Pain during bowel movement is one of the most excruciating experiences of all times with its occurrence in an unexpected part of the body. In this article find out what causes this sharp pain, in the lower abdomen, in female, male, with no blood, at night and how to get rid of or relief it
Sharp Pain Causes and Symptoms
In medical terms, the pain is referred to as Proctalgia fugax and Levator ani syndrome. These two are similar but different in the section of the rectal passage they affect and the type of pain felt. Read on to find out more..
Anatomy
Perhaps you need to understand a bit of anatomy in a rather superficial sense. The bowel canal is normally surrounded by a number of parts. These include the uterus and pelvic floor muscle in women and the prostate in males.
In fact, the pelvic floor muscle is what is known as the levator ani. There are a variety of causes of pain but the most affected gender is females owing to the number of adjacent organs that surround the canal.
Speaking of the type of pain and where it occurs, that associated with proctalgia fugax is known to be sudden and intense. Such pains last less than a minute but may exceed this in some patients. It could go for an hour.
The pain associated with this type of pain is due to muscle spasms that may occur without any particular trigger.
In other cases, the cause may be a neuronal entrapment of condition leading to unintentional contraction and relaxation of the muscles. This may lead to depletion of energy stores and lead to cramping felt more like what happens with uterine spasms during the menstrual period.
People describe it as crampy and stabbing at the opening of the canal and occurrence or frequency seems to be in tandem with cluster pains during the day which may disappear for weeks. You notice this resembles cluster headaches, do you?
Well, the levator ani is a syndrome meaning that it is a group of conditions. The pain is this time round felt deep into the rectal canal. It is more like a tension felt between two points with a tight pressure. When this pressure is increased through seating or walking, it may worsen the pain.
Unlike the proctalgia fugax, this pain does not occur in clusters and therefore lasts longer, as much as 30 minutes and continuously present without a discernible disappearance.
Symptoms
There is some degree of idiosyncracy or particularity when it comes to the symptoms. They could be variable enough to warrant a thorough diagnostic procedure so as to eliminate differentials. Remember that there are a variety of other organs that require to be investigated to rule them out.
The pain is in itself a symptom and this could be of any condition that is considered a cause of such a pain. For instance, you will discover that hemorrhoids are associated with external hemorrhoids.
These are those that reside inside the end part of the large intestine and form a discontinuous layer of thickened tissue. The arteries supplying this tissue can be thrombosed and this is usually associated with pain.
Hence, hemorrhoids associated with pain should trigger a differential diagnosis with options such as excretory opening fissures, solitary rectal syndrome and pelvic floor dysfunctions such as pelvic dyssynergia, proctalgia fugax and internal sphincter spasm.
If bleeding occurs, it is dangerous as hemorrhoidal bleeding is arterial in nature and bright red rather than venous is due to the direct communication of the arteriovenous within the cushions.
If it is a fissure, then the pain is described quite differently. Those affected say it resembles being cut by a sharp blade which then resides into a dull ache lasting for hours.
In some cases, bleeding may occur. There is a tendency to delay bowel movement which may lead to constipation and sharper pains as the stool passes the torn areas.
Some pains are felt to navigate between the uterus and the excretory opening. It is described as a ‘shooting’ pain between these areas. Excessive pain that is cramping in nature associated with spasms of the pelvic muscle may be associated with Chronic Pelvic Pain (CPP). The spasms occur mostly at night and they arouse you.
Some pains are felt in the peri-umbilical area of the abdomen while at the same time coincide with the pain. This may reflect a urinary tract infection that may have led to Painful Bladder Syndrome.
Therefore, thorough examination needs to be done so as to be able to discern the cause of the pain. The type of pain comes in handy in this decision but cannot be relied upon as the only diagnostic lead.
Possible general causes
- Diverticulosis or diverticulitis
- Hemorrhoids
- Fissure
- Abscess and fistula
- Ulcers
- Large polyps
- Constipation
- Proctalgia fugax
- Levator ani syndrome
- Pelvic dyssynergia
- Solitary rectal syndrome
- Rectal prolapse
- Constipation
- Colorectal cancer
Pain when passing Stool but no Blood
What can lead to sharp pain during bowel movement? The common causes of pain without sight of blood include:
- Proctalgia fugax – this is caused by spasms in the sphincter muscles leading to pain close to the edge of the excretory opening. It may also occur due to a neurological entrapment that leads to an involuntary relaxation and contraction of the muscles.
- Levator ani syndrome – as the name suggests, this condition results in pain due to spasms associated with the levator ani mucles of the pelvic region.
- Pelvic dyssynergia – according to the International Foundation of Functional Gastrointestinal Disorders, this anorectal dysfunction contributes to constipation. It is also known as anismus and occurs due to a failure of the pelvic floor muscles to relax during bowel movements leading to what a ‘Paradoxical contraction’
- Solitary rectal syndrome – this condition leads to rectal bleeding, prolonged excessive straining, perineal and abdominal pain and. It is associated with constipation and a feeling of incomplete bowel movements. According to the World Jounal of Gastroenterology (Qing-Chao Zhu et al, 2014), it is caused by an obliteration of the lamina propria which is one of the layers of the luminal walls and also due to thickening of the muscularis mucosa.
