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Anal fissures

Anal fissures are small tears in or around your anus. They often occur when passing large or hard stools. Symptoms include an intense, stinging pain when your open your bowels as the anal fissures cause the muscles around your anus to spasm. Other symptoms include:

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A visible tear near your anus
An outgrowth of skin near your anal fissure
Blood on your stools or the toilet paper after you wipe your bottom
A burning sensation around your anus
An itchy anus

Anal fissures usually heal on their own in around a month. During this time, you can reduce your pain by drinking more fluids and eating more fibre — this will soften your stools so they are easier to pass.

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You can also try sitting in a sitz bath (a shallow basin that sits on top of a toilet, which you fill with warm water) and applying an over-the-counter anti-inflammatory cream or pain relief cream. If you are still in pain, see your doctor. They may recommend trying laxatives or other treatments.

Haemorrhoids

Haemorrhoids, which are also called piles, are swellings that develop inside your back passage (rectum) or around your anus. They affect up to a third of the UK population.

Haemorrhoids can be caused by straining when opening your bowels and/or sitting on the toilet for too long. Your risk of piles increases if you are overweight, obese or pregnant.

Haemorrhoids can cause bleeding and pain when opening your bowels. If you develop a blood clot in your haemorrhoid (thrombosed haemorrhoid), you may also experience pain when sitting and walking. Other symptoms of haemorrhoids include:

A painful or sensitive lump near your anus
Anal discharge
An itchy anus
Swelling around your anus

If you are in pain or discomfort, you can try:

Applying an over-the-counter haemorrhoid cream
Applying a cold compress to reduce swelling
Taking a nonsteroidal anti-inflammatory drug (NSAIDs) such as ibuprofen or naproxen — avoid painkillers containing codeine or opiates as they can cause constipation
Taking a warm bath or shower

Also, whenever you take a bath or shower, make sure you gently wash your anus and avoid using scented soaps. When wiping your bottom after opening your bowels, use soft toilet paper or a bidet.

To avoid constipation, which can worsen your haemorrhoids symptoms, follow a diet rich in fibre and drink lots of water. This will help soften your stools, so opening your bowels will be less painful. You can also speak to your doctor about taking fibre supplements or laxatives to soften your stools.

For severe haemorrhoids, you may need more invasive treatment to remove your haemorrhoids, such as surgery.

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Inflammatory bowel disease

Inflammatory bowel disease refers to two different conditions with overlapping symptoms: ulcerative colitis and Crohn’s disease.

Both Crohn’s disease and ulcerative colitis cause soreness, swelling and ulcers in your large intestine and rectum. This makes passing stools painful. Other symptoms include:

Diarrhoea or stools that contain blood or pus
Fatigue
Pain or discomfort in your abdomen
Reduced appetite
Stomach cramps
Unexpected weight loss

If you have ulcerative colitis, you may also feel an urgent need to open your bowels and after doing so may still feel that your bowels are not empty.

Both Crohn’s disease and ulcerative colitis are lifelong conditions. However, you can manage your condition by changing your diet, ie following a low-meat, low-dairy, moderate-fibre diet with little to no alcohol or caffeine. Some medications can help ease your symptoms, including:

Anti-inflammatory drugs eg mesalamine or olsalazine
Diarrhoea medications eg methylcellulose or loperamide
Immunosuppressant drugs eg azathioprine or methotrexate
Medications to control your immune system eg adalimumab or natalizumab
Painkillers eg paracetamol
Steroids

If you have an infection, your doctor may prescribe antibiotics eg metronidazole. If you have intestinal bleeding, you may develop anaemia and may be prescribed iron supplements.

As inflammatory bowel disease can reduce your ability to absorb nutrients from your food, you may also be prescribed calcium and/or vitamin D supplements to reduce your risk of developing osteoporosis.

In more severe cases, surgery may be recommended. This involves removing parts or all of your large intestine and rectum. A small pouch will be left connecting your small intestine to your anus or a bag outside of your body.

Skin conditions

Chronic (long-term) skin conditions can affect the skin around your anus, causing pain before, during and after you open your bowels, as well as bleeding and itching after your stools come out. These conditions include eczema, psoriasis and warts.

Infections

Certain infections can cause pain in and around your anus before, during and after opening your bowels. This includes:

Anal abscesses — a painful pool of pus near your rectum or anus caused by an infection; also known as a perianal abscess or anorectal abscess; other symptoms include redness or swelling around your anus
Fungal infections — pain can range from mild to severe
Sexually transmitted infections (STIs) eg chlamydia, gonorrhoea, herpes and syphilis — other symptoms include bleeding, anal discharge and itching

Chlamydia or syphilis

Chlamydia or syphilis are STIs, which spread through unprotected sex with someone infected. When spread through anal sex, they can infect your anus and rectum and cause:

A burning sensation when you urinate
Discharge from your genitals
Pain during sex
Swelling and pain when opening your bowels

Treatment for these STIs includes antibiotics (eg azithromycin or doxycycline) and for severe syphilis, penicillin injections. When you are undergoing treatment for an STI, you should abstain from sex to avoid spreading your infection.

