Bowel movements are normally associated with sensations of urgency caused by contractions of the bowels. These sensations are due to the passage of feces through the colon (large intestine) and into the rectum in preparation for defecation. The pressure sensations increase in intensity as the feces pass into the rectum, urging the person to quickly adopt the appropriate defecating position. Defecation finally releases the pressure sensations in the bowels and is accompanied by a sensation of relief.
Pain is not a normal sensation associated with bowel movements and should not occur either before or during the bowel movements. Even the most intense sensations of urgency associated with normal bowel movements are not painful. When pain does accompany bowel movements, it should be investigated promptly since it indicates some underlying disease, injury or disorder. In some cases, the cause of the pain could be temporary and may go away on its own. In other cases, however, the cause could be serious and can lead to life-threatening complications if left untreated.
Pain is a symptom and may be accompanied by a host of other symptoms can be associated with pain during bowel movements:
- Diarrhea or constipation may accompany the painful bowel movements.
- Mucus or blood in the feces may be seen either during wiping or as blood staining in the toilet.
- Abdominal cramps may also be associated with the pain.
- Excessive flatulence may also occur before or during painful bowel movements.
Causes of Pain Before and During Passing Stool
Painful bowel movements can occur due to a number of different causes. Some of these causes are minor and temporary, whereas others are serious and persistent. In some cases, the exact cause of pain before bowel movements may not be obvious. The following are some of the conditions associated with pain before or during bowel movements:
Infections of the bowel are the most common cause of pain associated with bowel movements. Viral gastroenteritis is the most common cause of complaints of acute abdominal pain with diarrhea, nausea and sometimes vomiting. Gastroenteritis can also result from bacterial or protozoal infections. All of these infections are usually self-limiting and go away on their own within a week but in rare cases can persist for longer.
Food poisoning, caused by consumption of foods contaminated with certain pathogens and toxins, is also a common cause of pain in the bowels. The pain and diarrhea associated with the bowel movements in cases of food poisoning are usually self-limiting. In some cases, however, the condition might be serious enough to warrant medical intervention.
Intestinal worm infestation is also a less common cause of pain associated with bowel movements as these infestations are usually asymptomatic (without symptoms) or the symptoms are very mild For example, fluke worm infestations are associated with constant hunger, abdominal cramps and diarrhea. Sexually transmitted diseases could also lead to infections that result in pain during bowel movements. Proctitis is an example of such a condition.
Injury to the bowels can occur due to a variety of factors. For example, radiation therapy for cancer could affect the lining of the intestines. Certain drugs or toxins could lead to inflammatory reactions that injure the intestine. Injury to the bowels could also result from physical trauma in violent physical attacks or vehicle accidents. Less commonly, injury may occur during diagnostic procedures and sometimes during surgery. In many cases, it is relatively easy for the physician to isolate the trauma that is causing the pain during bowel movements.
Immune system disorders
A malfunctioning immune system could also be the cause of painful bowel movements. A common example is inflammatory bowel disease (IBD) that causes ulcers or sores in the intestinal lining. Inflammatory bowel disease is classified into two types: ulcerative colitis and Crohn’s disease. IBD is a serious condition and certain types may increase the risk of colon cancer.
Celiac disease is another example of an immune disorder that affects the bowels. In this case, the trigger is the gluten protein found in wheat. Ingestion of foods made from wheat triggers an immune reaction that results in damage to the intestinal lining and causes painful bowel movements.
Restricted blood flow to the intestine could also result in conditions that cause painful bowels. A lack of blood supply to a tissue is termed as ischemia. Ischemic injury can occur in any part of the intestine. It is more likely to happen when a portion of the bowel gets trapped in a hernia (strangulated hernia). Painful sensations arise from the affected region which includes the colon and the rectum.
Hemorrhoids or piles are also common causes of pain during defecation. This condition affects the rectum and the anal region and is characterized by swollen tortuous blood vessels. Apart from pain, hemorrhoids can also be characterized by blood in the feces, which results from injury to the blood vessels during the act of defecation.
Drugs and toxins
Certain drugs or chemicals can injure the intestinal lining, resulting in painful bowel movements. Examples include laxatives, parasympathomimetics, insecticides, pilocarpus herb and nerve gas. In addition, antibiotics used to treat bacterial infections could lead to antibiotic-associated diarrhea and this may be accompanied by painful bowel movements.
Certain cancers associated with the digestive tract, such as colorectal cancer and anal cancer, can cause pain during bowel movements. The pain may also precede defecation as the strong contractions in the colon pushes the stool into the rectum prior to it exiting the anus.
Lactose intolerance is a common condition that affects people across the globe. Lactose intolerant individuals experience pain in the intestines when they consume milk or milk products. Food intolerance can also occur with other types of foods that cannot be digested or absorbed in the intestines of the affected individuals.
Short bowel syndrome is a congenital disorder in which the small intestine is missing certain segments and is consequently shorter in length than a normal intestine. This shortened length affects the proper digestion and absorption of foods and can cause pain associated with problems in GI motility.