis – dysfunction of the pubic articulation, in which the patient feels pain in the pubic area when walking and is forced to walk in a crumbling.

If the pain is very severe and radiates in all bones and joints of the pelvis, then this is no longer just a stretching of the cartilage, but a rupture of the pubic articulation – symphysiolysis.

Pain in the perineum after childbirth

The perineal area (regio perinealis) forms the floor of the pelvis and is composed of muscles, fascia, adipose tissue and skin. Pain in the perineum after childbirth occurs when it is injured – rupture or dissection (perineotomy).

According to obstetric practice, most often perineal injuries occur in women with well-developed muscles, in elderly primiparas, with a narrow vagina with inflammatory tissue changes, with tissue edema, and also in the presence of scars after previous childbirth.

With a perineotomy, only the skin of the perineum is cut, and with an episiotomy, the perineum and the posterior wall of the vagina are cut. Both of these procedures are done when there is a threat of an arbitrary perineal rupture, as well as to avoid traumatic brain injury of the newborn. If the perineum is torn or cut immediately after delivery, they are sutured. The outer sutures are removed the day before discharge from the hospital, the inner ones dissolve over time.

At the same time, a surgical incision of the perineum is better than a rupture, since the wound is smooth and clean and in 95% of cases heals, as doctors say, prima intentio (primary intention) – that is, quickly and without consequences.

However, pain in the perineum after childbirth is inevitable. With proper hygiene, the wound heals after a couple of weeks, during which the woman cannot sit, so as not to break the stitches. With an episiotomy, stitches can cause vaginal pain after childbirth, which will last longer as the internal tissues heal.

Groin pain after childbirth

Many women begin to bother with pain in the groin area even during the period of bearing a child.An increase in the volume of the uterus, as well as a gradual divergence of the pelvic bones, can lead to pain in the groin. In addition, groin pain after childbirth (radiating to the lower back) may be associated with the presence of a stone in the kidney or ureter. It is impossible to exclude such a reason as inflammation of the inner mucous membrane of the body of the uterus – endometritis. As noted by gynecologists, acute postpartum endometritis occurs when the uterus becomes infected during childbirth quite often, while after a cesarean section it manifests itself in almost 45% of cases.

Acute postpartum endometritis is characterized by symptoms such as pain in the lower abdomen and groin, fever, purulent discharge, and uterine bleeding. If you have these signs, you should immediately seek medical attention.

In addition, groin pain after childbirth gives genital herpes, which was diagnosed in a pregnant woman.

Headaches after childbirth

Experts associate headaches after childbirth with several reasons.First of all, this is a change in the hormonal background in the postpartum period: the instability of the level of estrogen and progesterone. Moreover, if a woman in labor does not breastfeed, then headaches occur much more often than in nursing women. Promotes headaches after childbirth and taking birth control pills that contain estrogen.

Stress, overwork, lack of sleep, etc., have a negative impact on the health of a woman in the postpartum period. Against the background of hormonal changes, these factors can lead to the fact that the newly-made mom will be pestered by frequent and rather intense headaches after childbirth.

Muscle pain after childbirth

Muscle pains of various localization (in the lower back, muscles of the pelvis, legs, back, chest, etc.) is a natural phenomenon after such a strong muscle tension that they experience during the birth of a child. Such pains pass naturally and do not need any therapy.

Nevertheless, it should be borne in mind that all the changes through which the body of the woman who gave birth must go through again, it is necessary to control and prevent the exacerbation of existing diseases.For example, diseases of the spine, genital area, gastrointestinal tract, which can manifest themselves with renewed vigor after the stress transferred during childbirth.

Chest pain after childbirth

We have already talked about the hormone oxytocin, which stimulates uterine contraction after childbirth. In addition, oxytocin has another critical function. During lactation, it causes a contraction of the myoepithelial cells surrounding the alveoli and ducts of the mammary gland. Thanks to this, breast milk produced under the influence of the hormone prolactin passes into the subareolar ducts of the mammary gland and is excreted from the nipples.

Milk appears in the breast after the baby is born – first in the form of colostrum. The timing of the “arrival” of milk itself is individual, but obstetricians consider 48-72 hours after childbirth to be the norm for the onset of lactation. This process occurs literally before our eyes – by swelling of the mammary glands, which is quite often accompanied by chest pain after childbirth. In the future, the process of milk production will be regulated, and all unpleasant sensations will pass.