- Constipation – refers to difficulty in passing stool due to a variety of causes some of which have been mentioned in the causes above. This is a trigger to hemorrhoids and fissuring.
Sore Excretory Opening after Bowel Movement
To Bowel Research Institute, some people experience soreness after a bowel movement. Most of these are digestive health issues that cause this discomfort. Some common problems have been discussed in the previous sections and this section will thus reiterate.
Hemorrhoids
Hemorrhoids normally aid in the process of bowel movement. In fact everyone has hemorrhoids but many do not have symptoms or signs from them. They are cushion-like bundle of tissues composed of vasculature and smooth muscle.
When there is formation of fibromuscular tissue along the rectal canal that causes thickening of the epithelium, the blood vessels that supply this part of the gut may hemorrhage. External thrombosed hemorrhoids are associated with pain especially during bowel movements.
Fissure
This is a tear to the epithelium that lines the canal. Constipation normally causes it by leading to overstretching and friction to the skin. Related reasons include a neurological defect that leads to increased tightness of the sphincter muscles.
Diverticulosis or diverticulitis
This condition develops when there is an occurrence of small pouches known as diverticuli. They occur in weakened sections of the epithelium of the small intestines and form a protrusion into the lumen. The most affected part of the large intestine is the sigmoid colon.
Diverticulitis occurs with symptoms unlike diverticulosis and with an infection that leads to an inflammation to which its name owes. A fever is associated with diverticulitis-associated pain.
Diarrhea
You might have realized that bouts of diarrhea leave that region feeling a bit sore. This is caused by the forced expulsion of the loose stool that may even lead to tear of the canal.
Rectal prolapse
Bowel movements when the concluding part of the large intestine is ‘inside out’ may make it difficult to pass stool and if need arises in such circumstances, leaves the area sore.
Constipation
Difficulty in passing stool may cause inflammation causing soreness and proctatitis.
Sharp Pain Lower Abdomen Female
Sharp pain in these areas may be gastro-intestinal or gynecological in origin.
However, the latter is the most common cause and may be due to the following sources WebMD forums
- Endometriosis – this condition can lead to adhesion of organs in the abdomen causing pain. The adhesive substance is caused by formed bands of scar tissues that are filmy from withheld blood. It occurs when some tissue from the uterus grows in other parts such as the bowel, ovaries and the bladder.
- Pelvic congestion syndrome – just like varicose veins, this condition occurs due to back-flow of blood causing bulging of the veins. It causes pain in the abdomen and the rectal region.
- Adenomyosis – unlike endometriosis, this condition occurs when the uterine cells grow, not in the endometrium, but in the myometrium.
- Pelvic Inflammatory Disease – this is an infection of the pelvis that may lead to formation of adhesions as seen in endometriosis. The inflammation could cause peritonitis that may infect other organs in the abdomen including the GIT and subsequent pain.
- Uterine prolapse – associated with heavy pain, this condition also involves telescoping of the uterus into the reproductive organ. This causes pain in the abdomen that may shoot to the other end.
- Masses in ovary or uterus – these are a variety including fibroids. They exert pressure on other organs causing abdominal pain.
- Vulvodynia – in this condition, there is pain that is described as burning and irritating. This means that penetrative sex and tight clothing exercabate the abdominal pains.
- Interstitial cystitis – also known as painful bladder syndrome. There is inflammation of the bladder and this causes pain especially when urinating.
Sharp pain from Uterus
Pain that is sharp and transverses the uterus to the excretory opening is mostly caused by endometriosis which is discussed in the previous immediate section. Another cause is Chronic pelvic pain (CPP) that is experience in the lower abdomen.
There is associated peri-umbilical pain in the female reproductive organ or perineum. The shooting pain between the uterus and the opening occurs in the perineum. This condition may persist for a number of years.
Sharp Pain in Male
According to Johns Hopkins, prostatitis is the main cause of sharp pain if all the other causes are ruled out. This is an inflammation of the prostate gland or the area around it that is not a cancer yet.
Since the prostate sits anterior to the rectal area and below the bladder, it may lead to pain in these areas. It is caused by a recent UTI, enlarged prostate, abnormal urinary tract anatomy.
Sharp pain at Night
Intermittent chronic pain syndrome: Proctalgia fugax
Pain due to proctalgia fugax occurs irregularly and therefore describes as intermittent. It is however chronic as it grows over time due to an underlying condition and persists. It only has to be managed.
Presentation
Its presentation is based on recurrence of episodes of pain, severe cramps of the sphincter muscles and the time it takes to recede. With the latter, it takes seconds to 1 minute to resolve and occurs in clusters. However, symptoms occur at night and this leads to insomnia.
Pain Relief-Home Remedies & Treatment
There are home remedies to some of the causes the pain. Such include constipation or diarrhea. Constipation can be treated by laxatives and this can be purchased over the counter though under the supervision of a pharmacist.
Diarrhea has to be managed by treating the underlying infection if present and then bulking agents administered such as Ispaghula husk and kaolin.
Antibiotics are particularly important in treating infections in diverticulitis and pelvic inflammatory disease. Venotonic agents such as diosmin, Lidocaine, and antiseptics are indicated for hemorrhoids.
Some require surgery such as endometriosis, adenomyosis, polyps and rectal prolapse.
