Painful bowel movements can cause a great deal of discomfort. There are many potential causes. Some are easily treatable, but others — such as anal cancer — can be more serious.
It is normal to occasionally experience mild pain during bowel movements. However, when this happens regularly, it could indicate an underlying medical condition.
In this article, we cover 10 possible causes of painful bowel movements and how to treat them. We also explain when it is necessary to see a doctor.
A person may experience a painful bowel movement for a number of reasons, including:
A person can become constipated for multiple reasons, such as:
- a hardening of stool due to a lack of fiber or water
- a slowing of intestinal movements
- as a side effect of a medication
- emotional issues
Healthcare providers may use the Rome IV criteria to diagnose constipation. To receive a diagnosis of constipation, two or more of the following symptoms must be present for at least 1 month in infants and children up to 4 years old:
- passing two or fewer bowel movements in a week
- if they usually have complete control of their bowels, having at least one accidental bowel movement per week
- a history of fecal withholding, or not using the bathroom despite having an urge
- passing hard and painful stools
A doctor may diagnose chronic constipation in a child over 4 years old if these symptoms persist for at least 2 months.
Health professionals tend to recommend increasing water and fiber intake or taking fiber supplements as the first steps in treating constipation.
If symptoms persist despite making these dietary changes, taking over-the-counter (OTC) laxatives is also a good treatment option. A pharmacist can advise on the best product in each case.
If there is no movement within 2–3 days, or if pain develops or worsens, it is important to seek medical attention immediately.
2. Anal fissures
An anal fissure is a tear in the skin around the anus. Anal fissures can occur as a result of constipation or passing hard stools. Anal penetration can also cause a fissure.
Other possible causes include:
- sexually transmitted infections (STIs)
- chronic diarrhea
- inflammatory bowel disease
- human papillomavirus
- anal cancer
- vaginal delivery
If constipation has caused an anal fissure, a healthcare provider may recommend taking stool softeners to help it heal.
Lidocaine jelly is also helpful for reducing the pain of an anal fissure. A doctor may also suggest nitroglycerin or nifedipine ointments. Both drugs will increase blood flow to the anus, which helps the body heal the injury.
People with chronic anal fissures may need surgery. Another treatment option for more severe cases is to inject botulinum toxin A (Botox).
Sometimes, people will also see blood on the toilet paper or in the toilet bowl.
Several OTC treatments are available for hemorrhoids, such as hydrocortisone. More severe hemorrhoids may require surgery, however.
Doctors and pharmacists will recommend that people with hemorrhoids keep their stools as soft as possible. This will help ease the pain of passing a bowel movement over a hemorrhoid.
Passing three or more loose or watery bowel movements per day may indicate diarrhea. Chronic cases of diarrhea can last for longer than 4 weeks.
To treat diarrhea, a health professional may recommend loperamide (Imodium). If an infection is causing the diarrhea, a person will need to take antibiotics.
Chronic or bloody diarrhea requires prompt medical attention.
5. Food intolerances and sensitivities
People with food intolerances or sensitivities may experience painful bowel movements or diarrhea if they eat certain foods. Common examples include lactose and glucose intolerances.
The best form of treatment is to avoid eating any foods that the person knows can trigger a reaction.
6. Inflammatory bowel disease
People with ulcerative colitis may experience bloody diarrhea with or without mucus. Episodes of diarrhea can cause pain during bowel movements. Other symptoms of ulcerative colitis may include:
- urgently needing to pass stools
- abdominal pain
- weight loss
People with Crohn's disease may experience some different symptoms. For example, they may feel abdominal pain on the lower right side or have diarrhea without any blood.
Treatments for both ulcerative colitis and Crohn's disease, such as prednisone, work to suppress the immune system. These medications reduce inflammation to manage the symptoms.
Some people may need to take corticosteroids regularly as a long term treatment.
7. Proctitis and anusitis
Proctitis refers to inflammation in the rectum. Anusitis, meanwhile, is inflammation in the anus. These conditions share many symptoms with hemorrhoids.
To treat proctitis and anusitis, it is necessary for a doctor to first understand the cause. Several factors can lead to proctitis or anusitis, including:
- ulcerative colitis
- colon infections
- certain medications
- consuming a diet too rich in citrus, coffee, cola, beer, garlic, spices, or sauces
8. Anal cancer
- bleeding from the anus
- pain or irritation in the anus or pelvis
- weight loss
- feeling a weight in the anus or rectum
- severe constipation
It is important to consult a doctor immediately if these symptoms occur.
In endometriosis, tissue that normally lines the uterus develops in other areas of the body, such as the ovaries.
- pain during bowel movements
- mucus in the stool
- bleeding from the rectum
- diarrhea or constipation
Health professionals tend to treat bowel endometriosis using hormonal therapy or surgery.
10. Skin conditions
Sometimes, painful genital warts can also develop on or near the anus.
Painful bowel movements have many potential causes. Some — including constipation, diarrhea, and hemorrhoids — are treatable at home. However, other causes may require medical attention.
People who find blood in their stools or feel severe pain during bowel movements should see a doctor for advice and treatment.
Following a diet rich in fiber is essential for preventing constipation and keeping good bowel health. Getting regular physical activity also helps prevent constipation.
Keeping the bowel healthy requires daily care. It is important to eat fiber rich foods and drink enough water. Many causes of painful bowel movements are preventable.
Some people have conditions or infections that cause painful bowel movements. These are not always treatable with OTC remedies, so it may be necessary to see a doctor.