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What to do if you have a Pain in the Butt?

Our bodies are equipped with an amazing apparatus to deal with evacuation of solid matter. In Chinese medicine, the anus is referred to as the “dark star”. It has the capacity to distinguish between solid liquid and gas. It can allow for the passage of gas while keeping solid and liquid stored. It usually works, and when it doesn’t, it can be a pretty big deal. (Please see the anatomy section to get the terminology right.)

Most of the time we don’t think a thing of it. Most of the time we take this complex function completely for granted. But(t) sometimes things go wrong. Let’s discuss some of the common problems and how to handle them.

One of the most alarming problems is bleeding. If you have had a bad time recently with bowel movements, diarrhea or constipation, it is not unusual to have some superficial bleeding. By superficial, I mean a small amount of blood on the toilet paper or even dripping into the toilet water. This can also happen after trauma to the rectum, accidental or intentional (sexual). That being said to reassure you, I will also say that it is never a bad idea to have a medical professional talk to you and LOOK AT YOUR BOTTOM. (I put that in capital letters because you may have to ask your medical provider to actually look at your anus. You may have to insist. It takes time and really isn’t a favorite thing to do.) You just want to make sure you don’t have cancer. 

If you are having bleeding regularly, you may have a hemorrhoid or fissure. A hemorrhoid is basically a varicose vein in the stretchy tissue of the anus. There are a couple of rings in series of the rectum, so you may have a hemorrhoid in side where you can’t see it. Many times, as you may have heard from commercials on the TV, hemorrhoids can be painful, itchy lumps you feel on the out side of your anus. Hemorrhoids hurt with bowel movements and for some time after. Sometimes they just hurt, throb and/or itch all day long. They may or may not bleed. Sometimes sitting or standing for a long time can be painful. 

Once in a while, a hemorrhoid can get a blood clot in it. That’s called a thrombosed hemorrhoid. That really hurts a lot, unrelentingly and different from your previous level of discomfort. A doctor may have to inject an anesthetic and make a small incision to get the clot out. Not fun, but a big improvement in a short amount of time.

Hemorrhoids are hereditary in many cases. (Familial weak rectal tissue; what a legacy!) They are common during and after pregnancy and in people who spend a lot of time sitting, like truck drivers. If you find yourself with hemorrhoids, there are some things you can do to help yourself. In general, try to keep your stools soft and easy. What goes in definitely determines what comes out. Less red meat. Less cheese. More water, fruit and vegetables. Please see the chapter on “Constipation” for a more in depth discussion.

Local care of hemorrhoids would include keeping the area clean. Use a little soap in the bath or shower. And then rinse copiously with lots and lots of water. An essential element is to use a hot soak every time you use the toilet. Every time you go to the bathroom, even if it’s just to pee, run the faucet to get the water as hot as you can tolerate. Get a few tissues or sheets of toilet paper soaking, dripping wet with the hot water, and use it as a compress to the affected area while you are sitting on the toilet. If you have a bidet, that would serve the same purpose. After a bowel movement, clean with witch hazel. Witch hazel is an excellent antiseptic without stinging or drying.

The most comfortable position to be in when your hemorrhoids are flairing up is on your chest and knees with your butt up in the air, like a sleeping baby. If that is too tough on your neck, or too embarrassing, you can lie on your side with the top leg more bent and in front of the lower leg. Sitting and standing are the worst. 

If you are sure you have hemorrhoids, and none of this “do it yourself” care is working, you can try going to the store and getting hemorrhoid cream or suppositories. If that isn’t enough, you may need to get a prescription cream or suppository and possibly even end up with surgery.

If you have a bumpy thing on the “dark star”, you may want someone to take a look and see if you have warts. They are scary and annoying and embarrassing to some, but they surely are treatable with fairly low-tech medical intervention. DO NOT IGNORE a new body part coming out of your rear-end just because it doesn’t hurt or is not bleeding or you feel embarrassed.

Fissures are a bit different. They are kind of like when you get a split at the corner of your mouth and it gets re-opened every time you open your mouth. Fissures don’t hurt most of the time. But, boy when you poop….YIKES. It feels like a knife as the stool goes by, forcing the anus to stretch and re-opening that split. The fissure can bleed onto the toilet paper and/or dripping into the toilet bowel. 

Trying to keep the stool really soft is a major key to letting the sphincter heal. You’ll need to be aware of your diet and the way your body handles certain foods to be good at this. Local care of the hot soaks with every trip to the bathroom and the use of witch hazel after bowel movements will definitely help healing. If you can’t get ahead of this with stool softening and local care, you may end up with surgery by your local colorectal surgeon. It is a fairly simple procedure and is very successful.

Then there is this other painful rectal thing called “proctalgia”. Oooweee! This is like getting a Charlie horse of the anus. No real triggers. No real effective treatment. No identified cause. The problem with this particular pain in the butt is that it can be so intense as to make you feel nauseated, disoriented, dizzy, sweaty, and even short of breath. It is totally scary. Now, the fifty-fifth time is happens, you might not be so scared, because the pain is most assuredly the primary problem. Frankly, your anus hurts so badly, you might not even care if you’re having a heart attack. These episodes can last minutes to hours, usually more on the minutes side. Western medicine doesn’t have any good answers to this problem. Some suffers use alcohol or other muscle relaxers. That might not be an acceptable intervention if you have to work or drive or otherwise be coherent.

There are lots of interesting things that can happen around the rectum that might get your attention. If you get a yeast infection or jock itch that extends to the butt crack or around the anus, it can be, as we say in Massachusetts, wicked uncomfortable. The little bit of soap, lots of water cleansing is part of the care. Using over-the-counter jock itch medicine can help. Corn starch is an excellent dry powder, and really inexpensive in the baking aisle of your grocery store. It’s a little more expensive in the baby aisle, but comes in a nicer shaker dispenser there.

There are a ton of sweat glands and hair follicles in the perirectal area. Once in a while, one might get clogged or infected. As anywhere else on your skin, a hot compress, just a paper towel or wash cloth wet with the hottest water you can tolerate, applied to the painful red bump for a minute or two several times during the day can be very helpful in letting your body take care of this. If the bump gets really big and/or painful, you may need antibiotics or even an incision made to drain it. Please do not squeeze these to try to pop them. When you squeeze a pimple, abcess, or other skin infection, you are squeezing as many germs inward as you are squeezing out. In the perirectal area, there can be particularly nasty bugs. You don’t want to push those into your bloodstream.

If a painful red bump appears right in the crack above your anus, it may be something a bit more complicated in that there are some people who have pores in that midline that go very deep. This can be a serious problem called a pilonidal cyst and might require antibiotics and sometimes even a surgery to remove it.

If you have a rectal problem and are not sure, please make sure you have a professional LOOK AT IT. Just get reassurance that you don’t have rectal cancer. If you have poop with blood mixed into it, that is not usually a rectal problem. That is something happening in the colon and requires a different set of recommendations. Black or tarry stools indicates something happening even higher in the GI tract. Other recommendations yet.




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