Internal hemorrhoids
Varicose veins of our anal canal.

Bleeding from our anus is very commonly from hemorrhoids.
This is likely if it is bright red and seen on the toilet paper rather in the toilet bowl.

Small haemorroids can't be seen nor felt, except when your doctor inserts an instrument to look in the anal canal.
The doctor's finger needs to go in too, to check for other things.

There is an old saying in medicine.

"If you don't put your finger in it, you put your foot in it."

It's not a great experience for you nor for your doctor. There was a consultant at the Royal Womens Hospital years ago whom we had a nickname for... "Query PR later." He always left per rectum examinations for someone else and covered his own ass by writing that in the medical record.

Three quarters of rectal cancers can be felt, and they will also cause bright red bleeding PR.

It doesn't stop there if nothing is found, nor if piles are found. One can easily have piles plus something else above.

A clue to bleeding from further up in the bowel, is plumb colored blood. One is now definitely thinking of bowel cancer or diverticulosis.



As haemorroids enlarge, they can protrude out of the anus when we are pushing down. They feel like small grapes, and can be pushed back inside.

Large hemorrhoids stay out, but they are still attached to the inside of the anal canal.

These can become strangulated, when pain results in tightness of the anal muscle in addition to the tight fibrous band which is usually there to start with.

They are then very swollen, painful, reddish purple and weeping. Creams for treating them used to contain morphine and cocaine, they are that painful.

Ice packs and aloe vera jelly are useful, as is laying down with hips elevated on pillows.

If you can get a leaf of aloe vera, use a vegetable peeler to remove the green skin, wash off the yellow sap, and crush the translucent colorless center in a garlic press.

Smaller piles associated with discharge and discomfort, are helped by hydroxyethylrutosides (Paroven.)

Pawpaw ointment can also be useful it these.

Surgical treatment includes rubber band ligation, and excision (removal.)



Thrombosed external pile,
perianal haematoma

You've suddenly got a hard, tender and painful lump beside your anus. It is attached right here, not poking out through the anus from inside.

When a medical student in the emergency room, I was rather taken aback at the treatment used. The doctor simply chopped the top off with scissors.

He explained that a local anaesthetic injection would have hurt just as much. I'm sure he was right, but I usually use the local anaesthetic.

One then squeezes out the shiny black clot of blood.

If it is small and you are prepared to put up with it, just roll up a towel and sit with it across under your thighs just in front of the tender spot.

It will be better in about a week, but will leave a little fold of skin. This is the advantage of chopping the top off - no skin tag left.



Anal pain from fissure in ano - skin split in anal canal

This is probably a more common cause of pain here.

Your anal canal skin has split, when passing a large, hard bowel action. This is continually broken open with subsequent bowel actions, so fails to heal.

If it fails to heal for a long time, over 4 weeks, poor blood supply here is involved.

There may be a little ("sentinal") tag of skin at the bottom end of the split, from a strip of skin being peeled down. This may be felt just at the opening of the anus.

Treatment can be application of local anaesthetic, glyceryl trinitrate or a calcium channel blocker drug topicaly, botulinum toxin injection, faecal softeners and surgery.

Discovery of a constant, midline subcutaneous tract within the sentinel tag, if present, and extending up to 1 cm further down than the fissure, has resulted in the operation of subcutaneous fissurotomy.

This tract is laid open, in exactly the same way a fistula in ano tract is laid open.



Fistula in ano - a perianal fistula

A boil comes up beside the anus, discharges and heals over. Later it does the same thing all over again.

The boil is being fed with germs from inside, by a narrow passage from inside the anal canal.

Provided it is not due to something such as Crohn's disease, this is treated by laying open the tract as above, and letting it heal together, obliterating the tract in the process.



Proctalgis fugax - Brief pains in your ass (up inside)

This is a cramp up in the rectum, coming on unpredictably at very irregular intervals, often at night and lasting 10 minutes at most.

It can come on after straining to pass a bowel action or in males within a few minutes of ejaculation.

It is often accompanied by a tight sensation in one's upper abdomen, in the center between the ribs (epigastrium) or over one's breastbone in the middle of the chest (praecordium - literally in front of the heart,)  making one gasp for breath.

It is often severe, at times even enough to cause a faint.

There is no tenesmus at the time, nor passage of wind.

It is believed due to spasm of the muscles of the pelvic floor¹

The immediate treatment is the same as any other cramp - to stretch the muscle.

Keep a tennis or golf ball for the purpose, and sit on it, so that it pushes up on your anus. Sometimes it is enough to just push up with the fingers laid across your anus. Keep up the pressure until the pain completely subsides.


Pilonidal sinus - in the crack, behind your anus

Make that your gluteal cleft.

A sinus is basically a hole, opening to a surface. The opening here is in the midline, but the hole is usually on one side, and full of hairs.

Here one can't tell whether the hole or the hairs came first. Hairdressers used to get pilonidal sinuses between their fingers, and there the hairs definitely came first.
Cut hairs are sharp enough to cut through the delicate skin there.

If you first become aware of this when it becomes infected, antimicrobial treatment will not be enough on its own. The hairs have to be meticulously removed with some fine forceps. They can't be seen, so one just has to dive into the hole and grab.

Surgery may be needed, now, or later to prevent recurrence.



From hemorrhoids page to home page

From hemorrhoids page to abdominal pain pages

Hemorrhoids are similar to varicose veins, and some of the treatments are the same for hemorrhoids and chronic venous insufficiency in the legs.

Paroven is marketed for both hemorrhoids and leg aches.

See the lower limb pain page for other potential treatments of hemorrhoids.

References for hemorrhoids page

1. A. H. Douthwaite "Proctalgia Fugax" BMJ July 21st 1962 pp 164 - 165




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Tenesmus is a feeling one urgently needs to use bowels or bladder, with spasm of the appropriate sphincter preventing this.

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