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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Why Can Cause Pain In Anus?

Why does my anus hurt? It itches, burns, and when I get up or sit down it kills me. I cant stand for a long time either because it starts itching really bad. It is almost like i have a cut that burns and it keeps ripping open every time i sit or use the bathroom and it is not healing. When I go to the bathroom it hurts in a way it is hard to explain. I know what hemorrhoids are and I am pretty sure I do not have them because I have none on my anus. When I have sex a certain way I feel like there is something trying to come out. It feels like there is some kinda big thing just wedged in there. I have never had a normal cycle. I am lucky to have a bowel movement once a week. Sometimes I can go up to 2weeks at a time.
Mon, 9 Oct 2017
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Internal Medicine Specialist 's  Response
You have to rule out both anal fissure as well as hemorrhoids .An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements

Signs and symptoms of an anal fissure include:

Pain, sometimes severe, during bowel movements
Pain after bowel movements that can last up to several hours
Bright red blood on the stool or toilet paper after a bowel movement
Itching or irritation around the anus
A visible crack in the skin around the anus
A small lump or skin tag on the skin near the anal fissure

Common causes of anal fissure include:

Passing large or hard stools
Constipation and straining during bowel movements
Chronic diarrhea, Childbirth ,Crohn's disease or another inflammatory bowel disease
Less common causes of anal fissures include:
Anal cancer , HIV

Risk factors -Infancy. Childbirth, Aging. Anal intercourse
Constipation, Crohn”s disease

Complications - An anal fissure may extend into the ring of muscle that holds your anus closed (internal anal sphincter), making it more difficult for your anal fissure to heal.

Diagnosis –If possible, your doctor will perform a digital rectal exam, or use a short, lighted tube (anoscope) to inspect your anal canal. However, if this is too painful for you, your doctor may be able to diagnose an anal fissure only by observation. Your doctor may recommend further testing if he or she thinks you have an underlying condition:

Flexible sigmoidoscopy.This test may be done if you're younger than 50 and have no risk factors for intestinal diseases or colon cancer.

Colonoscopy. This test may be done if you are older than age 50 or you have risk factors for colon cancer, signs of other conditions, or other symptoms such as abdominal pain or diarrhea.

Lifestyle and home remedies

Add fiber to your diet. Eating about 25 to 30 grams of fiber a day can help keep stools soft and improve fissure healing. Fiber-rich foods include fruits, vegetables, nuts and whole grains. Adding fiber may cause gas and bloating, so increase your intake gradually.

Drink adequate fluids. Fluids help prevent constipation.

Exercise regularly. Engage in 30 minutes or more of moderate physical activity, such as walking, most days of the week. Exercise promotes regular bowel movements and increases blood flow to all parts of your body, which may promote healing of an anal fissure.

Avoid straining during bowel movements. Straining creates pressure, which can open a healing tear or cause a new tear.
Anal fissures often heal within a few weeks if you take steps to keep your stool soft, such as increasing your intake of fiber and fluids. Soaking in warm water for 10 to 20 minutes several times a day, especially after bowel movements, can help relax the sphincter and promote healing.If your symptoms persist, you'll likely need further treatment.

Nonsurgical treatment

Externally applied nitroglycerin (Rectiv), to help increase blood flow to the fissure and promote healing and to help relax the anal sphincter. Nitroglycerin is generally considered the medical treatment of choice when other conservative measures fail. Side effects may include headache, which can be severe.
Topical anesthetic creams - lidocaine hydrochloride (Xylocaine) may be helpful for pain relief.
Botulinum toxin type A (Botox) injection, to paralyze the anal sphincter muscle and relax spasms.
Blood pressure medications, such as oral nifedipine (Procardia) or diltiazem (Cardizem) can help relax the anal sphincter. These medications may be taken by mouth or applied externally and may be used when nitroglycerin is not effective or causes significant side effects.

Surgery

If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery. Doctors usually perform a procedure called lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing. Studies have found that for chronic fissure, surgery is much more effective than any medical treatment. However, surgery has a small risk of causing incontinence.


