The anus is the lowest part of the digestive tract, the opening from which stool is passed out of the body. Anal discomfort includes pain, itching, or burning.
Discomfort in the anal area can take many forms, including pain, itching, or burning. It is rarely life threatening, but it can be quite annoying. There are several possible causes.
When a person has anal discomfort, the healthcare professional needs to know: When did the discomfort start?What is an exact description of the discomfort?How long has the discomfort been occurring?Is the discomfort constant or does it occur only occasionally?Is the discomfort made worse by having a bowel movement?Has there been any bleeding from the anus?Does he or she engage in anal intercourse?Has he or she ever had a sexually transmitted infection (STI)?What are the person's bathing and washing habits?Does he or she have any other medical conditions?What medicines or drugs is the person taking?Does the person have any other symptoms?
Other questions may be asked, depending on the answers to the questions above and on the results of the physical examination.
Causes of anal discomfort include: anal fissure, which is a small erosion or wearing away of the lining on the inside of the anusanal fistula, which is an abnormal connection between two areas of the bodycancer or a tumor involving the anus, such as anal cancerhemorrhoids, which are enlarged veins in the anal areainfections, including sexually transmitted infections (STIs) such as gonorrhea, herpes, and chlamydiainflammatory bowel disease, any of several related conditions that involve inflammation of the bowel, often for unknown reasonsirritation of the anal skin or lining, which can be caused by excessive washing or an allergic reactionpruritis ani, which is a general term for itchiness of the anus that often has no known causetenesmus, which is an urgent desire to move the bowelstrauma, which may be caused by anal sex or by putting foreign objects into the anus
Other causes are also possible. Sometimes, no cause can be found.
Prevention is related to the cause. For example, safer sex practices such as the use of condoms can reduce, but not eliminate, the risk of STIs. Avoiding anal sex can prevent cases from trauma due to this cause. Many cases cannot be prevented.
Sometimes the diagnosis is obvious from a careful history and physical exam, made simpler if the person trusts the healthcare professional and does not hide important items of history. In other cases, further tests will be needed. If an STI is suspected, a culture may be done to determine the exact cause of an infection. A culture is a test in which bacteria or other organisms are grown in the lab from a sample of tissue.
Tissue is collected by using special cotton swabs to wipe the area around and inside the anus. If inflammatory bowel disease is suspected, anoscopy or sigmoidoscopy may be advised. These are special procedures that allow a healthcare professional to view the inside of the intestine by putting a small instrument into the anus that contains a light and a camera.
Most long-term effects are related to the cause. Anal discomfort from diarrhea usually goes away without treatment and has no long-term effects. Inflammatory bowel disease can cause serious problems throughout the body. These may include damage to the intestines, joint pain, and visual impairments. Anal cancer can sometimes cause death.
Anal discomfort is not contagious. However, if an infection is the cause, the infection might be contagious.
Treatment is directed at the cause. Excessive washing of the anus with soap is discouraged and often makes the pain worse. Most STIs can be treated with antibiotics. Inflammatory bowel disease is often treated with medicines such as prednisone (i.e., Sterapred) to reduce inflammation. Medicine or hemorrhoid surgery may be used for hemorrhoids. People with anal cancer may need surgery, chemotherapy, or radiation therapy.
Side effects depend on the treatments. For example, antibiotics may cause allergic reactions or stomach upset. Surgery can be complicated by bleeding, infection, or reactions to anesthesia.
Outcomes after treatment are related to the cause. A person with diarrhea from an infection often feels better once the infection clears up. A person with inflammatory bowel disease often has repeated flare-ups of the disease. A person with anal cancer may die if treatment fails.
Any new or worsening symptoms should be reported to the healthcare professional.
Harrison's Principles of Internal Medicine, 1998, Fauci et al.