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You can reduce your risk of catching an STI by always using protection such as condoms when having sex, including anal and oral sex, and getting STI tests if you are sexually active.

Human papillomavirus (HPV)

HPV infection causes warts near your anus, genitals, mouth or throat. Anal warts can cause a raw, stinging pain when you open your bowels.

There is no complete cure for HPV, however, the warts can be removed with cryotherapy or laser treatment.

Left untreated, HPV can cause anal and cervical cancer, so if you have been infected with HPV you should regularly be tested for STIs and screened for cancer.

To reduce your risk of being infected with HPV, make sure you:

Get the HPV vaccine if you’re aged under 45
Get regular cervical smears if you are a woman
Get regular tests for STIs
Use condoms whenever you have sex, including oral and anal sex

Endometriosis

Anal cancer

Pain when pooping is not usually caused by anal or rectal cancer but it is a possibility. Symptoms include:

Anal bleeding — this is often an early sign; you may notice blood on your stools or the toilet paper after you wipe your bottom
Anal discharge
Changes in your stools — this includes
- Stools that look thinner than usual
- Stools that are a different colour or shape than usual
Itchy anus
New or unusual lumps in or around your anus which hurt when you apply pressure
Soreness and pressure when opening your bowels

You may also experience bloating, lots of gas, frequent constipation or diarrhoea, fatigue, constant pain or cramps in your abdomen and unexpected weight loss.

If you have any of these symptoms, see your doctor as soon as possible. Early treatment reduces the chances of the cancer spreading and improves your chances of making a complete recovery.

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Treatment for anal and rectal cancer includes:

Chemotherapy injections or pills to destroy the cancer cells
Radiation treatment to destroy the cancer cells
Regorafenib tablets to treat advanced rectal cancer by stopping cancer growth
Surgery to remove anal or rectal tumours and reduce the spread of the cancer — this may involve removing your whole rectum and parts of your colon

Proctitis and anusitis

Proctitis refers to inflammation of the lining of your rectum, while anusitis refers to inflammation of the lining of your anus. They can be caused by an STI, inflammatory bowel disease or radiation treatment for cancer. Symptoms overlap with haemorrhoids and include:

Bleeding when you open your bowels or wipe your bottom
Diarrhoea
Feeling the urge to open your bowels even after you have just done so
Mucous-like discharge from your anus
Pain when you open your bowels

You can reduce your chances of proctitis and anusitis by

Avoiding sex with anyone who has bumps or sores in or around their genitals
Taking medication you have been prescribed for an infection eg doxycycline or acyclovir
Taking medication you have been prescribed for inflammatory bowel disease eg mesalamine, prednisone or the immunosuppressant infliximab
Taking medication you have been prescribed for radiation side effects eg mesalamine or metronidazole
Taking over-the-counter laxatives to soften your stools
Using condoms or other protection whenever you have sex

If parts of your bowel have been damaged by disease, surgery to remove the damaged parts may also reduce your chances of developing proctitis and anusitis.

Proctitis and anusitis can be treated with argon plasma coagulation or electrocoagulation.

Diarrhoea

Diarrhoea itself may not make passing stools hurt. However, having to wipe your bottom a lot and passing lots of loose stools can irritate your skin. This can make your anus feel raw and sore. Symptoms of diarrhoea include:

Bloating and nausea
Blood in your stools
Fever
Needing to open your bowels more often
Passing more stools and losing too much fluid via your stools
Stomach cramps or pain

Severe cases of diarrhoea are usually treated by rehydrating your body via fluids passed directly into a vein (intravenous line). You may also be prescribed antibiotics if your diarrhoea was caused by an infection.

You can reduce your risk of diarrhoea by:

Not drinking tap water or eating food washed in tap water when you travel abroad — instead drink bottled water and wash food in bottled water too
Speaking to your doctor before going abroad to discuss whether you need to take antibiotics
Washing and cooking food properly — make sure you eat it as soon as you’ve cooked it and store leftovers in the fridge
Washing your hands with soap and water for at least 20 seconds before and after eating

Food intolerances and sensitivities

If you have a food intolerance or sensitivity (eg lactose intolerance or glucose intolerance), eating a trigger food may cause diarrhoea or painful bowel movements. Try to avoid eating foods known to trigger your food intolerance or sensitivity.

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