Perianal pain
Many people assume that pain in the anus equals piles. When they see a doctor, they complain, “Doctor, I have piles” instead of “Doctor, I have pain in the anus.”
In fact, there are many causes of pain in the peri-anal region (around the anus). The most common cause is probably an anal fissure. This is a split in the skin at the anus. The break is due to passage of hard stools through a tight anal sphincter (anus control muscle). There is sharp pain during passage of motion, followed by a small amount of bright, red blood. The pain subsides after the event; only to recur every time there’s passage of hard stools. The pain causes the anal sphincter muscles to get even tighter. This ends up as a vicious cycle of tight anal sphincter, hard motion and fissuring.
A view of a fissure, which is the red streak at 5 o’clock position. The surrounding anal skin looks a normal pearly colour.
The diagnosis is easily made by visual inspection of the anus. That’s all it takes. No further examination can be made until the fissure heals (because of the pain). After healing, further examination is justified to look for other causes of pain and bleeding deeper in the anal canal.
The treatment is to break the vicious cycle of tight sphincter - hard stools - fissuring. Adequate fibre in the diet and supplemented by syrup lactulose (makes stools soft) will go a long way to enable gentle passage of stools. An analgesic (i.e. a pain-killer) may be required during the acute, painful period of the fissure. Most fissures will heal with just these.
Some non-healing fissures may require more complicated therapy. To relax the anal sphincter, there are a few methods. One way is to apply glyceryl trinitrate (as used by heart attack patients) to relax the muscles. Another method is botox injection (same as the botox for treatment of facial wrinkles) into the muscle. However, the standard is an operaton to divide some of the fibres of the anal sphincter muscle in order to relax it.
Easy as toast. So, boys and girls, don’t say “Doctor, I’ve got piles.” Say, “Doctor, I’ve got pain, please examine me and see what’s wrong.” Tomorrow: another cause of peri-anal pain.
doctor, i got pain here, pain there, pain everywhere! (to be non specific lah)
LM, diagnosis: LCT.
Reminds me of an old granny who complained to me, “Pedih magang, nadai utai nadai pedih” (”Everything hurts, there’s nothing that doesn’t hurt”)
p.s. LCT = long chong thea. credit: my matron mia idea.
My pa had to undergo surgery for piles. What actually causes piles?
Ohh .. I suffered tht before when I was having bad constipation. Painful butt.
I wonder .. how those homosexual - gays to manage which I suspect or potentially is true that they utilize the part often in their relationship????
mott, in short, piles is caused by straining at stools.
There was an earlier post on piles. It says a little about the cause of piles.
hoiling, you’re right. anal-receptive sex can cause fissures.
Hi, hopped over via NyonyaPenang’s website. Your blog makes very interesting read especially for a self-proclaim “hypochondriac” like me. Will definitely come back. :o)
after the operation to divide some of the fibres of the anal sphincter muscle to relax it, will it compromise on the ability to ‘hold’ whenever there is a tummy ache? will it cause lau sai loke khor or not?
Fissures reminds me of volcanic fissures, and that means eruption at any time….meaning never overlook any little pain? but not to extent of getting paranoid of course
LOL, interesting choice of topics: the buttock region. I wonder if people are embarassed about this and hope for a quick fix from the doctor; resulting in them coming up with that ‘piles diagnosis’.
i had a patient , 27 yrs old, pregnant , complaining of piles..was treated everywhere and given Daflon for abt 6 months..n still complaining of bleeding every time at stool..she came to see me for the pregnancy actually…which i did a scan n bb was alright..i referred her to UMMC , n they found her to have cancer of the rectum…the patient was advised to terminate her pregnancy..which she refused..n has since gone home to Sarawak..i don’t know what happen to her after that….bleeding n pain does not necessarily mean piles..i agree w u bernard….
Firehorse, welcome anytime. “hypochondriacs” included.
nyonya, that is called “faecal incontinence”, meaning loss of control of the bowel movement. It’s a difficult problem to treat.
