Bowel movements are a normal physiological process that everybody experiences and while it may be associated with various sensations, it should not be painful. Any pain experienced during bowel movements is often a symptom of some underlying problem usually with the colon, rectum and/or anus. This can range from painful abdominal cramps to burning of the anus and pain while defecating. There are many possible causes of this pain and it may present with a host of other signs and symptoms which are useful indicators of the underlying problem.
Normal Pain To Pass Stool
It is normal to experience an urging sensation when a person needs to pass stool. As time passes this urge intensifies and as stool is passed it subsides. By the time the rectum is emptied a person feels a sense of satisfaction due to a complete bowel movement. Some people who may not have a complete bowel movement may still feel uncomfortable but even in these cases there is usually no pain. Therefore it is inaccurate to describe pain as being normal at any time when it comes to passing stool, either before, during or after the act.
Any pain before, during or after bowel movement should be investigated. Pain on its own without any other symptoms can be difficult to identify. The presence of other signs and symptoms can therefore be helpful in identiying a cause. Other symptoms may include rectal bleeding, mucus in the stool, a sense of incomplete bowel movement or constant urging, anal itching, buring in the anus, diarrhea or constipation. Further medical investigations may be necessary to identify the cause like a colonscopy.
Causes of Painful Bowel Movements
There are a number of different causes of painful bowel movements and it is important to differentiate pain in the anus and buttock, from pain in the rectum which lies deeper and pain higher up in the gut usually within the colon.
Constipation is one of the leading causes of a painful bowel movement. Pain does not affect every person with constipation. It is usually occurs in people with hard stools and where hemorrhoids is present. The stool may also be very large and scrapes agains the delicate anus as it is passed out during defecation. Sometimes fecal impaction can arise in severe constipation and this may lead to abnormal stretching of the colon and rectum. This stretching can then cause pain.
Another common cause of painful bowel movement is hemorrhoids. This is where the veins of the rectum and around the anus becomes swollen and inflamed. There are a number of reasons why hemorrhoids arises, such as with constipation, excessive straining when passing stool and repeated trauma to the anus and rectum. The passage of stool irritates and injures the swollen veins and wiping further worsens it. Often there is rectal bleeding present with hemorrhoids and it is more noticeable when wiping after a bowel movement.
Any injury to the anus, rectum and colon can lead to painful bowel movements. This can stem from a host of different causes including anal intercourse, vigorous insertion of suppositories, procedures like a colonoscopy when poorly performed and any other form of trauma to the buttock area. The trauma causes inflammation and pain usually subsides once the inflammation resolves. Even scratching the anal areas particularly with long nails or wiping the anus with rough toilet paper can injure the anus.
Irritants and Allergens
Some substances can irritate the anal area or even trigger an allergic reaction of the delicate skin lining the anus. Irritants can range from soap and water to body lotions, bleaches and even fecal residue. This can irritate any person. Allergic reactions on the other hand only affects people with a history of sensitivity and allergies. Contact dermatitis is one condition that can occur with exposure to irritants or allergens. While the anus is not a commonly affected area, contact dermatitis can affect the anal lining in the same way it affects other areas of the skin.
Anorectal and colon infections can also cause painful bowel movements. This can occur with conditions like enterocolitis which is often caused by consuming contaminated food or water. Proctitis is another infection that affects the rectum and anal canal. Some of these infections may be sexually tranmistted and arise with anal intercourse. Pelvic inflammatory disease (PID), prostatitis (prostate gland infection) and cystitis (bladder infection) can also cause painful bowel movement as these organs lie right next to the colon and rectum.
Inflammation can occur with injuries and infections but there are some inflammatory diseases that arise even without any trauma or infections. Ulcerative colitis, a type of inflammatory bowel disease, can cause inflammation of the colon and even rectum as a result of an autoimmune abnormality.
Sometimes the problem is not related to the gut. Endometriosis is one such instance where the inner uterus lining is deposite elsewhere and undergoes the same changes as the uterus during menstruation. This can also occur with polycystic ovarian syndrome. Sometimes the pain during a bowel movement occurs when the pressure within the abdomen increases during straining to pass stool.
Anal fissures are tin tears that occur in and around the anus. It can occur with trauma, infections, constipation, diarrhea and inflammation of the anus. The pain is worse during a bowel movement and when wiping the anus after passing stool. Long periods of sitting and even touching the anal area can also trigger burning and pain. Small fissures may go unnoticed apart from some pain and burning but in larger fissures there may be other symptoms like rectal bleeding.
Anal warts are abnormal growths that are caused by the human papilloma virus (HPV), the same virus that causes skin warts. Small warts may not be problem but larger warts can lead to pain. Benign polyps within the colon which in some instances can extend to the rectum may also be responsible of painful bowel movements, usually when the polyps are large. Lastly, colorectal cancer or even anal cancer can present with pain during a bowel movement.