[19M] Experiencing anal pain and slight constipation

Patient Description

A 19-year-old male is experiencing dull anal pain that sharpens when standing on the right leg. The pain is rated as a 3 out of 10 in severity and is slightly exacerbated after large meals. The patient has slight constipation but no complete obstruction, with no pain during bowel movements. There is no blood present after bowel movements, and the patient has noticed some redness around the anal area, attributed to chafing. The patient has been on a daily dosage of 1200 mg of lithium, with recent missed doses. No other medications are being taken, and there are no known drug allergies. The patient has had one sexual partner for the past year without consistent use of protection. No new or multiple sexual partners recently. There is no history of similar symptoms following receptive anal intercourse in the past, and no pre-existing conditions or chronic illnesses have been reported.

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Arora's Assessment

What might be happening

Based on the information you've provided, possible causes for your symptoms include:

  • Anal Fissure: This is a small tear in the thin, moist tissue (mucosa) that lines the anus. This may occur when you pass large or hard stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. You might also experience a visible crack in the skin around your anus.

    • Treatment usually involves measures to relieve constipation, including dietary changes (more fiber and water), stool softeners, and in some cases, surgery.
  • Hemorrhoids: These are swollen veins in your lower rectum. Internal hemorrhoids are usually painless, but tend to bleed. External hemorrhoids can cause pain, itching, and anal discomfort.

    • Treatment typically involves over-the-counter creams or ointments, lifestyle changes (more fiber, water, exercise), and in severe cases, surgery.
  • Proctalgia Fugax: This is a severe, crampy pain that can be felt in the rectum and can last for a few seconds to a few minutes. The pain usually occurs spontaneously and has no specific triggers.

    • Treatment usually involves managing symptoms, as the cause of proctalgia fugax is not well understood.
  • Anal Sex: Receptive anal intercourse can cause anal pain if not performed carefully. This can be due to small tears in the tissue or muscle strain.

    • Treatment involves abstaining from anal sex until symptoms resolve, using sufficient lubrication in the future, and seeking medical attention if symptoms persist.

Please note that this is not an exhaustive list and other conditions may also cause your symptoms.

What you can do

  1. Increase your fiber intake: Eating more fruits, vegetables, and whole grains can help soften your stools and make them easier to pass.
  2. Stay hydrated: Drink plenty of fluids, especially water, to help prevent constipation.
  3. Avoid straining during bowel movements: This can worsen hemorrhoids and anal fissures.
  4. Over-the-counter treatments: Creams or ointments for hemorrhoids can be found at your local pharmacy and may provide some relief.
  5. Warm bath: Sitting in warm water for 15 minutes, especially after bowel movements, can help soothe the anal area.

What you should look out for

You should seek immediate medical attention if:

  • Your pain becomes severe or unbearable
  • You notice blood in your stool or on toilet paper after a bowel movement
  • You develop a fever or other signs of infection, such as pus or a foul-smelling discharge
  • Your symptoms do not improve or worsen over time

Remember, while I strive to provide accurate information, I'm not a doctor. It's important to consult with a healthcare professional for a formal diagnosis and treatment.

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9 mo ago


People Also Ask


What are the common causes of anal pain that worsens when standing on one leg?

Anal pain that worsens when standing on one leg could be due to conditions like hemorrhoids, anal fissures, or muscle strain. These conditions can cause discomfort that may be exacerbated by certain positions or activities.


How can constipation contribute to anal pain, and what are some ways to alleviate it?

Constipation can lead to anal pain by causing straining during bowel movements, which may result in hemorrhoids or anal fissures. To alleviate constipation, increase fiber intake, stay hydrated, and consider using stool softeners.


What are the potential side effects of missing doses of lithium, and could it be related to anal pain?

Missing doses of lithium can lead to mood instability and other side effects, but it is unlikely to be directly related to anal pain. However, any changes in medication should be discussed with a healthcare provider.


How can one differentiate between hemorrhoids and anal fissures based on symptoms?

Hemorrhoids typically cause itching, discomfort, and sometimes bleeding, while anal fissures often result in sharp pain during bowel movements and visible tears in the anal skin. A healthcare provider can help differentiate between the two based on symptoms and examination.

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