Generality
Anal pain is a symptom common to many diseases, some of which are quite common and fortunately transient. Describing the main causes of origin, the article helps to correctly interpret this symptom based on the characteristics of the pain and the associated symptomatology.
PLEASE NOTE: if the anal pain is particularly severe or with a tendency to worsen over time, it is advisable to undergo a specialist medical examination. The same recommendation is valid in the case of anal blood loss, which could be linked to an anorectal carcinoma; although this last occurrence is quite rare compared to other possible causes of anal bleeding, contacting your doctor is the only way to clear up any doubt
Anal fissures
Anal fissures are small cuts resulting from the tearing or tearing of the anal mucosa; these ulcers tend to form when the stools are thicker or harder than normal, so constipation is certainly the main predisposing factor.
Anal fissures are associated with acute (violent, sharp, burning) and intermittent anal pain, with a tendency to present or worsen during or immediately after defecation. Furthermore, anal pain is typically accompanied by small bleeding, visible in the form of bright red streaks on toilet paper.
In most cases, anal fissures resolve spontaneously in the absence of treatment. A careful and correct intimate hygiene can be helpful, associated with a diet rich in liquids, fruits and vegetables, better if accompanied by regular physical activity.
Hemorrhoids
In the common language the term hemorrhoids indicates the enlargement of the normal vascular pads (haemorrhoidal veins) located around the anus. These venous dilations are favored once again by constipation, but also by other conditions such as pregnancy, liver cirrhosis or a genetic predisposition to the fragility of the vein wall with tendency to varicose veins.
In general, "simple" hemorrhoids are almost asymptomatic; anal pain is absent or very mild, while the most relevant symptom consists of small bright red bleeds at the end of defecation. When the picture becomes more complicated, the internal hemorrhoids can escape from the anus, due to defecation or a cough; once leaked, they can re-enter spontaneously (less severe cases) or only after being pushed by external pressure. The prolapsed hemorrhoids appear as a prominently visible and palpable protuberance that comes out of the anus. When the hemorrhoidal vessels remain trapped outside, the anal sphincter can choke them, causing particularly intense and violent anal painful pangs. The obstruction of hemorrhoids (both internal and external) can also be linked to the formation of a blood clot inside them (a condition known as haemorrhoidal thrombosis). When the hemorrhoid undergoes thrombosis, the prolapsed mass or anal swelling become harder, painful to the touch and take on a bluish color.
Fistula and perianal abscess
The anal fistula is a small pathological tunnel that connects the anal canal with the skin surrounding the anal orifice. From this tunnel purulent and fecaloid material emerges; all accompanied by local pain, itching and swelling. The formation of a fistula is often the result of an infection of the anal glands with the formation of an abscess (sac of pus) which, breaking itself, puts itself in communication with the outside.
In perianal abscesses + anal pain is constant, dull, and in the absence of treatment it gradually increases over time; it can also be associated with fever and is typically accompanied by swelling (swelling) and red, hot and painful anal skin.
The treatment consists in drainage under local or general anesthesia by incision.
Other causes (more rare) of anal pain
- Sexually transmitted diseases: such as chlamydia, gonorrhea, herpes or anal warts (in the latter case, small growths can be seen in the anogenital region similar to warts). Pain and itching tend to be constant and are not influenced by stool evacuation; often, they are accompanied by mucous, blood or purulent losses with faeces and sometimes by genito-urinary symptoms typical of the infection.
- Anorectal carcinoma: the pain tends to be constant during the day and increases progressively as the weeks go by until it becomes severe; it can be associated with rectal bleeding and the release of ribbon-like stools.
- Fleeting Proctalgia: anal pain occurs without apparent justification (absence of organic diseases) and suddenly attacks, only to disappear completely within a few minutes (usually less than 20). Painful attacks can also be separated for several months from one another or occur more often (eg once a day, especially at night) for a short time before disappearing for a long time. The fleeting proctalgia may be due to a muscle spasm of the anal sphincter and is often associated with irritable bowel syndrome
- Anus elevator syndrome: pain lasts for at least 20 minutes and is associated with pain on palpation of the pubo-rectal muscle. It is probably caused by a spasm of the levator ani muscle
- Coccigodinia: it is a pain around the coccyx region, often caused by sacro-coccygeal trauma or by the maintenance of a prolonged sitting posture. Pain can also radiate to the genitals, the anal region and sometimes the buttocks.
- Prostatic affections: inflammation of the prostate, given its proximity to the rectum (which is located posterior to the gland) can cause pain in the perineal and anorectal region.