A “sphincterotomy”, meaning division of the sphincter does risk incontinence. The risk is reduced by performing a very conservative (as little as possible) division AND avoiding this procedure in patients with high risk of underlying sphincter problems (e.g. history of multiple deliveries or delivery by forceps etc.)
just me, no larr… a fissure is actually more of a bother than a danger. it’s just that treating it is more satisfying if the correct diagnosis was made.
jonzz, right on! that’s the actual reason why people just give the diagnosis rather than a complaint… to avoid the doctor from examining them.
eve, thanks for sharing this. what a sad situation. once you see this kind of patient, you’ll never forget.
Eve there are many cases as such! Assumptions are a sum of sins!
wow just realised your hosba article had 500 over hits. Now people know how beautipul kedah is!
mott, i forgot… there’s another post about piles which talks about preventing piles.
thanks doc!!! will check both out!!!
I keep getting pain in my anus, but apparently don’t have anal fissure - have seen the GP who says my sphincter is really tight and he gave me glyceryl trinitrate. The pain has been so bad it has made me cry. Currently, it’s a bit better, but there is quite a lot of pain when I need to break wind and also before I need to use the loo. My GP reckons it’s anxiety. Also, he examined my abdomen and reckoned I’m constipated, despite the fact that I eat loads of fibre. My stools are mostly very loose, and I get bouts of diarrhea about 2 or 3 times per month. I’m getting really sick of the pain and inconvenience. I don’t have any real worries - have a great marriage, lovely grown up daughter, no money worries. Help!
Perhaps the problem worrying you is the anus itself…
It would be helpful to know what your toilet habit is like… when do you go to toilet? How long? What makes you go? Do you feel satisfied after going?
I wonder whether there’s any discharge in the surrounding area.
I go to the toilet three times a day - after eating generally. I’ll go once, straight away, then ten mins, again, and 10 mins more or so again. I still don’t feel satisfied though. I always feel like I’ve just “taken the edge off it” as it were. My stools are usually very soft (I eat quite a high fibre diet and drink plenty of water). There isn’t any discharge as far as I’m aware. I reckon if I could have a good crap first thing I’d be fine! One doctor, last year suggested fybogel to give my system something to work against, but I felt terribly constipated with this and passed really thin unsatisfying stools, and felt so bloated I gave it up after a couple of days. Sometimes, say, two or three times per month, I’ll have a day or two when I really get bad diarrhea - watery explosions - several in succession - I guess this really doesn’t help things - may be connected to my menstrual cycle (which is pretty normal I think - have never consulted a GP about menstrual problems - also am not on the pill). I’m 43 by the by and still having very regular periods.
My GP asked if this happened during sex - it doesn’t, but then being in so much pain hasn’t made me feel like it lately anyway to be honest. I don’t have anal sex by the way.
Of course, being in lots of pain isn’t exactly conducive to relaxation! I’m not actually worried too much about the problem as such (other than it’s disturbing my life and preventing me from doing as much as I’d like) but I suppose it can’t be anything serious as there has been some improvement.
Pain seems to occur as its worst when i need to break wind/use the loo. When I’m preparing lunch, at say 11.00/11.30, it’ll start hurting. Breaking wind helps to ease the pain, and then more or less as soon as I’ve eaten I’ll need the loo.
Driving is particularly uncomfortable. Sometimes the pain/ache seems to be my whole coccyx area. I don’t pass blood as far as I am aware., but in the past have had one or two small spots on the loo paper.
I’m going to see my GP in a couple of weeks again (he said to come back to update him on what’s happening).
Does this make things any clearer?
Also, I wake up during the night in pain and unable to sleep, needing to break wind. It’s not easy to get it out and I have to pull my knees up to my chest. The pitch of the wind isn’t necessarily very high, although is sometimes. Am so knackered from lack of sleep now!
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