Experiencing a painful bowel movement is never a pleasant experience. It can also be referred to as straining to defecate, painful intestinal cramps, and pain while defecating. Typically, when you pass stool, it should be neither painful nor difficult, but require minimal or moderate effort without inducing pain. Having pain before and during bowel movement is considered an abnormal occurrence and can signify an underlying process affecting the defecation mechanism and your digestive tract as a whole.
Having painful bowel movements on a consistent basis should raise some suspicion for an underlying process, as there are a host of causes. Some are benign in origin while others are related to more serious conditions.
Infections: The most common cause of acute bowel symptoms. The seasonal flu and viral gastroenteritis are just some causes of sharp pain before a bowel movement, prompting you to scramble to find the nearest bathroom available. Most cases of infection are not serious, typically resolving on their own with adequate fluid and bed rest. However, some bowel infections may require medical intervention. Common infections include:
Gastroenteritis: Inflammation of the gastrointestinal tract may be caused by bacteria, viruses, or protozoan.
Food poisoning: Caused by the consumption of contaminated food with microbes or its toxins.
Clostridium difficile: Due to an imbalance of gut bacteria caused by antibiotic use.
Intestinal worms: Produce symptoms of excessive hunger, abdominal pain/cramping, diarrhea, and constipation.
Diverticulitis: Infection of an abnormal outpouching in the colon known as a diverticulum, commonly found in the elderly population.
Proctitis: Inflammation of the lining of the rectum.
Injury: Can be mechanical, chemical, or electromagnetic injury causing inflammation of the bowel wall. Isolating which of these types of injury has occurred may be difficult, as they tend to present in a similar fashion. Examples of injury include blunt force trauma, radiation exposure, and poisons.
Immune: Conditions that cause the body’s own immune system to attack healthy tissues are called autoimmune diseases. When the focus of attack is the bowel or digestive tract, it can lead to pain before and during bowel movements. The most common immune-related bowel conditions are Chron’s disease, ulcerative colitis, and celiac disease.
Circulatory: Blood flow is required for all tissue in the body to operate and function properly. If blood flow is restricted for any reason (also known as ischemia), it will lead to pain and death of the involved organ tissue. Ischemic bowel disease can affect any part of the small and large intestine, leading to severe abdominal symptoms. It can cause pain related to bowel movements that can increase over time if not treated.
Drugs & Toxins: A source of chemical injury to the bowels, excessive and strong bowel contractions, as well as possible bleeding from the bowel wall. These substances include laxative abuse, poisoning with insecticide or pesticides, and nerve gas.
Other: These may include irritable bowel syndrome (IBS), some colorectal and anal cancers, lactose intolerance, and short bowel syndrome.
Anal intercourse, vigorous cleaning or wiping of the anus, accidental injury, enemas, or even the passage of hard stool during cases of constipation can all lead to anorectal injury. Also, the insertion of foreign bodies into the anus or rectum may cause trauma and contribute to severe pain.
A collection of pus that develops near the anus. They are commonly a result of an infection of small anal glands, the most common of which is a perianal abscess. Abscesses on the anus appear as painful boil-like swelling, possibly red in color and warm to the touch. However, anal abscesses may be less visible when developed in deeper tissue.
A small channel or tube-like connection between the end of the bowel and the skin near the anus. Anal fistulas can bleed and discharge when passing stool as well as becoming very painful. They are also a common complication of anal abscess surgical removal. Surgery is often the only treatment option for anal fistulas.
Inflammation is a normal bodily process that is initiated by the immune system. If it occurs in the lower part of the gut and pelvic organs, it can contribute to pain during the defecation process. Inflammation may occur for a number of reasons and can affect virtually any part of the gastrointestinal tract. This includes the rectum (proctitis), colon (colitis), prostate (prostatitis), bladder (cystitis), and small intestine (enteritis). The following are common inflammatory conditions that may cause painful bowel movements:
Those who suffer from bouts of diarrhea or constipation can have irritation of the lining of the rectum and anus, contributing to painful defecation. Specifically, constipation may contribute to painful bowel movements as it often causes excessive straining due to dry hard feces. This can also lead to the development of hemorrhoids and fecal impaction.
Tears in the lining of the anus are referred to as anal fissures and are commonly caused by constipation or even trauma to the anus. Anal warts are associated with the human papillomavirus (HPV) and are commonly sexually transmitted. Hemorrhoids are swollen and inflamed blood vessels in the lower rectum or anus. All of these conditions can cause pain with defecation.
Those involving the skin around the perianal area, anus, or that extend slightly into the anal canal can lead to pain during defecation. Skin conditions include psoriasis, eczema, cellulitis, necrotizing fasciitis, and fungal infections.
Polyps of the colon are one of the most common growths within the colon, causing altered bowel habits. They can either be benign or malignant in nature, with the worse outcome leading to colorectal carcinoma. Large tumors involving other organs in the pelvic cavity may also cause pain on defecation and include uterine cancer, cervical cancer, prostate cancer, and bladder cancer.
Surgical drainage of the abscess before it erupts is the recommended treatment for anal abscesses. Depending on the size and location, drainage can be done in a doctor’s office for superficial anal abscesses under local anesthetic, or you could be admitted to the hospital for abscesses that are larger or located deeper. Once drained, patients are often given pain medication for relieving pain and antibiotics.
Fistulotomy: Used in 85–95 percent of cases, the procedure involves a surgeon cutting open the entire length of the fistula and flushing it out. Healing usually only takes about a month or two.
Seton techniques: Utilizes a piece of a thread called a seton, which is left in the fistula tract and is usually done if you are at high risk of developing incontinence when the fistula crosses the sphincter muscles. Several operations may be necessary.
Advancement flap procedures: Done in complex fistula cases or when there is a high risk of incontinence. It is done by removing a piece of tissue from the rectum or from the skin around the anus and attaching it to the opening of the fistula once it has been removed. The flap procedure is successful in about 70 percent of cases.
Fibrin glue: The only non-surgical option and involves the use of a glue that is injected into the fistula to seal it, with the opening then stitched closed. Initial success rates as high as 77% drop to 14% after 16 months.
Bioprosthetic plug: Uses a cone-shaped plug made from human tissue to plug the internal opening of the fistula.
Depending on the cause, colitis treatments will differ. However, despite this, to stabilize people in cases of undiagnosed or uncontrolled colitis, initial treatment will involve rehydration and pain management.
Management involves reducing inflammation, pain control, and treating the infection. if there is an associated underlying condition, such as a sexually transmitted infection, specific treatment for that cause will also be implemented. If your case of proctitis is due to ulcerative colitis or Chron’s disease, immunosuppressant medication or every surgery may be indicated.
Serious medical conditions causing painful bowel movements should be diagnosed and treated by a trained medical professional. If you have been assured that this is not the case for you, pain caused by defecation can often be affected by changes to your diet and lifestyle.
Cutting down on processed foods that lack nutrients, fiber, and enzymes necessary for healthy digestion should be the first order of business. Instead, choose to incorporate more dietary fiber and drink plenty of water to stay hydrated. These two simple changes can help bulk up the stool and keep it soft for easy excretion. Raw vegetables are a great source of fiber with the added bonus of containing up to 70 percent in water volume.
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