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Bowel movements or defecation is normally a painless and comfortable process. It shouldn’t be painful or difficult. Cramps, pain or excessive straining during defecation are all abnormal and usually are a manifestation of a disease.

There are a number of diseases that can cause pain during defecation. It is mostly associated with another symptom like bleeding or constipation. It’s important to note all your symptoms in addition to pain because they will lead to the final diagnosis.

The conditions which cause pain while passing stool are;

An anal Fissure is a tear in the internal lining of anus usually caused by constipation. Hard or large stool injures the anal mucosa during defecation. It is a very common condition that causes pain and itching in the anus. It is often associated with bleeding per anum when the stool is passed. This condition is very common in young adults. By treating the constipation, anal fissure is eventually healed.

Hemorrhoids are the swollen or dilated vein around the rectum or anus. It is associated with pain, bleeding and itching around the anus. If the dilated veins are present in the anal canal it is called external hemorrhoids. If they are present in the lower part of rectum, this condition is called internal hemorrhoids. External hemorrhoids are usually more painful.

Infection and inflammation: Inflammatory conditions of the lower part of the gastrointestinal tract are also associated with painful bowel movements. Inflammation of the rectum (proctitis), colon (colitis), bladder (cystitis), prostate and pelvic organs can cause pain during defecation. In sexually active people, sexually transmitted infections (STDs) should be ruled out.

Other inflammatory conditions of the gut like diverticulitis, ulcerative colitis or Crohn’s disease can also cause painful bowel movements. These chronic conditions have associated symptoms like diarrhea, constipation, pain in the abdomen, bleeding from rectum. 

Therefore it is important that you note all your symptoms carefully and consult a doctor to rule out some serious conditions.

Perianal Abscess and fistula: An abscess is a collection of abnormal fluid (pus). It can be formed around the anus as a consequence of infection. It is associated with fever and painful bowel movements and often complicated with a perianal fistula, which is an abnormal passageway between the two cavities

Tumors and Growths: Colonic polyps are the benign growths on the mucosa of the colon and are associated with pain and bleeding during defecation. Malignant conditions of the colon like colorectal carcinoma presents with rectal bleeding, weight loss and sometimes painful bowel movements. It usually presents in old age.

Trauma: Physical or mechanical injury to the anal canal or rectum can also result in painful bowel movements for example anal intercourse, very hard stools and vigorous cleaning/wiping can all result in a direct injury to the anus and eventually cause pain during the bowel movements.   

What To Do?

If you are having pain during every bowel movement, it is necessary to consult a doctor and have a complete evaluation. The doctor will take your complete history and examination. The examination may also include a rectal examination, therefore you should be mentally prepared for it. 

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