By Dr Uwakwe-mangse Hanna (MBBS, MRCS)
I doubt if there is any human who had not and will not experience some form of anal pain of some sort in their life time and to be honest a pain in the back side could be a very distracting and daunting one.
No matter how distressing it may be it is often just the result of a minor, treatable condition.
The medical name for pain in and around the anus or rectum (back passage) is PROCTALGIA.
CAUSES OF ANAL PAIN
There are many causes of anal pain but I will list them out and discuss the very common ones.
•Anal fissure (a small tear in the lining of the anal canal)
•Anal itching (pruritus ani)
•Anorectal fistula (an abnormal channel between the anus or rectum usually to the skin near the anus)
•Coccydynia or coccygodynia (tailbone pain)
•Crohn’s disease (a type of inflammatory bowel disease)
•Diarrhea (causing anal irritation)
•Fecal impaction (a mass of hardened stool in the rectum due to chronic constipation)
•Hemorrhoids (swollen and inflamed veins in your anus or rectum)
•Levator ani syndrome (spasm in the muscles that surround the anus)
•Perianal abscess (pus in the deep tissue around the anus)
•Perianal hematoma (a collection of blood in the perianal tissue caused by a ruptured vein, sometimes called an external hemorrhoid)
•Proctalgia fugax (fleeting pain due to rectal muscle spasm)
•Proctitis (inflammation of the lining of the rectum)
•Solitary rectal ulcer syndrome (ulcer of the rectum)
•Thrombosed hemorrhoid (blood clot in a hemorrhoid)
•Ulcerative colitis (a type of inflammatory bowel disease)
•Ulcerative proctitis (a type of inflammatory bowel disease)
The more common ones that I will discuss are Anal fissures, Haemorrhoids, Anal fistulas and abscess while the 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, ulcerative colitis – 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.
An anal fissure is a small tear in the skin of the anus that can be caused by passing a large or hard poo.
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 persists, you may need special ointment that relaxes the ring of muscle around your anus.
Occasionally, surgery may be needed to help the fissure heal.
If you have experienced this, my advice is to go see a doctor.
Haemorrhoids (piles) are swellings containing enlarged blood vessels that are found inside or around the bottom. They’re often thought to be caused by straining on the toilet as a result of prolonged constipation.
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).
I will do an article on this next week just to give more insight on it.
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 doctor 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.
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 doctor.
But it’s a good idea to see your doctor 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 doctor – anal pain is a common problem that they’re used to seeing. Your doctor can try to work out what the problem is and give you treatment advice.
They’ll probably ask to see your bottom and may carry out a rectal examination (where they gently insert 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 (colorectal surgeon) for advice and further tests.
See You next week where I will discuss Haemorrhoids or Piles in detail.
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