Painful Bowel Movement

Pain during defecation is a relatively common problem, but many people do not visit a doctor because of shame or fear. It is a pity, because many causes of such problems are non-serious and well-treatable. This of course is not valid for all causes o pain during bowel movements, but every pathologic condition can be better treated, when diagnosed in time.



This is probably the most common cause of painful defecation. Protruding dilated venous lesions may be injured by passing stool, especially by constipation. There is often found red blood in stool and on the toilet paper.

Anal fissure

A tear in lining of anus is very painful and bowel movements can become a true agony. Fortunately, this condition is relatively easily solved with a surgical procedure performed in general anesthesia. More information can be found in relevant article.


Severe constipation with solid stool damages mucous membrane of the rectum, which hurts. Constipation worsens symptoms of coincidently present hemorrhoids or anal fissure.

Rectal cancer

Tumor growing in rectum and anal area is usually associated with pain during defecation and occurrence of red blood in stool. The tumor is often palpable by digital rectal exam.

Idiopathic bowel disease

Rectum is affected in ulcerative colitis and perianal area is typically damaged by certain forms of Crohn's disease. Crohn’s disease affecting anus usually causes formation of anal fistulas. These fistulas can get infected by bacteria and such situation increases risk of rectal abscess occurrence.

Radiation proctitis

When treating a tumor located in pelvis by irradiation, there is always some damage caused to intestines including rectum. Intestinal mucosa is sensitive to radiation, it becomes inflamed and that is connected with many problems including pain by bowel movements.

Functional disorders

Like other symptoms coming from digestive tract, even painful defecation can be caused by “only” functional problems. Functional disorder means a condition without a clear underlying organic disease. Such intestinal disorders are often referred to as so-called irritable bowel syndrome. Before this diagnosis is made, organic diseases must be excluded to avoid underestimation of potentially serious condition.

Diagnostic approach

Medical history is most important as by other symptoms. We need to get information about stool frequency, duration of difficulties, blood in stool and constipation or diarrhea presence. Physical examination should follow. In anal area doctor can see presence of anal fissure, local fistulas and other inflammatory changes. Digital rectal exam shall be performed always as it helps to find blood in stool, larger internal hemorrhoids or rectal tumor. A rectoscopy can evaluate mucosa of anal channel and deeper rectum, complete visualization of colon is ensured by colonoscopy. Further examination depends on acquired findings.

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources