What diseases should be considered for pain related to defecation
(1) Anal fissure: The pain is characterized by burning pain in the anus at the beginning of defecation, which is more severe after defecation than before defecation, and lasts for several minutes to several hours.
(2) Strangulated internal hemorrhoids: During defecation, the mass protrudes from the anus and cannot be retracted, resulting in severe persistent pain and a history of internal hemorrhoids prolapse.
(3) Anal sinusitis: The pain is mild and usually disappears by itself a few minutes after defecation.
What diseases should be considered for pain not related to defecation
(1) Perianal infection: There is persistent pain and increasing pain in the anus or anal canal, often accompanied by inflammatory manifestations, such as fever and increased white blood cell count.
(2) Thrombotic external hemorrhoids: The patient suddenly felt a spherical mass on the edge of the anus, which was purple or black, caused by the rupture of the perianal vein, accompanied by persistent severe pain, which was aggravated when walking or standing.
(3) Anal canal cancer: There is often mild persistent tingling in the anus, and the whole body is not well in the late stage, and a hard mass can be felt in the anal canal.
(4) Foreign bodies in the anal canal: such as chicken bone slices, bamboo spurs, fish bone spurs, etc., enter the anal sinus and cannot be discharged, but sudden severe pain in the anus, the pain is continuous, and aggravates during stool. The patient generally has no blood in the stool or inflammation. Digital rectal examination can often confirm the diagnosis (sometimes digital rectal examination under local anesthesia is required).
Excessive consumption of chili, garlic, mustard, spirits, etc. can cause irritating ingredients in the stool, which can also cause pain and discomfort in the anus.
According to statistics from the World Health Organization, sexually transmitted diseases that have occurred in the anus, rectum, and colon in recent years have become increasingly popular. For example, cytomegalovirus (CMV) ulcerative proctitis is a common disease in gay men. Mainly manifested as anorectal pain, burning sensation, anal itching, mucus blood in the stool, tenesmus and so on. Endoscopy can reveal rectal mucosal ulcers, ranging from superficial punctate lesions to relatively deep fusion ulcers. The entire ulcer is covered by pale yellow and white wounds. Multiple bite biopsy and virus culture can confirm the diagnosis. Surgeons must also be familiar with the manifestations of these diseases in the anus and rectum and early diagnosis techniques.
Chronic anal pain
(1) Perineal descent syndrome: Perineal descent syndrome is a pelvic floor muscle degeneration and dysfunction caused by various reasons. It is a pelvic floor disease in which the perineum declines more than the normal range when forced to defecate. Parks (1996) first described the disease and believed that the intrinsic symptoms were the accompanying symptoms of rectal prolapse. The main reason is directly related to excessive defecation. Common symptoms are characterized by unclean defecation, anal bulging, difficulty defecation, and pain in the perineum.
(2) Pelvic floor achalasia syndrome: The pelvic floor achalasia syndrome was named puborectalis syndrome in the past, and the main change of the disease is the spasmodic hypertrophy of the puborectalis muscle. Kuijpers was named pelvic floor achalasia syndrome in 1985, which is believed to be caused by normal muscle dysfunction. The main clinical symptom is slow and progressive bowel movements, which can last for several hours, which is very painful.
(3) Internal rectal prolapse: Severe internal rectal prolapse often causes chronic anal pain. Anorectal intussusception caused by internal rectal prolapse can stretch the rectal fornix, produce tenesmus, and make the internal sphincter in a state of tension and spasm for a long time. The anal pain of these patients may be secondary to the ischemia-reperfusion injury of the anal canal caused by the pathological hyperplasia of the internal sphincter.