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Q. What could be the reason for the burning sensation after passing stool even though I was completely cured from piles?

Answered by
Dr. Ajeet Kumar
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Sep 04, 2022 and last reviewed on: Sep 14, 2022

Hi doctor,

I have had internal and external piles for five years, and two years back, I got laser surgery for piles and fissures. I got recovered completely. During my past treatment for piles and fissures, I have done a couple of colonoscopies and endoscopies, and both returned negative.

Sometimes I get pain when I have a bowel movement. And this happens like once in two to three months.. And this pattern is kind of on and off. There is no bleeding when I get this type of pain. I only get a burning sensation and pain. So this type of episode happened recently after having chips and wafers with a little spice. I had loose stools, and after that started feeling a burning sensation and pain for two to three hours. I had a similar episode of pain a few months back and visited a surgeon for a physical examination. The surgeon had checked my anal passage and told me there were grade 1 piles and no active fissures. I was given Daflon 500 mg twice daily for one month, and I am still taking it. I do not have BP or diabetes.

I have a few queries, and they are:

1. Will outside spice or masala cause a burning sensation in the anus post a bowel movement?

2. If there is no active fissure, then what is causing me so much discomfort and irritation?

3. Can these reoccurring episodes of anal discomfort, irritation, and pain be initial signs of cancer?

4. Is there a need to repeat the colonoscopy for these repetitive discomfort episodes?

5. I get mentally irritated during these painful episodes.

6. I do not have outside food but very rarely do I have, and this causes so much pain the next day. A couple of years back, I did not have these issues if I had outside food, but lately, my body has become sensitive. Kindly help.

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#

Hello,

Welcome to icliniq.com.

I understand your concern.

This is a typical anal type of pain. Well, I think this is a fissure, and given your last surgeon's evaluation that this is an external pile, it is possible that it was chronic anal fissure or sentinel pile. External hemorrhoids and chronic anal fissures look the same. However, the condition is treated with the same medicines. So I would suggest:

  1. Sitz bath at least twice daily, which will help soothe the area, relaxes the muscles of the anal canal and will help with the pain.
  2. Local application of Diltiazem gel or Glyceryl trinitrate cream twice daily will relax the muscles of the anal canal.

To answer your concern:

  1. Yes, masala and outside meals cause problems. In addition, any excess of spices can cause this type of pain since they precipitate spasms of the anal muscles.
  2. No, they are not signs of cancer. Cancer causes severe constipation, per-rectal bleeding, and weight loss.
  3. No, you should go for a colonoscopy since your last colonoscopy did not reveal anything significant.
  4. You need to consult another surgeon to resolve your issues permanently.

I hope this will help.

Kindly revert for more queries.

Thank you.

Thank you for your reply, doctor.

What will be the next course of action to resolve my ongoing problem? Will it be another colonoscopy and surgery for the fissure and piles? Or will it be medicines to treat the condition? Kindly help.

#

Hi,

Welcome back to icliniq.com.

I would be able to tell you the treatment option only if I had the diagnosis in hand. Since the diagnosis is still in doubt, the best course of treatment would be to start with medicines and surgical fissurectomy if the anal fissure is non-resolving. Surgery is also an option for hemorrhoids and external piles, but usually, they get resolved by avoiding constipation and with tablet Daflon (Diosmin and Hesperidin) and sitz bath.

Thank you.

Hello doctor,

I visited a gastroenterologist and a surgeon for my anal pain post bowel movement (with no bleeding) issues, and a pelvic MRI was done (fistulagram). The MRI was normal, with no indication of fissure and fistula, and the surgeon performed a proctoscopy also. I have attached the MRI reports and the medication the gastroenterologist and the surgeon prescribed. The surgeon suggested surgery is not required. Please review my reports and the medication prescribed and indicate if these are good treatment plans.

My symptoms are not entirely relieved, and I still have pain post defecation. I would like to know if these medications will take a few days or weeks to complete cure.

Thank you.

#

Hello,

Welcome back to icliniq.com.

I have seen the reports of MRI (magnetic resonance imaging) fistulogram and doctor's prescription (attachments removed to protect the patient's identity). I agree with the diagnosis of anal fissures with some internal hemorrhoids. I also agree with the treatment plan and suggest you follow these measures.

1. Do not strain while passing stools.

2. Drink a good amount of water daily.

3. Apply cream for local pain relief and healing.

I suggest you continue using a Sitz bath (water and baking soda) with warm water at least twice daily. The anal fissure is not dangerous, although painful, but it should resolve with two to four weeks of treatment. As far as you give pressure on stools, this will cause pain. But once your stools are soft and easy to pass without straining, the fissure will start to heal. Ideally, acute fissures take variable time depending upon patient factors and treatment. The treatment you have mentioned is justified and looks perfect.

Thank you.


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