High fiber diet 25-35gms per day

OTC Stool softeners to make stools easier to pass

drink more fluids

warm sitz baths for15 -20 minutes few times daily and after each bowel movement

Lidocaine gel apply to skin around anus for pain relief

Diltiazem or Nitroglycerin cream to relax the anal sphincter


Hope this helps .
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Why Can Cause Pain In Anus?

You have to rule out both anal fissure as well as hemorrhoids .An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements Signs and symptoms of an anal fissure include: Pain, sometimes severe, during bowel movements Pain after bowel movements that can last up to several hours Bright red blood on the stool or toilet paper after a bowel movement Itching or irritation around the anus A visible crack in the skin around the anus A small lump or skin tag on the skin near the anal fissure Common causes of anal fissure include: Passing large or hard stools Constipation and straining during bowel movements Chronic diarrhea, Childbirth ,Crohn s disease or another inflammatory bowel disease Less common causes of anal fissures include: Anal cancer , HIV Risk factors -Infancy. Childbirth, Aging. Anal intercourse Constipation, Crohn”s disease Complications - An anal fissure may extend into the ring of muscle that holds your anus closed (internal anal sphincter), making it more difficult for your anal fissure to heal. Diagnosis –If possible, your doctor will perform a digital rectal exam, or use a short, lighted tube (anoscope) to inspect your anal canal. However, if this is too painful for you, your doctor may be able to diagnose an anal fissure only by observation. Your doctor may recommend further testing if he or she thinks you have an underlying condition: Flexible sigmoidoscopy.This test may be done if you re younger than 50 and have no risk factors for intestinal diseases or colon cancer. Colonoscopy. This test may be done if you are older than age 50 or you have risk factors for colon cancer, signs of other conditions, or other symptoms such as abdominal pain or diarrhea. Lifestyle and home remedies Add fiber to your diet. Eating about 25 to 30 grams of fiber a day can help keep stools soft and improve fissure healing. Fiber-rich foods include fruits, vegetables, nuts and whole grains. Adding fiber may cause gas and bloating, so increase your intake gradually. Drink adequate fluids. Fluids help prevent constipation. Exercise regularly. Engage in 30 minutes or more of moderate physical activity, such as walking, most days of the week. Exercise promotes regular bowel movements and increases blood flow to all parts of your body, which may promote healing of an anal fissure. Avoid straining during bowel movements. Straining creates pressure, which can open a healing tear or cause a new tear. Anal fissures often heal within a few weeks if you take steps to keep your stool soft, such as increasing your intake of fiber and fluids. Soaking in warm water for 10 to 20 minutes several times a day, especially after bowel movements, can help relax the sphincter and promote healing.If your symptoms persist, you ll likely need further treatment. Nonsurgical treatment Externally applied nitroglycerin (Rectiv), to help increase blood flow to the fissure and promote healing and to help relax the anal sphincter. Nitroglycerin is generally considered the medical treatment of choice when other conservative measures fail. Side effects may include headache, which can be severe. Topical anesthetic creams - lidocaine hydrochloride (Xylocaine) may be helpful for pain relief. Botulinum toxin type A (Botox) injection, to paralyze the anal sphincter muscle and relax spasms. Blood pressure medications, such as oral nifedipine (Procardia) or diltiazem (Cardizem) can help relax the anal sphincter. These medications may be taken by mouth or applied externally and may be used when nitroglycerin is not effective or causes significant side effects. Surgery If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery. Doctors usually perform a procedure called lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing. Studies have found that for chronic fissure, surgery is much more effective than any medical treatment. However, surgery has a small risk of causing incontinence. High fiber diet 25-35gms per day OTC Stool softeners to make stools easier to pass drink more fluids warm sitz baths for15 -20 minutes few times daily and after each bowel movement Lidocaine gel apply to skin around anus for pain relief Diltiazem or Nitroglycerin cream to relax the anal sphincter Hope this helps .