Granted, this is a pretty icky topic… but discomfort in the tush is not something to take sitting down. Anal pain is such a bother that, of course, we want to know how to get rid of it — but more importantly, we need to know when it might signal a serious problem that needs medical attention.
Bruce A. Orkin, MD, chief of colon and rectal surgery at Tufts University School of Medicine, outlined causes of anal discomfort and offered guidelines on what to do. If you experience…
Itching. The likely diagnosis is pruritus ani, caused by excessive moisture or residual stool in the anal area. “Do not scratch or scrub the area with soap and a washcloth — you could damage the skin and wash away protective oils,” Dr. Orkin advised. Do: Wash gently with warm water and moistened toilet tissue or with unscented baby wipes, then pat dry. If symptoms don’t subside within two weeks, see your doctor — itching could be a mild sign of any of the other conditions below.
Sharp pain. You may have an anal fissure, a small tear in the lining of the anal canal. Fissures usually are caused by straining to pass hard, dry stools. Along with knifelike pain when moving your bowels, you may notice some bright red blood on the outside of the stool or on the toilet paper — so alert your doctor without delay. Fissures usually are not a serious health threat, but any rectal bleeding should be investigated as a possible sign of cancer, inflammatory bowel disease or another disorder.
“Most fissures heal on their own if you keep stools soft, so eat a high-fiber diet, take a daily fiber supplement and drink at least six glasses of fluids each day,” Dr. Orkin said. To ease pain, sit in a warm bath for 10 minutes twice daily and use nonprescription topical anesthetic cream. For persistent or severe symptoms, a prescription calcium channel blocker ointment can promote healing by relaxing anal muscles and increasing blood flow to the area. Occasionally, surgery is needed.
Increasing tenderness and swelling. This suggests a perianal abscess, in which bacteria infect and block a gland just inside the anus. You also may notice a warm lump and, eventually, a discharge of pus. See your doctor without delay — an untreated abscess could lead to damage to the anal muscles or to a bodywide infection. Surgically opening the abscess to drain the pus provides immediate relief. Unfortunately, about half of patients develop a new abscess or an anal fistula, an abnormal channel that runs from the affected gland within the anal canal to the skin outside the anus. A fistula must be treated with surgery.
Protrusion. A soft bump that slides out of the anal opening (typically during a bowel movement) and then back in (on its own or when pushed) is most likely a prolapsing internal hemorrhoid, a bulging blood vessel with a loose overlying mucosal lining that protrudes from the anus. These often disappear when you increase fiber and fluid intake.
A firm, rubbery, painful lump that develops quickly at the outer edge of the anus suggests a thrombosed external hemorrhoid. Pain usually goes away within a few days (in the meantime, warm baths may bring relief)… the lump may remain for several weeks. If pain is severe or persistent, see your doctor to discuss treatment options, including surgical removal.
Could it be cancer? See your doctor if you have any persistent, firm lump in the anal area… ongoing anal pain… bleeding or discharge from the anus… and/or persistent narrowing of the stools. These are possible warning signs of anal cancer or rectal cancer. Remember: The earlier cancer is caught and treated, the better the outcome is likely to be.
