Question: Recently, I have been experiencing severe pain when I poop. Even though I have the need, I am avoiding going to the toilet as it hurts when I poop. Sometimes, there is blood mixed in the poop. What can this be? Should I see a doctor?

Answer: Pain or bleeding when having a bowel movement is most often associated with constipation or haemorrhoids. Generally, the slow progress of the faeces through the colon absorbs water from foods. This hardens and packs the faeces in the intestine. People suffering with constipation may find having a bowel movement extremely painful. Constipation occurs due to lack of fibre and fluid in the diet. Therefore, if you have pain and bleeding when you poop your diet should be changed to include foods high in fibre. Constipation also occurs due to physical inactivity, medications, certain foods, low water intake and irritable bowel syndrome. Some women experience constipation during pregnancy.

Chronic constipation leads to haemorrhoids. This occurs when the veins around the anus become swollen or inflamed. There are two kinds of haemorrhoids. These are external and internal haemorrhoids. External haemorrhoids occur under the skin around the anus. Internal haemorrhoids occur in the lower rectum. There are instances when internal haemorrhoids protrude out of the anus. These may shrink back into the anus, but there are instances when this does not happen. This requires treatment or surgery. Bleeding when you poop and feeling pain when you poop are common symptoms of haemorrhoids.

Other Reasons for Pain with Bowel Movement

The abovementioned conditions are the most commonly assumed when someone says "it hurts when I poop". However, there are more causes associated with pain when having a bowel movement.

• Anal Fissures - Anal fissures are small tears that occur in the lining of the anus. This usually happens with constipation. Straining to pass stools tears the lining causing pain and bleeding when you poop. A person who has an anal fissure experiences severe pain with bowel movements and for many hours after the bowel movements. There can also be itchiness around the anus and a crack in the skin around the anus. The tears caused by anal fissures may heal within a number of weeks. However, there are instances when they may not. This may require medical treatment or surgery. The prevention of anal fissures depends on eating a diet high in fibre, drinking plenty of fluids and exercising on a regular basis.
• Anorectal Abscess - Bleeding when you poop and pain when having a bowel movement can also be due to an anorectal abscess. This is an abscess that forms near the anus, and may be caused due to a blocked gland near the anal area; an infected anal fissure; or due to a sexually transmitted infection. Anorectal abscesses may spread to other tissues. Therefore, antibiotics or surgical drainage may be necessary to clear the risk of infection.
• Other Obstructions of the Rectum or Anus - Sometimes, when you think "it hurts when I poop", it may be due to an obstruction of the rectum or anus. The anus or rectum may be blocked if there is a growth. Most often, pain and bleeding when having a bowel movement may be indicative of cancer or polyps. A digital rectal examination and an endoscopy may help detect the cause of the obstruction.

Preventing Constipation

As pain and bleeding with bowel movement is commonly associated with constipation there are a number of remedies that help prevent constipation. Following through on these prevention methods help avoid other complications arising from constipation. For example, keeping the bowels well hydrated prevents constipation. Therefore, drinking plenty of water helps avoid constipation. In addition, the urge for a bowel movement should not be ignored. Ignoring the urge increases the risk of constipation. Including dietary fibre in the diet, in addition to several varieties of fruit such as papaya and prunes also prevents constipation. Avoiding caffeine and chocolate as much as possible helps reduce the excessive drying effect on stools.

Pain with a bowel movement can be a nuisance and a discomfort. Severe constipation will require medical aid and medication such as laxatives. However, taking proper preventive measures helps alleviate problems associated with constipation.