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Anal Pain

The anal canal and especially the anal opening is very well innervated, meaning it has a lot of nerve endings and is very sensitive to painful stimuli. Anal pain is one of the most frequent proctological complaints.

Acute anal pain has a history of a few days or weeks and is mostly related to anal fissures, anal abscesses or complications of hemorrhoids.
Chronic anal pain is more complex, can be related to recurrent anal fissures or recurrent flare ups of hemorrhoids, but often has no other obvious source than spasms or discoordination of the anal or pelvic floor muscles.

Anal Spasm, Anismus, Non-relaxing Puborectalis Syndrome, Anal dissynergia

Anal spasm is the unconscious, long lasting tightening of the anal muscles. It sometimes only causes discomfort or a feeling as if a foreign body is in the anus or rectum, but most of the time it is perceived as pain. Often there is – at least at the start of the problem – a definite painful disease or situation, like anal fissure, thrombosed hemorrhoid, unusually painful anal surgery – which starts off the spasm and/or pain. Years later the initial problem is long gone but the spasm and or pain is still haunting.

Anismus is the inability to consciously relax the circular external sphincter muscles. Non-relaxing Puborectalis Syndrome is the inability to consciously relax the puborectalis muscle. Anal dissynergia is a hiccup in the coordinated movement of the abdominal and ano-rectal muscles and pelvic floor during defecation, resulting in dyssynergic defecation. The most frequent form of this is a conscious push by thightening the abdominal muscles, combined with a lack of constious relaxation of the anal/pelvic floor muscles, or even paradoxical tightening of these muscles, resulting in a “push against closed door”, which falls in the category of obstructed defecation.

What signs and symptoms one has with this problem?

The main complaint is anal pain. It can be pain only on the toilet, pain for some times after toilet, pain all day, pain attacks at night, pain unrelated to toilet. In addition there is in most cases difficulties on the toilet: inability to empty the rectum, long toileting, too much pushing needed etc.