Anal-Rectal Pain
Nearly all rectal difficulties are described by those who suffer from them in terms of pain, bleeding, or protrusion from the anal opening. Uppermost in mind, however, is the continual fear that such difficulty may be, or may become a cancer. Each rectal disease has a characteristic pain pattern which helps to identify the disease present.
Anal pain of great intensity which starts suddenly and remains constant; which is painful to touch, but not made worse by bowel movement, is probably hemorrhoid pain. This sharp pain is caused by a blood clot forming within an external hemorrhoid. It remains intense from about a week or ten days, but happily goes away completely with little or no treatment. Severe pain to one side of the anus, which is constant, intense, and attended by a throbbing, hardened enlargement under the skin, resembles pain of an anal abscess. It does not begin suddenly, but arises over a day or two and grows to intense proportions. An anal abscess is very painful and disabling, and can be relieved only through drainage of the abscess, either spontaneous or induced by a small incision.
The pain of fistula, which frequently follows an abscess, is usually not severe. There is a more or less constant drainage of pus, and sometimes food from a small opening which was the drainage site of the original abscess. Fistula pain actually constitutes more of a soreness than a real pain. It can be very irritating and annoying, but it is not disabling. Pain about the anus, possibly severe, but present only during and following bowel movement, is the typical pain of an anal fissure. Looking like a crack in the side of the anal opening, a fissure becomes spread out as the anus expands for bowel passage. The fecal material touches the open fistula and creates pain which may be slight or as intense as the cutting of a knife. It usually subsides after the bowel passage, but may linger as an aching pain for a short time afterwards.
Itching pain in a sore macerated skin area about the anus is probably caused by internal hemorrhoids which by themselves are painless. They hang like grapes on the inside of the rectum and their engorged condition causes them to secrete a sticky mucous material, which works out through the anal opening to continually bathe the anal skin. This secretion produces a macerated, itching and excessively sore anus. The hanging grape-like hemorrhoids inside the rectum, may also protrude from the anus on straining with the bowel movement.
The pains therefore, of anal diseases are recognizable. The sudden but temporary pain of external hemorrhoids; the intense boil-like pain of anal abscess; the continual skin irritation in the visible presence of a fistula; the severe pain at bowel movement time with a fissure; and the continually sticky macerated and irritated anus of internal hemorrhoids, sometimes with protrusion, do not speak for the pain of cancer in the anal-rectal region. Cancer is a disease which has no characteristic pain, but produces most often an uncomfortable ache, and possibly the sensation that the rectum is continually filled. Cancer of the rectum is almost never accompanied by sharp or severe pain in the anal region.
It is well to know that the anal-rectal region may have two or more diseases. Even though the pain present might indicate a non-serious type of anal disease, a secondary disease such as cancer could be present only inches away. For this reason, whenever anal or rectal diseases are present severe enough to cause bleeding, pain, protrusion, or continuous itching, it is well to have the entire rectum examined.