Pain when pooping

Pain when pooping could be a symptom of an underlying health condition. It is therefore not something you should put up with. There are many health conditions that cause pain when pooping, which are easily treated. By seeing your doctor, you can get a diagnosis and, if needed, appropriate treatment.

Why does it hurt when I poop?

Constipation

As food moves through your gut, water is absorbed. If it passes too slowly through your gut, too much water is absorbed. This causes hard stools that are difficult and painful to pass out of your body; you may also feel pain or discomfort in your lower gut due to backed up stools. If this occurs and you are passing stools less than three times a week, you have constipation. 

Constipation can be caused by not having enough fibre in your diet, not drinking enough fluids, not exercising enough, taking certain medications or major changes in your lifestyle, eg travelling abroad or pregnancy. 

Symptoms of constipation include:

• Anal pain or gut pain when you open your bowels
• Bloating 
• Cramping in your lower back or lower gut
• Feeling as if you still need to open your bowels after you have just done so
• Feeling as if your intestines are blocked up
• Hard, dry stools that pass out of your body in small chunks

To reduce your risk of constipation, try to: 

• Drink at least two litres of water every day
• Reduce foods and drinks in your diet that increase your risk of constipation — this includes: 
• Alcohol
• Caffeine
• Dairy products
• Fried foods
• Highly processed grains eg white flour and white bread 
• Red meat
• Eat probiotic foods to improve your gut health eg probiotic yoghurts
• Exercise for at least 30 minutes every day eg walking or swimming 
• Follow a diet rich in fibre or take fibre supplements — speak to your doctor or a nutritionist before taking any dietary supplements
• Go to the toilet when you feel the urge to open your bowels ie do not hold your stools in as this increases the chance that they will become hard or get stuck

If your constipation persists, see your doctor as they may recommend trying laxatives.

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:

• 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. 

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.

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.

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

Endometriosis is a common condition where tissue similar to the lining of your womb (endometrium) starts to grow elsewhere and attaches to other organs, such as your ovaries and fallopian tubes. During your period, this tissue bleeds and can cause chronic pain, inflammation and swelling. Other symptoms include: 

• Heavier periods
• Infertility
• Pain and cramps in your lower abdomen and back before your period starts
• Pain during or after sex
• Pain during your period
• Shooting pain when you open your bowels

Treatment for endometriosis includes:

• Birth control injections (eg medroxyprogesterone) to control the abnormal growth of tissue outside your womb and ease your symptoms
• Gonadotropin-releasing hormone (GRNH) to reduce levels of the hormone oestrogen which promotes the abnormal tissue growth
• Hormone therapy to control the abnormal growth of tissue outside your womb
• Laser surgery to remove the abnormal tissue
• Painkillers eg ibuprofen and paracetamol
• Surgery to remove your womb, cervix and ovaries — this is only done in extreme cases and will stop your periods and the abnormal tissue growth

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.

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.

Getting a diagnosis for painful bowel movements

There are many potential causes of painful bowel movements and your treatment will depend on which condition you have. Some can be treated at home with lifestyle changes while others will need medical treatment. 

You should seek urgent medical attention if you have: 

• Anal pain or bleeding for a week or more
• Anal pain or other symptoms after sex, particularly if you are having sex with a new partner
• Fever or unusual fatigue
• New lumps in or around your anus
• Severe pain or cramps in your abdomen or back
• Unusual anal bleeding or anal discharge when you open your bowels

Lifestyle tips for a healthy bowel

If you have diarrhoea, make sure you stay hydrated by drinking lots of water and also follow a BRAT diet ie eat more bananas, rice, apple sauce and toast.

If you have constipation, make sure you follow a diet rich in fibre and exercise regularly.