Pain during menstruation after childbirth

Very often, after childbirth, menstruation in women becomes less regular than before pregnancy.And within 5-6 months after the birth of the baby, this should not be a cause for concern. In addition, the first 4 months after childbirth, regulations can be of different intensity and duration. That is also not a pathology, since hormonal changes to the “pre-pregnant” regime continue.

It has been noticed that most women who had algomenorrhea (painful menstruation) before pregnancy are relieved of these pains after childbirth, or at least the pains become much weaker.But it also happens the other way around – pain during menstruation after childbirth begins in those who have not experienced them before.

If there is the slightest concern about the restoration of the menstrual cycle after childbirth, including about pain, you need to consult a gynecologist.

Pain during urination after childbirth

Pain during urination after childbirth and an unpleasant burning sensation during this physiological process are very common in the first days of the postpartum period.

Often, women in labor are faced with such problems as the inability to empty the bladder due to the complete absence of urge. All of these symptoms have causes. The fact is that the space for expansion of the bladder after childbirth has increased, or during childbirth the bladder could be injured, then the urge may be absent for some time.

Pain during urination after childbirth leads to edema of the perineum, as well as soreness of the stitches imposed when stitching a tear or incision of the perineum.In any case, 8 hours after the completion of labor, the woman should empty her bladder. This is extremely important both for the contraction of the uterus and for preventing possible urinary tract infections.

If the pain during urination after childbirth continues even after the suture on the perineum has healed, then this is already a sign of trouble: inflammation of the bladder is likely, which is accompanied by an increase in temperature. In this case, you should immediately seek medical help.

Pain during sex after childbirth

Postpartum recovery normally takes at least two months. Before this period, doctors do not recommend resuming sexual relations between spouses. However, even after these two months, at least a third of women experience physical discomfort and even pain during sex after childbirth.

Vaginal pain after childbirth can be caused by various local infections that lead to inflammation of the genital mucosa, and this is what causes painful sensations during sex after childbirth.And the pain in the clitoris after childbirth is associated with its edema and the presence of sutures in the perineal region, especially after an episiotomy.

Diagnosis of pain after childbirth

For the timely identification of possible pathologies after the birth of a child, each woman needs to visit her doctor – one and a half months after childbirth. This visit will be useful even if the woman is feeling well and is not complaining about anything.

Examination by a gynecologist, first of all, will show how things are with a woman’s reproductive organs.The health of a woman largely depends on their health.

If there are any complaints, the diagnosis is made on the basis of the same examination and collection of anamnesis, including the history of labor management, which indicates all their stages, complications and manipulations performed.

If it becomes necessary to examine a doctor of another specialization (for example, an orthopedic neurologist, gastroenterologist, nephrologist), then the patient is given an appropriate referral. And then the diagnosis of the existing pathology is carried out by a narrow specialist – by appropriate methods.For example, for pubic pain after childbirth, the diagnosis of symphysitis or symphysiolysis is made on the basis of an examination using an X-ray or computed tomography.

Pain management after childbirth

Pain in the lower abdomen after childbirth will disappear on its own in a maximum of 7-10 days, but this will happen faster if the woman establishes normal emptying of the bladder, which will allow the uterus to contract.

Doctors say that you can use Panthenol spray (usually used to treat burns) for pain in the perineum after childbirth.This bactericidal and local anesthetic drug is used to accelerate healing for various injuries of the skin and mucous membranes and postoperative wounds. Panthenol is applied to damaged skin several times a day, it can be used during pregnancy and lactation.

In order to injure the seams on the perineum as little as possible, doctors recommend using not ordinary pads, but special postpartum ones, in which the top layer is made of a material that does not stick to the seam.

For spinal pain after childbirth and back pain after childbirth, exercise is recommended:

  • lying on your back, bend the right leg at the knee, the left leg remains in a horizontal position,
  • put the toe of the bent right leg under the calf of the lying left leg,
  • With your left hand, grab your right thigh and tilt your right knee to the left.

This exercise is performed 8-10 times, then the same is done with the left leg.

In case of back pain, try to bend less, do not lift anything heavy, during feeding, choose a position that is most comfortable for the back – with obligatory support under the lumbar region.

The task of paramount importance in the postpartum period is to get rid of constipation! Because problems with stool can increase pain in the coxus and sacrum. No laxatives, except – in extreme cases – enemas or glycerin suppositories. Best and safer – there are dried fruits, oatmeal, dairy products; take in the morning a tablespoon of sunflower oil, and on an empty stomach drink a glass of cold purified water without gas.

