Pain when evacuating: 5 possible causes and what to do

Pain when evacuating is usually related to changes in the anal area, such as hemorrhoids or fissures, but it can also happen due to variations in the stool, especially when they are very hard and dry.

Thus, if this type of pain occurs in a person with constipation, it usually happens because the stool is very hard and therefore can cause injuries when passing through the anus. However, if an abnormality of the anus is suspected, it is important to go to a general practitioner or a proctologist to identify the diagnosis and initiate the correct treatment.

1. Hemorrhoids

Hemorrhoids are a major cause of pain when evacuating and usually, in addition to the pain, they also cause bleeding and blood may appear on the toilet paper or even in the vessel. Hemorrhoid is similar to a varicose vein, as it is a dilated vein that arises in the anus, especially in those with constipation, as they can arise from increased pressure when trying to evacuate.

Most of the time, hemorrhoids do not cause any other symptoms, but there are cases where the person may still experience itching in the anal area and discomfort during the day. In case the hemorrhoid appears in the external region of the anus, it may still be possible to feel a slight swelling in the region.

What to do: The ideal is to consult a proctologist to confirm the presence of the hemorrhoid and start the appropriate treatment, which is usually done with ointments such as Proctosan or Proctyl, for example. See other examples of ointments for these cases.

2. Constipation

In the case of people with constipation, the pain when evacuating is very frequent, not only because they need to apply more force, but because the stools are very hard, they can end up injuring the anal area when they leave and cause small wounds. For this reason, it is also common for small blood stains to appear on the toilet paper, which appear as a result of bleeding from these wounds.

What to do: The best way to combat constipation is to eat a diet rich in fiber, exercise regularly and drink at least 2 liters of water per day. However, when these measures do not work, it may be necessary to make a laxative prescribed by a doctor, for example, to soften the stool and allow it to pass. See more about how to fight constipation and evacuate without pain.

3. Anal fissure

The anal fissure is a small sore that can appear in the anal area, occurring when there is a trauma in the region, such as when the anus is cleaned excessively, when you have very hard stools or due to other diseases such as Sexually Transmitted Infections (STIs) or Crohn's disease, for example.

Although the fissure can cause a burning sensation during the day, the pain is usually stronger when evacuating, due to the passage of stool. Because it is a wound, there is a greater risk of infection, which can end up causing swelling in the region and very severe pain throughout the day.

What to do: The fissure can heal naturally, requiring no treatment. However, as you have a higher risk of infection, it is advisable to maintain adequate intimate hygiene. Therefore, whenever possible, after evacuating it is very important to wash the region with abundant water. See also how to do a sitz bath to relieve discomfort.

The use of healing ointments, such as Xyloproct, the use of analgesics to relieve pain, such as Dipyrone, or the use of laxatives, such as lactulose or mineral oil, may also be indicated, in addition to recommending a diet rich in fiber. and the consumption of plenty of fluids during the day, so that it is possible to prevent the stool from becoming hard.

4. Anal abscess

The anal abscess consists of the accumulation of pus under the skin, close to the anus region. This abscess usually happens due to the obstruction of the glands around the anal area and, although it can cause a lot of discomfort and pain, it is easy to treat with minor surgery.

Anal abscess is characterized by the development of a swelling that increases over time and that can become red and very painful, and can also be associated with fever. At first, the symptoms can be very mild and intensify when evacuating, but it is common for the pain to get worse, affecting day-to-day tasks, such as sitting and making efforts.

What to do: The only treatment for abscess is to have a small surgery to drain the pus inside. Therefore, if an abscess is suspected, it is advisable to consult a proctologist to confirm the diagnosis and schedule the surgery. Understand the symptoms that indicate anal abscess and how the treatment is done.

5. Intestinal endometriosis

When the pain when evacuating arises during menstruation or is very intense during this period, it can be a sign of endometriosis in the intestine. Endometriosis consists of tissue growth similar to that of the walls of the uterus, but elsewhere in the body. Normally, this type of tissue becomes inflamed during menstruation due to the effects of hormones and, therefore, if it is in the intestine, it can cause severe abdominal pain during menstruation, which can get worse when evacuating.

In these cases, in addition to pain, constipation, severe cramps and bleeding in the stools may also occur, for example. Check for other signs that may indicate that pain when evacuating is endometriosis.

What to do: Endometriosis is usually treated with the use of a birth control pill, to regulate hormone levels and decrease inflammation of the tissue that is inside the intestine. However, in the most severe cases, surgery may be necessary to remove the tissue. Learn more about intestinal endometriosis and how it is treated.

When to go to the doctor

In most cases, pain when evacuating is not a sign of a serious problem, but it is always advisable to consult a proctologist to start the most appropriate treatment, especially if symptoms such as:

• Fever above 38º C; Excessive bleeding when evacuating; Very severe pain, which prevents sitting or walking; Redness or excessive swelling of the region.

Although it is more rare, some types of cancer, such as cancer of the rectum or prostate, can also cause pain when evacuating, so it is always important to make an appointment with a doctor to address these more serious problems.