Painful bowel movements: What does sharp pain, burning, itching or pressure mean?

Pain during bowel movements can be a symptom for various diseases in the anal area. Painful defecation is many times a symptom for various diseases. It does not have to be directly related to the rectum, it can also be of a gynaecological or genital nature.

Depending on whether pain is the only symptom or whether other symptoms can also be observed, it can be determined whether it is a serious condition that needs to be referred to a doctor or a transient problem.

Pain during defecation without other symptoms, except perhaps the occasional appearance of blood in the stool, is very likely to be due to anal disease. The less serious ones are haemorrhoids or fissuring.

Haemorrhoids and pain

Hemorrhoids are caused by a disturbance in the functionality of the vascular plexuses in the rectal area. This is the basis for the formation of nodular dilations of blood vessels. They can be internal or external.

Associated difficulties:

• discomfort in the anal area
• itching of the rectum and its surroundings
• feeling of pressure, tension in the rectum
• pain, especially with inflammation, skin irritation and persistent prolapse of the internal haemorrhoid
• bleeding, blood on toilet paper
• rectal discharge, mucus secretion
• stool discharge due to sphincter leakage and soiling of the underwear by stool
• output of the golden vein when pushing on the stool
• swelling in the rectal area
• redness to fissure in the area of the anus
• constipation 

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Hemorrhoids: Symptoms and treatment

The appearance of hemorrhoids is conditioned by:

• age, people over 50
• sedentary job
• lack of exercise
• reduced fluid intake
• diet deficient in fibre
• alcohol
• low temperatures
• psychological factors, stress, tension

In addition to surgery, it is necessary to change the diet of the affected person in the future by increasing the fibre content. Conservative treatment also includes an increase in fluid intake, anal hygiene, treatment with ointments and suppositories.

Anal fissure and pain during defecation

Fissura ani, i.e. anal fissure, is a small tear in the lining of the anus. These fissures are frequent and painful during defecation. The pain is caused by mechanical damage.

It can be acute or chronic. The acute form is characterized by disruption of the surface epithelium. The chronic form affects the entire thickness of the mucous membrane of the anal opening.

Outpatient treatment is preferred because the patient is given, for example, anal plugs and dilators. Part of conservative treatment is dietary modification with regard to proper stool consistency. Surgical treatment is on the decline.

Diseases of the reproductive system as a cause

It is also important to monitor for other symptoms. If there is pain in the lower abdomen, when urinating and increased body temperature, it may be uteritis, which is a fairly common disease in women.

Inflammation can be located in different parts of the uterus, whether in the musculature, mucosa or throat. In most cases, the disease is caused by a bacterial infection. Here, soreness in the lower abdomen is present, and pain is present when passing stool, which is only one of the symptoms of the disease.

Sexually transmitted diseases can manifest as pain when passing stool. Infections get into the area around the anus and cause painful inflammation and infection. Examples are gonorrhea, syphilis, genital warts and herpes. 

Other issues and conditions

Sometimes rectal pain when defecating is also manifested by tumours in the rectum, but also, for example, irritable bowel syndrome, which is a functional problem. So, these other issues may be serious and less serious conditions.

Radiation proctitis is a complication of radiation therapy for cancer, especially in the treatment of diseases in the pelvis. In addition to pain, bleeding, diarrhea and other discomforts may be associated.

Difficulty, and pain when passing stools, also arise with constipation, in which case hard stool is hard to pass through the anus. As a consequence of constipation, the aforementioned hemorrhoids and also fissure are formed.

The rectum is also affected by minor infectious and inflammatory diseases, which can be acute or chronic. Pain also occurs in ulcerative colitis or Crohn's disease.

In the same way, the problem may also be in the small intestine. If the pain is more prolonged and other complications, such as blood in the stool, are observed, there is no need to hesitate to visit a doctor.

Pain may be caused by:

• hemorrhoids
• fissure - anal tear
• constipation
• diarrhea
• inflammation in the genital area, prostate, uterus, vagina, skin
• irritable bowel syndrome
• inflammatory bowel disease, Crohn's disease or ulcerative colitis
• sexually transmitted diseases such as syphilis or chlamydia, warts, HPV infection
• tumour/ cancer