Remember that any laxative medication while breastfeeding will have the same effect on your baby. But constipation in the mother will also cause intestinal problems in the child.

But in the treatment of pubic pain after childbirth, especially in the case of a rupture of the pubic joint (symphysiolysis), bed rest, pain relievers, physiotherapy procedures and a pelvic bandage are needed to fix the bones. All this should be prescribed by the doctor – after the diagnosis is made.

Folk remedies for the treatment of pain after childbirth include decoctions and infusions of medicinal plants. So, shepherd’s purse is not only an excellent hemostatic, but also contributes to the contraction of the uterus. A decoction of a shepherd’s purse is prepared at the rate of one teaspoon of herbs per glass of boiling water (it is poured and infused for about half an hour). It is recommended to drink it three times a day for a tablespoon.

Aloe will help in healing perineal tears: the juice from the leaf is squeezed out onto a sanitary napkin.Reduce pain when cutting or tearing the perineum, and also soften breasts hardened from the rush of milk, compress with a decoction of ginger root: 50 g of ginger per liter of water.

And you can relieve a headache after childbirth with the help of essential oils (lavender, lemon, graperuit, basil, rosemary and lemon balm), with which they rub the temples, behind the ears and the area of ​​the cervical vertebrae.

If the pain after childbirth does not stop (or worsen) three months after the birth of the child, then you cannot do without treatment.But the use of any medications by a nursing woman, primarily painkillers, is unacceptable without a doctor’s recommendation!

Prevention of pain after childbirth

Postpartum pain prevention should be started during pregnancy. For example, in order to reduce postpartum pain in the lumbar region, expectant mothers need to engage in special fitness or aerobics in the water, master and correctly apply breathing techniques during childbirth. To avoid problems with pain in the spine, legs and muscles, you must strictly monitor your weight throughout pregnancy and prevent persistent swelling of the legs.

The postpartum period normally lasts six to eight weeks. During this time, the body of the woman in labor is rebuilt again, and her reproductive organs return to the prenatal state – they involution. Unfortunately, most women who have given birth experience pain after childbirth. But the pain quickly passes, and the joy of motherhood remains for life!

And so that pain after childbirth does not overshadow this joy, do not forget to consult with your gynecologist.His recommendations will help you bounce back and stay healthy faster.

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Drawing pain in the anus

One of the most common diseases in the field of proctology is pulling pain in the anal sphincter area. Often such pains are given to the perineum and lower abdomen, but can be localized in the rectum. In some cases, on the contrary, discomfort occurs in the abdomen, genitals and from there passes to the anus.

Causes of pulling pain.

Unpleasant sensations in the anal canal can be the result of any pathology or disease, that is, it can be, in fact, a symptom. But sometimes pulling pain occurs without any organic cause.

It should be noted that pulling sensations do not belong to the category of intense, that is, they are mostly characteristic of the chronic stages. The latter is understood as a form of development of the primary disease in which standard non-surgical methods of healing are ineffective.

Most often, pain in the anus occurs for the following reasons:

  • Proctological disorders – diarrhea, constipation, hemorrhoids, etc.
  • Cramps and spasms of the sphincter muscles.
  • Mechanical damage to the anus.
  • Ulcers and fistulas.
  • Oncological and infectious diseases.
  • Gynecological diseases and injuries – ovarian cysts, ruptures of the vaginal mucosa, etc.

Also, pain can be the result of injury or illness, pelvic organs, or diseases of the genitourinary system. In this case, the “true cause” is in another part of the body, and the anus gets uncomfortable because of the anatomical connection. In particular, pulling pain in the rectum often occurs in women on the first day of menstruation.

Anal pain relief.

Until the root cause of the pulling pain is established, simple measures can be taken to relieve discomfort.Among them:

  • Warm sitz baths with herbal infusions. This method is indicated in the presence of sphincter spasms and pain in the lower abdomen. If the pain is accompanied by inflammation of the hemorrhoids, the grass is replaced by oak bark, which has a wonderful tanning effect.
  • Local medications – ointments and rectal suppositories. Drugs with anti-inflammatory, healing effect relieve most of the pain http: // proktology-md.ru / anal-fissure and contribute to the cessation of anal spasms.
  • Physical exercises aimed at normalizing blood circulation in the pelvic organs and the anal region. However, this method does not include lifting weights, exercising on strong machines and with dumbbells.
  • Walks in the fresh air and normalization of food. The method is quite effective when pain occurs spontaneously and for no apparent organic cause.

However, having achieved relief and even disappearance of pain http: // proktology-md.