“Why does it hurt so much when I poop?”
Rectal pain is one of the most common symptoms encountered in my office. A common cause of rectal pain during bowel movements is external hemorrhoids. However – this is not always the case.
I cannot stress enough how many patients enter my office thinking they have symptomatic hemorrhoids and don’t understand why their pain has not improved after applying over-the-counter creams for months before seeking help.
Why isn’t it helping? These patients may have an anal fissure, which is treated with completely different medications than external hemorrhoids. In addition, many patients do not understand the importance of controlling the lifestyle behaviors that exacerbate conditions like hemorrhoids and anal fissures – such as constipation and straining on the toilet – in order to achieve long-term symptom relief.
Another less common cause of rectal pain during bowel movements is levator muscle spasm, a form of pelvic floor dysfunction, which also has its own treatment.
Bottom line: your rectal pain may be related to the more commonly known external hemorrhoids, but there could be other causes that should be ruled out by a specialist.
“What is coming out of my butt?”
The sensation of tissue slipping out of the anus (tissue that should be internal) is known as prolapse. The most common cause of prolapse is enlarged internal hemorrhoids. External hemorrhoids, which are located just outside the anus, are covered with skin and tend to cause severe pain when they are enlarged. Internal hemorrhoids are located just inside the anus and are covered with the slimy mucus lining similar to the rectum.
When internal hemorrhoids become enlarged, they cause bleeding and also prolapse. Chronically enlarged internal hemorrhoids become increasingly elastic, and even a small amount of straining on the toilet can cause them to prolapse.
Patients commonly report that they feel something slip outside the anus, and this tissue either spontaneously goes back inside or they have to manually push the tissue inside. They complain of drainage that is described as mucus if they do not reduce the prolapse. Treatment of the hemorrhoids is imperative to alleviate the prolapse, and may require surgery depending on the severity of the problem.
Another cause is rectal prolapse, during which the entire rectal wall prolapses out from the anus, which tends to be larger and described by many patients as a “large ball” falling out of their anus after bowel movements.
Rectal prolapse is most commonly seen in older women, particularly those who have a history of chronic constipation with straining for many years and/or pelvic floor trauma (think multiple vaginal deliveries).
It is important to differentiate between hemorrhoid and rectal prolapse, as the treatments are different, and early recognition of rectal prolapse will lead to more prompt intervention and better outcomes with treatment.
“Why am I leaking stool?”
One of the most embarrassing topics for patients to gather the courage to discuss is fecal incontinence – the unintentional loss of stool. This condition is actually more common than most know. Many patients suffer in silence for years out of embarrassment before seeking help. Accidents can occur with warning, which patients describe as feeling the urge of a bowel movement – and they are unable to hold it in long enough to make it to a toilet.
The episodes can also occur without warning, during which stool will spontaneously leak out from the anus and often is not noticed until the patient recognizes they have soiled themselves. Fecal incontinence is typically multifactorial and has many potential causes. Although embarrassing to acknowledge and discuss, there are many treatment options available depending on the factors leading to the incontinence. Patients need to know they are not alone and that help is available.
Dr. Kristin Vercillo is a board-certified colon and rectal surgeon with Advocate Condell Medical Center. A specialist in proctology, minimally invasive colon surgery and anorectal surgery, Dr. Vercillo sees patients in Libertyville.
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