Everyone knows what a pain in the butt is: something or someone irritating and which disturbs us constantly and repeatedly. However not all of us are aware that a "pain in the butt" is also a real physical entity that actually causes considerable pain and discomfort to many people all around the world. For many people it is not just a minor irritation or minor disturbance, but many sufferers undergo intense agony and develop a morbid fear of recurrent pain especially in relation to bowel movements.
If the pain is not aggravated by bowel movements and if the anal canal is normal on physical examination then anal sphincteric spasm is suspected. This condition is called proctalgia fugax or "anal lightning pain". In this situation, anal pain is sporadic and occurs unexpectedly. Typically it occurs whilst sleeping. The situation is similar to calf muscle spasm. The anal spasm and pain may last from seconds to half an hour or even longer in some cases. Whilst most patients report this sort of spasm to occur infrequently some patients have it regularly several times a month. Inserting a lubricated gloved finger into the anal canal during an attack and pulling gently but firmly backwards relieves the spasm immediately. In many patients, use of this stretching method not only relieves the acute attack but also reduces further attacks.
If there is associated mucus discharge or blood seen during passing motion then we need to be sure that there is no cancer within the low rectal or anal canal area. When this sort of cancer invades the anal skin the pain may increase in intensity from a dull aching to a more intense sharp pain over a period of months to years. Consultation with a colorectal doctor will be a wise move.
If anal pain is brought on by bowel movement and there is no fever or other evidence of infection and there are no haemorrhoids, the pain in this situation may be due to anal fissure. There are two sorts of anal fissure. I call them superficial fissures and deep fissures. Superficial fissures are common and may be due to explosive diarrhoea as well as bulky stools tearing through the anal muscles during defaecation. These sorts of fissures are shallow and skin deep only. They may however cause severe pain and result in a fear of passing motion whilst they last which may be for a few days to a week. Some of these however may persists and deepen to cause deep fissures. Deep fissures result when the anal tear is deep and anal muscle spasm is severe resulting in a local drop in blood circulation and a non-healing wound. This condition results in many patients having a deep fear of toilet and a vicious cycle of increasingly severe anal pain and increasing constipation. Taking a high fibre diet when this happens will only aggravate this problem. Medical advice should be sought when this happens.
Acute swelling due to strangulation or thrombosis within prolapsed haemorrhoids may result in severe backside pain. These patients may or may not have a prior history of prolapsing haemorrhoids. There may be a short history of severe diarrhoea or acute straining at stool just before the prolapse. Removal of the thrombosis or even surgery may needed to resolve this problem.
If perianal redness or fever is present, anal abscess or fistula infection may be present. Most of such patients present with perianal fluctuant swelling, throbbing pain and fever. Whilst many patients may be diabetic, not all such patients have high blood sugar. Such patients also need immediate drainage of the abscess to resolve the pain.
Some infection which causes pain may not have associated constitutional symptoms. And some sexually transmitted diseases like syphilis and even patients with HIV may present with anal ulcers and tears which may not even be that painful.
Pain in the backside is not an uncommon problem. Most of them can be easily resolved with medical attention. That pain in the butt need not linger for longer than you already have endured!