Introduction
Pain in the area of the anus is relatively common. The causes can be varied and range from harmless irritation of the mucous membranes to diseases requiring treatment such as anal venous thrombosis. Many affected persons avoid going to the doctor out of shame.
The discreet and professional approach of the doctor, however, quickly removes the reservations of those affected and allows fears and feelings of shame to take a back seat. A more precise clarification by a specialist is indispensable, especially in the case of prolonged pain, painful pain, bloody stools, weight loss or night sweats. The underlying cause can be found by the family doctor or by a specialist for rectal diseases, the so-called proctologist, and then a targeted treatment can be started.
Causes for pain in the anus
Other causes of pain in the anus include
- Hemorrhoids
- Tears in the mucous membranes
- Anal venous thrombosis/perianal venous thrombosis
- Anal abscess / Perianal abscess
The most common cause of pain in the anus region is hemorrhoids. Hemorrhoids are swollen veins located in the rectum. Often a weakness of the connective tissue is responsible for the formation of hemorrhoids.
Hemorrhoids are subdivided according to their location, spread and size. The spread and size does not necessarily determine the suffering of the affected person. It is therefore quite possible that small hemorrhoids cause more severe symptoms than large ones.
Depending on their size, hemorrhoids can be palpated and seen in the area of the anus. They can protrude visibly from the intestine. Depending on the severity of the problem, a manual repositioning can then be performed.
Hemorrhoids are often associated with itching, burning (see: burning at the anus) and pain in the area of the anus (see: Hemorrhoid symptoms). Very strong pressing while going to the toilet or during a firm bowel movement can cause the hemorrhoids to tear open and lead to bleeding in the intestinal area. Today, treatment is rarely surgical.
As a rule, ointments are used which cause the bulging veins to contract. Cooling and preventive measures help to alleviate the discomfort in the anus. The stool should be kept soft to avoid strong pressing.
A healthy diet rich in dietary fibre and a sufficient amount of drinking fluid helps here. Other causes of pain in the anus region can be small tears in the mucous membrane, which are called fissures in medical terminology. They usually occur on the outer edge of the anus and can be a few millimeters to almost a centimeter.
Fissures can be caused by very firm bowel movements or by strong pressing during defecation, but in other cases the cause remains unknown. Fissures in the mucous membrane of the anus can be extremely painful. Especially the bowel movement is perceived by affected persons as extremely unpleasant, because the stool has to pass the fissure during excretion and as a result further or even deeper fissures can occur.
Furthermore, a blood clot in a small vein in the area of the anus of a so-called anal venous thrombosis or perianal vein thrombosis can cause pain in the anus. The clinical picture is comparable to a thrombosis of the legs. However, swelling, which is typical for a thrombosis of the leg, is rather rare.
In the foreground are mainly pulling or also pressing pains in the area of the anus. The pain occurs mainly when sitting and is usually intensified by going to the toilet (especially if the stool is firm). The pain of anal venous thrombosis can be so severe that sitting becomes largely impossible.
Whereas anal venous thrombosis was almost always operated on in the past (for example, the vein in the anus was cut and the blood clot was cleared out), today people have become more reluctant to undergo surgery. In many cases, the symptoms and also the thrombosis in the anal vein disappear again by themselves within a few days. However, if the symptoms persist or become worse, a proctologist should be consulted.
Sitting baths, cooling pads and exercise can help relieve the pain. The stool should be kept soft to facilitate excretion. Furthermore, treatment with Bepanthen® ointment can also be helpful.Anal pain can also be caused by more serious causes, such as anal abscess or perianal abscess (when the abscess is adjacent to the anus).
An abscess is a cavity filled with pus and inflammatory fluid. It occurs when bacteria (mostly staphylococci) overcome the skin barrier and enter the body. To prevent further spread, the body forms a shell around the bacteria.
Immune cells begin to fight and decompose the bacteria, which eventually leads to the known pus formation. Abscesses are conspicuous by a swelling, which can be painful under pressure. In some cases, the pain caused by an anal abscess is so strong that sitting is hardly possible for those affected.
For the therapy of small abscesses, e.g. pulling ointments can be used. For the treatment of larger abscesses surgery is usually necessary. The abscess is removed under general anesthesia.
The postoperative wound is usually left open and must be showered out regularly by the patient in the postoperative treatment. Wound healing is often slow and can take up to 6-8 weeks. A dreaded consequence of an abscess is the fistula at the anus.
A fistula is a duct that has attached itself to an abscess and can reach deep into the body. A fistula can also cause pain in the area of the anus. Fistulas almost always require surgery because the ducts carry the risk that the bacteria can spread into the depths of the body. Fortunately, fistulas in the area of the anus are not common. In the case of a known abscess formation, an ultrasound scan is usually used to check whether a fistula has already formed.
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