Painful Stool (Hard, Large, Bleeding) Causes and Remedies

The act of passing stool, also known as defecation or having a bowel movement, is not without any sensation. There may be some degree of discomfort in some instances although most people experience a sensation of relief. Thiis is due to the stretched rectum full of feces, which is normally uncomfortable, returning to a its original size as feces is passed out during a bowel movement.

Why is stool painful?

Having a bowel movement should not be painful. When this occurs, it is considered to be abnormal. Stool itself cannot be painful. Rather there is pain in the rectum or anus when stool is being passed out. Sometimes there can also be abdominal pain or even groin pain during a bowel movement. Irrespective of where the pain is arising from, it is an indication of irritation, injury and/or tissue damage in the area.

Read more on painful bowel movements.

Painful stool may be accompanied by other signs and symptoms such as:

  • Hard, dry and/or large stool
  • Rectal bleeding
  • Mucus in the stool
  • Anal itching
  • Irregular bowel habit, including constipation or diarrhea

Even in the absence of these other signs and symptoms, painful stool shold be assessed by a medical professional.

Pain with Hard Stool

Normally stool should be soft yet not of a liquid consistency. However, in conditions which lead to constipation the stool tends to be hard. This is largely due to insufficient water intake and excessive water reabsorption in the colon due to the prolonged duration the stool is within the colon. As it passes, the hard stool scrapes against the walls of the rectum and anal canal, as well as the anus. This causes pain.

Pain with Large Stool

Stool that is large in size may also occur with constipation. Without regular bowel movements, the stool becomes compacted and enlarged. It may also become hard and can therefore retain its large size during a bowel movement. The size may cause the anus to stretch excessively during defecation. As a result it can injure the lining of the rectum, anal canal and anus thereby leading to pain.

Pain with Bleeding when Passing Stool

Injury to the lining of the colon, rectum or anus, especially where there is break in the capillaries or vessels, can lead to bleeding when passing stool. This may be evident as blood in the stool or when wiping after a bowel movement. In some uncommon instances, the water in the toilet bowl may be stained red. If this bleeding is accompanied by pain then it is likely due to a problem of the lower colon, rectum and/or anus.

Read more on rectal bleeding with bowel movements.

Causes of Painful Stool

Some of the causes of pain when passing stool have been discussed below. These are the more common causes and there are various other less common causes that need to be considered. Always consult with medical doctor about painful stool as further investigations may be necessary to identify the exact cause.

Anal Fissures

These are tiny tears in the lining of the anus and is more common among people who are constipated. It tends to arise from the trauma caused by hard or large stools. Any form of trauma may lead to these fissures. It may also occur with diarrhea and even with infections.

Hemorrhoids

The blood vessels of the rectum can become inflamed and swollen which is known as hemorrhoids or piles. It commonly arises with constipation, diarrhea and sitting on the toilet for long periods of time. Hemorrhoids are also more likely to arise in people who are obese and in pregnant women.

Colitis and Proctitis

Colitis (inflammation of the colon) or proctitis (inflammation of the rectum often accompanied by inflammation of the anus) may also cause pain when passing stool. Most of the time it is due to an infection or trauma to the area. Other causes may include allergies, autoimmune conditions and interruptions of the blood supply (ischemia). Infection of small abnormal outpouchings in the colon (diverticulitis) may also be a cause of painful stool.

Colorectal Cancer

Cancer of the colon and/or rectum is one of the most common cancers globally. It is also among one of the deadliest cancers. Colorectal cancer may present with a change in bowel habit (constipation or diarrhea), rectal bleeding and unintentional weight loss. Benign growths of the colon or rectum like polyps can also be responsible.

Other Causes

A number of other conditions that may not involve the colon, rectum or anus can also cause pain when passing stool. Some of these conditions may include:

  • Cancer of the bladder, prostate, ovaries, uterus or vagina.
  • Cystitis (bladder), prostatitis (prostate) or vaginitis (vagina).
  • Hernias in the abdominal or pelvic areas
  • Polycystic ovarian syndrome (PCOS) or endometriosis
  • Ectopic pregnancy
  • Sexually transmitted diseases (STDs)

Remedies for Painful Stool

The cause of painful stool needs to be diagnosed by a medical professional. The choice of treatment depends on the underlying cause. However, a few simple dietary and lifestyle measures may assist with painful stool caused by common conditions like constipation. This tends to lead to hard, large and dry stool and is a major cause of anal fissures and hemorrhoids.

  • Eat more high fiber foods such as fruits, vegetables and wholegrains. Fiber cannot be digested and absorbs water in the gut. This helps to soften the stool. Fiber supplements may also be useful.
  • Drink plenty of water throughout the day. For adults this should be approximately 2 liters (68 ounces) daily although higher quantities may be necessary in hot environments or with strenuous physical activity.
  • Avoid beverages that can cause dehydration, such as alcohol and caffeinated drinks. The water loss in the urine can lead to hard, dry and large stools.
  • Regular physical activity can help with maintaining a healthy bowel habit. Always consult with a doctor before starting any exercise program.
  • Do not wipe or clean excessively after having a bowel movement. This can injure the anus. However, insufficient cleaning can also be a problem.
  • Soak in a lukewarm bath. This can help relieve inflammation to the anus and ease other symptoms like anal itching. However, it is only a short term remedy and medical attention is still necessary.

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