Anal pain is another common symptom of anorectal diseases. Among patients seen in the anorectal outpatient department, apart from those with majority having hematochezia (blood in stool), anal pain ranks second, with about 30% of patients seeking medical attention mainly due to anal pain. Anal pain is a subjective sensation experienced by patients and lacks objective measurement criteria. Based on the nature and severity of the pain, it can be categorized into severe pain, dragging pain, and dull pain. The main cause of anal pain stems from diseases of the anal canal itself, such as anal fissures which manifest as localized anal pain; or from diseases around the anal canal and rectum, like perianal abscesses, which cause pain slightly further away from the anus. Anal pain may be the primary symptom of a certain disease but not the only one, and it might also co-occur with hematochezia or other symptoms, for example, patients with anal fissures may seek treatment primarily due to anal pain. Dull pain refers to general mild discomfort that is bearable. The causes of anal dull pain are often inflammatory diseases of the anal canal and surrounding areas, and can also be seen in neurosis.
1) Ano sinusitis: Commonly seen in the anorectal outpatient department. Typical symptoms include anal dull pain and discomfort, gradually leading to short-term anal pain during defecation. If the sphincter muscle is stimulated by inflammation, it can also cause spastic anal pain that lasts longer. There is frequently secretion overflow from the anus, causing itching or skin eczema around the anus, keeping the local skin damp and unclean, and often contaminating underwear. The initial part of the stool during defecation may have mucus-like substances, which are inflammatory secretions from the ano sinus, sometimes mixed with blood threads. If left untreated for a long time, it can turn into chronic ano sinusitis.
2) Anal fistula: Commonly seen in the anorectal outpatient department. Typical symptoms include repeated ulceration and pus discharge around the anus, and anal dull pain during acute infection episodes. Patients have a history of acute perianal abscess, and after the abscess ruptures or is incised for drainage, a chronic anal fistula can form. Due to the long-term existence of chronic inflammation and infection stimulation around the anus, there is often a dull pain at the fistula opening and its deeper parts. Repeated ulceration and pus discharge, with pus stimulating the local skin, can lead to skin itching. The fistula opening may heal falsely, stopping the pus discharge, but after some time, the area swells and becomes painful again, breaking open and discharging pus, repeating this cycle.
3) Anorectal neurosis: Similar to other neuroses, the self-perceived symptoms are severe, but no positive physical signs are found upon examination. It can manifest as anal dull pain, worsening when focusing on it, and alleviating otherwise. Other symptoms include anal itching, abnormal sensations, crawling sensations, anal fullness, burning, and difficulty in defecation. Emotional fluctuations can worsen the symptoms, while appropriate suggestive therapy can reduce or alleviate them.
4) Rectitis: When suffering from rectitis, common symptoms include anal dull pain accompanied by diarrhea. Some patients may visit the doctor mainly due to blood streaks in their stool. It's important to maintain good living habits, avoid staying up late or using the internet for extended periods, engage in moderate exercise, eat a light diet, and avoid spicy or greasy foods. Consuming fiber-rich foods such as bananas, fiber drinks, fruits, vegetables, bamboo shoots, oatmeal, etc., all help promote bowel movements. It is recommended to go to a professional anorectal hospital for examination through an anorectal endoscope, and then receive targeted treatment based on the examination results. Untimely treatment can still cause significant harm that should not be overlooked.