Anal pain

Table of Content

1. Constipation: When Does It Become a Concern That Requires a Doctor’s Visit?
2. Causes of anal pain
3. Transient rectal pain - Proctalgia fugax
4. Pudendal neuralgia
5. The clinical diagnosis of pudendal nerve pain
6. Nantes criteria
7. Causes of pudendal nerve compression
8. Treatment of pudendal neuralgia
9. Treatment of anal pain
10. Some natural methods help relieve pain, including

What Is Anal Pain and When Should You See a Doctor?

Anal pain is a common symptom that affects individuals of all ages. It may present as either acute or chronic discomfort, felt in the anus, rectum, or surrounding area. The pain can occur suddenly or develop gradually over time. It is often accompanied by other symptoms such as itching, bleeding, difficulty with bowel movements, or a persistent feeling of pressure.

There are various causes behind anal pain. The most common include hemorrhoids, anal fissures, abscesses, fistulas, or impacted stool. However, in some cases, the pain may be due to less common causes such as nerve inflammation or pelvic floor muscle spasms.

This highlights the importance of proper diagnosis. Relying solely on symptoms is not sufficient—clinical examination is essential, and in more complex cases, further testing such as MRI scans may be required.

In Dubai, Dr. Daad Al-Taani is one of the leading specialists in diagnosing and treating anal and rectal conditions. With extensive experience, she provides accurate diagnoses and effective treatments tailored to each patient’s needs. Her clinic offers a wide range of treatment options, including medications, physical therapy, and surgical procedures when necessary.

Dr. Daad emphasizes the importance of not ignoring anal pain, especially if it persists for several days or is accompanied by bleeding or discharge. Early diagnosis can help prevent complications and reduce the need for surgical intervention.

In mild cases, pain relief may be achieved through simple methods such as warm sitz baths or dietary adjustments. However, in more serious conditions, medical intervention is required to treat the underlying cause.

This article explores the main causes of anal pain, associated symptoms, and how to accurately diagnose the condition. We also highlight the advanced treatments available at Dr. Daad Al-Taani’s clinic to help you regain your comfort and improve your quality of life.

📺 Follow Dr. Daad Al-Taani’s interviews and medical advice on our YouTube channel for valuable health insights.

Causes of anal pain

1- Anal diseases:

Internal or external hemorrhoids.
Anal fissures.
Perianal fistulas
Anal tumors
Anal abscess
Prolapse or prolapse of the rectum
Anal warts (anal sex and STDs)
Anal stenosis (narrowing of the anus due to fibrosis and inflammation due to Crohn’s disease)

2-Fecal impaction

Fecal impaction occurs when hard, dry stool collects in the rectum, causing pain in the anus and rectum and other symptoms such as stool leakage and bloating. Fecal impaction is caused by chronic constipation and often occurs in older people. Limited fluid intake, a low-fiber diet, and an inactive lifestyle also contribute to the problem.

3-Transient rectal pain – Proctalgia fugax

It is a type of levator ani syndrome, which is severe, episodic pain in the anus and rectum area. It can be caused by a muscle strain in the levator ani muscle, especially in the pubococcygeus muscle section.

4-Pudendal neuralgia

It is an uncommon, chronic pain that occurs due to compression or entrapment of the pudendal nerve in the pelvis. It occurs because of pressure on the pudendal nerve by nearby muscles or tissues.

Transient rectal pain – Proctalgia fugax

During a seizure, the patient feels cramp-like pain, sometimes it is very painful and causes anxiety during sleep or wakes the sufferer at night, and is often misinterpreted as a need to defecate, and the pain lasts from seconds to minutes; If the pain lasts twenty minutes or more, levator ani syndrome is diagnosed.
This disorder is accompanied by a thickening of the internal anal sphincter, so it is possible that it is a disorder of this muscle or may be due to a problem with the pudendal nerves.

The exact cause of transient rectal pain is still unknown, and it can occur after sclerotherapy for hemorrhoids, or after a vaginal hysterectomy. It is more common in people with irritable bowel syndrome and in people with symptoms of anxiety, and studies show that stress and constipation can make pain more likely.
There are no proven treatments for this condition. Using painkillers and taking a warm bath may help relieve the pain by relaxing the anal sphincter, in addition to therapeutic methods that help relax the anal muscles and prevent them from spasming (such as medications, Botox injections, or physical therapy).

Pudendal neuralgia

Pudendal nerve entrapment Alcock canal, also known as Alcock’s tunnel syndrome.

Symptoms of pudendal nerve entrapment:

People suffer from burning pain (which may be a tingling, pressing, or stabbing sensation) in the anal or genital area, which is severe when sitting and improves when standing or lying down.
Numbness or anal-genital tingling may occur.
Fecal and/or urinary incontinence, and the need to go to the toilet frequently or suddenly, may also occur.
Increased sensitivity to pain, as light touching or wearing clothing incites pain.
Sometimes pressure or a foreign body can be felt in the perineum.
The condition may be accompanied by pain during sex, difficulty reaching orgasm, and erectile dysfunction in men.
Sometimes the condition is accompanied by pain in the buttocks, legs and feet.

The clinical diagnosis of pudendal nerve pain

is made after denying the presence of other diseases to the patient’s symptoms. An MRI of the pudendal nerve can be performed to show the location of nerve compression, and electromyography can also be performed to evaluate the nerve.

Nantes criteria:

The criteria for diagnosing pudendal nerve pain are:

Pain that increases with sitting, does not wake the patient from sleep.
is not accompanied by loss of sensation in the affected area.
The pain improves with blockade of the pudendal nerve.

Causes of pudendal nerve compression:

Activities that cause pressure on the nerve, such as squat exercises, or cycling and horse riding for long periods.
Sitting for long periods.
Chronic constipation.
Surgery, fracture in the pelvic area, or injury to the pudendal nerve during childbirth.
Diabetes and inflammatory diseases that cause pudendal neuropathy, and infections such as genital herpes.
Lumps and tumors in the pelvis that press on the nerve.

Treatment of pudendal neuralgia

Behavioral modifications: Avoid things that incite pain. Such as cycling or horse riding for long periods, squatting exercises, gripping, or sitting for long periods. Also, using a pillow with a donut-shaped gap in the middle when sitting helps relieve pain. C or in the shape of a letter.
Physiotherapy or physical therapy: exercises to relax the pelvic floor muscles, or therapy using electrical nerve stimulation (so-called acupuncture machine) to help relieve pain. Transcutaneous TENS.
اMedications: such as painkillers, muscle relaxants, and sometimes antidepressants or antiepileptics.
Pudendal nerve block: by injecting a long-acting local anesthetic or cortisone injection around the nerve or at the point of injury, or injecting Botox into muscles that are tight or pressing on the nerve.
Pudendal nerve release surgery: Depending on the location of the compression, there are three approaches to release the nerve, surgery to repair the presence of spinal herniation if present, and removal of masses and tumors that are compressing the nerve.
Pulsed radiofrequency treatment of the pudendal nerve sacral nerve roots, or sacroiliac joint..
Neuromodulation using implantable electrodes.

Treatment of anal pain

Treatment depends on the cause of anal pain. For example, anal diseases such as hemorrhoids should be treated if they are present, retained stool should be removed if the cause is fecal impaction, and anti-infective medications should be taken if the cause is a bacterial, fungal, or viral infection or parasitic

Some natural methods help relieve pain, including

Sit in warm water for 15 to 20 minutes.
Eat more fruits, vegetables, and whole grains (foods rich in fiber) and drink enough fluids to soften hard stools.
Exercise daily.
Take stool softeners when needed to help with defecation and reduce straining during defecation.

Anal pain