Overview of Anal Pain: Symptoms, Causes & Prevention

Anal Pain refers to any pain felt around the anus and rectal area. Pain in this region can be excruciating and extremely distressing. There are many causes for such a kind of pain, each having its own treatment. Anal Pain is a symptom that must not be ignored. Prompt medical attention helps in better treatment outcomes.

Read ahead to know more about its symptoms, causes, and prevention methods.

Rectum and Anal canal

The rectum and anal canal are the regions that are at the end of your digestive tract. They are the end portions of the large intestine, the main function of which is to collect faecal matter and expel it.

To examine the anal canal, your doctor will have to first inspect the outside region before performing an examination. This is usually done using the fingers. It is done under careful precautions, using a numbing medication so as to decrease pain.

The doctor may also use an instrument called a proctoscope which allows them to view inside the canal. You will usually be asked to lie on your left side, with your knees folded to your chest. It is a quick procedure done with precaution using anaesthetising ointment to eliminate pain.

Common causes of Anal Pain and treatment

Here is a summary of some of the most common causes of Anal Pain along with their treatment.

1. Anal Fissures 

One of the commonest causes of Anal Pain is due to anal fissures. A fissure basically refers to a crack or break in the skin and lining tissue of the anal canal.

This can occur due to:

• Hard impacted stools

• Constipation

• Straining to pass stools

• Frequent diarrhoea

• Direct injury to the canal

Once a wound has occurred, every time the person passes motion, the stretching, opening and closing of the anus can result in severe pain. Anal fissures may also be associated with rectal bleeding and a small skin tag near the opening. 

The treatment for fissures can be conservative, with the use of ointments or creams which anaesthetise the area and also usually have a anti-spasm component which helps relax the area and decrease pain.

The immersion of the bottom end in warm water in a basin, also called a Sitz bath, is also recommended. If it does not resolve with this, or if it recurs, it may require surgical treatment.

2. Anorectal or Perianal Abscess

The anal canal has many anal glands around it which drain into it, and these glands may become infected and collect pus resulting in the formation of an anorectal abscess. An abscess is a collection of pus, dead tissue and infected material.

Anorectal abscesses are usually painful. They present as dull, throbbing pain over the anal and surrounding region, and it may be painful to sit. Associated symptoms usually include fever, constipation, pus draining through the anus, and swelling of the region.

People with compromised immune systems, like diabetics, people on steroid therapy, etc., are more susceptible to these infections.

The treatment of an abscess involves surgical drainage of the pus collection through a procedure known as incision and drainage, along with subsequent treatment with antibiotics.

3. Haemorrhoids or Piles 

Haemorrhoids refer to a condition where there is swelling of the veins of the anal canal, which can fall out into the anal canal. This tissue can also get infected causing pain. 

Most patients with piles initially complain of Anal Pain and bleeding while passing stools. Some common causes of piles include constipation, frequent diarrhoea, pregnancy, etc. 

Treatment for haemorrhoids includes measures like fibre rich diet to prevent constipation & hard stools, local ointments for pain relief and sitz bath. Simple surgical procedures like ligation and sclerotherapy can also be done, which are used to remove the haemorrhoid.

4. Anal irritation

Anal irritation, or Pruritus ani, refers to any irritation of the anus, triggering the person to itch the region. There are multiple causes for pruritus ani, which includes poor hygiene of the region with residual faecal matter over the area, infections with parasites and yeast, skin disorders like psoriasis, fissures, haemorrhoids, etc.

The treatment for anal itching mainly involves keeping the area clean and dry after passing stools. If there is a specific underlying cause, that has to be treated for relief of symptoms. Local creams and ointments can be prescribed to alleviate symptoms. Maintaining good bowel health is also important.

4. Inflammatory Bowel Disease (IBD)

Inflammatory bowel disease refers to a group of autoimmune diseases that affect the digestive system. It includes two diseases, called Crohn’s disease and Ulcerative colitis. Anal Pain in case of Inflammatory Bowel Disease is usually seen along with:

• Abdominal pain

• Bleeding rectally

• Blood in stools

• Passage of mucoid stools

• Feeling of incomplete defecation

• Weight loss 

IBD is a bigger disorder that requires blood tests, CT scan imaging, colonoscopy and biopsy of tissue. The treatment includes the use of steroids and immunomodulating medications, lifestyle modifications, and surgical intervention.

5. Anal Cancer

Cancer of the anal canal and rectum can present with Anal Pain. Other symptoms that can occur in anal cancer include:

• Change in bowel habits

• Lump or mass in the anal region

• Bleeding 

• Itchiness

• Loss of weight

• Diarrhoea

• Anal discharge

The diagnosis and treatment of anal cancer requires blood tests, CT and PET scans, colonoscopy and biopsy to confirm the type and spread of cancer. The treatment involves a combination of chemotherapy, radiation, and surgery depending on the severity and staging of the cancer. A known causative factor for anal cancers is HPV infection, and hence vaccination is recommended as a preventive measure.

6. Levator Ani Syndrome

Levator ani is a muscle present in the pelvis. This muscle can get spasms which can present as Anal Pain. It is usually a dull, aching, long lasting pain. The discomfort can be managed with pelvic relaxation techniques, anti-spasm medicines, botox injection to the muscle, therapeutic ultrasound therapy etc. 

Prevention of Anal Pain

Many anal disorders are caused by altered bowel habits, more commonly constipation. There are some simple steps you can follow at home to prevent constipation: 

• Eat a diet rich in fibre, including fresh fruits and vegetables

• Avoid eating processed foods such as breads, biscuits, cakes, etc. that are made of refined flour and are difficult to digest.

• Drink 2 to 3 litres of water every day

• Include regular exercise as a part of your daily schedule

• Avoid drinking alcohol and smoking

• Do not resist the urge to pass stools

• Patients often find it easier to pass stools when they improve their posture on the toilet by using a stool to raise their feet or leaning back.

Frequently Asked Questions (FAQs)

Here’s a list of common questions and their answers related to Anal Pain.

What should I keep in mind while visiting a doctor for Anal Pain?

Do not hesitate to visit a doctor or feel conscious or embarrassed to share your concerns. Details about any change in frequency, colour or consistency of stools are helpful too, so try to answer the questions asked by your doctor as clearly as possible. Being relaxed will also make it easier for your doctor to examine you and reach the diagnosis faster.

Can I ignore Anal Pain?

Anal Pain must not be ignored. Sometimes it may cause slight bleeding that goes unnoticed at first but can result in weakness and other symptoms. 

Can lifestyle changes help in dealing with Anal Pain?

Most of the common causes of Anal Pain can be effectively treated with lifestyle changes and topical creams. In some cases, your doctor may also prescribe a laxative to soften the stools and reduce pain. More serious cases may require surgical intervention.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. Please consult a doctor before making any health-related decisions.

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