Rectal pain
A common symptom of anorectal disorders, rectal pain is discomfort that arises in the anorectal area. Although the anal canal is separated from the rest of the rectum by the internal sphincter, the patient may refer to all local pain as rectal pain.
Because the mucocutaneous border of the anal canal and the perianal skin contains somatic nerve fibers, lesions in this area are especially painful. This pain may result from or be aggravated by diarrhea, constipation, or passage of hardened stools. It may also be aggravated by intense pruritus and continued scratching associated with drainage of mucus, blood, or fecal matter that irritates the skin and nerve endings.
History and physical examination
Begin by taking the patient's history. Ask him to describe the pain. Is it sharp or dull, burning or knifelike? How often does it occur? Ask if the pain is worse during or immediately after defecation. Does the patient avoid having bowel movements because of anticipated pain? Find out what alleviates the pain.
Be sure to ask appropriate questions about the development of associated signs and symptoms. For example, does the patient experience bleeding along with rectal pain? If so, find out how frequently this occurs and whether the blood appears on the toilet tissue, on the surface of the stools, or in the toilet bowl. Is the blood bright or dark red? Also, ask whether the patient has noticed other drainage, such as mucus or pus, and whether he's experiencing constipation or diarrhea. Ask when he last had a bowel movement. Obtain a dietary and drug history.
Then inspect the rectal area for bleeding; abnormal drainage, such as pus; or protrusions, such as skin tags or thrombosed hemorrhoids. Also, check for inflammation and other lesions. A rectal examination may be necessary.
Medical causes
Abscess (perirectal).A perirectal abscess can occur in various locations in the rectum and anus, causing pain in the perianal area. Typically, a superficial abscess produces constant, throbbing local pain that's exacerbated by sitting or walking. The local pain associated with a deeper abscess may begin insidiously, commonly high in the rectum or even in the lower abdomen, and is accompanied by an indurated anal mass. The patient may also develop associated signs and symptoms, such as fever, malaise, anal swelling and inflammation, purulent drainage, and local tenderness.
Anal fissure.An anal fissure causes sharp rectal pain on defecation. The patient typically experiences a burning sensation and gnawing pain that can continue up to 4 hours after defecation. Fear of provoking this pain may lead to acute constipation. The patient may also develop anal pruritus and extreme tenderness and may report finding spots of blood on the toilet tissue after defecation.
Anorectal fistula.Anorectal fistula causes rectal pain to develop when a tract formed between the anal canal and skin temporarily seals. It persists until drainage resumes. Other chief complaints include pruritus and drainage of pus, blood, mucus and, occasionally, stools.
Hemorrhoids.Thrombosed or prolapsed hemorrhoids cause rectal pain that may worsen during defecation and abate after it. The patient's fear of provoking the pain may lead to constipation. Usually, rectal pain is accompanied by severe itching. Internal hemorrhoids may also produce mild, intermittent bleeding that characteristically occurs as spotting on the toilet tissue or on the stool surface. External hemorrhoids are visible outside the anal sphincter.
Nursing considerations
▪ Apply analgesic ointment or suppositories.
▪ Administer a stool softener if needed.
▪ If the rectal pain results from prolapsed hemorrhoids, apply cold compresses to help shrink protruding hemorrhoids, prevent thrombosis, and reduce pain.
▪ If the patient's condition permits, place him in Trendelenburg's position with his buttocks elevated to further relieve pain.
▪ Prepare the patient for an anoscopic examination and proctosigmoidoscopy to determine the cause of the rectal pain, if indicated.
▪ Because the patient may feel embarrassed, provide emotional support and as much privacy as possible.
Patient teaching
▪ Explain the disorder and treatment plan.
▪ Instruct the patient on measures to ease discomfort.
▪ Discuss proper diet and fluid intake.
▪ Explain the use of stool softeners.
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Bowel movements
Read excerpts from these other book chapters related to Bowel movements:
Medical Books Excerpts
- DIARRHEA
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- Diarrhea
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Diarrhea
- "A Pocket Manual of Differential Diagnosis" (1999)
- [ read ]
- Constipation
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Diarrhea
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Rectal pain
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Constipation
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Diarrhea
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Diarrhea
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Diarrhea
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Rectal pain
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Constipation
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
- [ read ]
- Diarrhea
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
- [ read ]
- Diarrhea
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Bowel movements
» Next page: CONSTIPATION (Differential Diagnosis in Primary Care)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
