Painful Constipation (Lower Back, Abdomen, Rectal Pain)

Constipation can present with a host of other symptoms, apart from the too few bowel movements in a week, hard stools and difficulty to pass stool. Pain is one of the symptoms that may accompay constipation and may be caused by constipation. This pain commonly arises in the abdomen, back and rectum or pelvic region.

Reasons for Pain with Constipation

There are several reasons why pain may occur with constipation. Sometimes the cause of the pain is not always obvious despite it occurring with mild constipation. These reasons vary at the different sites but may include stretching of the bowel walls, compression of nerves, inflammation of the rectal veins and tiny tears in the anal mucosa.

Stretched Walls

The bowel walls can stretch significantly but with stool accumulating in the lower colon, this stretching can be excessive. As a result this excessive stretching can cause pain. It is usually felt in the lower abdomen and often starts on the left side of the abdomen (descending and sigmoid colon). Stretching of the rectum can also cause pain but usually more in the middle of the pelvis and towards the back.

Read more on pain above left hip.

Inflamed Rectum

The prolonged presence of feces in the colon causes it to become dry and hard. It may also become enlarged. Movement of this hard stool through the rectum can injure and inflame it. Furthermore the straining to pass stool can increase the risk of irritating the rectal veins. This causes the veins to become inflamed and this condition is known as hemorrhoids (piles). It is not uncommon for the rectal pain with hemorrhoids to worsen after a bowel movement.

Tiny Anal Tears

With the passage of large hard stools as well as straining, which  are both common in constipation, tears may occur on the anal lining. These tiny tears are known as anal fissures and is usually painful. Fissures are not a serious condition and usually resolves on its own in a short period of time. However, it may arise shortly thereafter with successive bowel movements if the constipation has not been adequately treated to prevent large hard stools and straining with a bowel movement.

Nerve Compression

As stool accumulates in the colon and rectum, it can become a hard mass that may eventually block the bowels. This hard mass of stool can sometimes not be passed out during a bowel movement which is known as fecal impaction. The mass can press on surrounding nerves like the sacral nerves. This nerve compression can cause lower back pain.

Other Reasons

  • Constipation may be a symptom of various bowel diseases. The accompanying pain may not be due to the constiption but due to the disease process that causes constipation. For example, constipation may occur in inflammatory bowel disease (IBD) although this is not common. The pain in IBD is usually due to the inflammation and ulcers in the bowel wall. Similarly constipation and pain occurs in diverticulitis due to infection of the enlarged colon pouches (diverticula).
  • Functional abdominal pain is where there is pain in the abdomen for no clearly identifiable reason once possible diseases have been excluded as a cause. This may occur in functional bowel disorders like irritable bowel syndrome (IBS). Specifically this may be seen with IBS-C (irritable bowel syndrome with constipation) and IBS-M (mixed irritable bowel syndrome.

It is also possible that constipation and pain in the abdomen, lower back and rectum are not related but occur simultaneously.

How To Relieve Painful Constipation

It is important to note that constipation and pain are both symptoms. The underlying cause of these  symptoms should be investigated and treated once identified. This will eventually help to relieve both the pain and constipation. However, the following measures may help with relieving painful constipation or at least minimize these symptoms.

More Fluid and Fiber

Increasing fluid and dietary fiber intake is one of the first and most important steps in easing constipation. It is often effective in restoring and maintaining regular bowel movements. If the pain is due to constipation, then the increased fluid and fiber consumption will ultimately assist with relieving the pain.

Do Not Strain

Forcing out stool during a bowel movement can cause complications like hemorrhoids (piles) and anal fissures which may contribute to rectal pain. People who are constipated are more likely to strain during bowel movements. Rather wait for the urging to have a bowel movement as this usually signals the onset of strong bowel contractions to push out the stool. Fluid and fiber will also help.

Try Exercises

Some exercises can help to expedite a bowel movement, especially in people who do not pass stool regularly. These exercises should only be considered if a medical doctor approves it. By using these methods to make bowel movements easier, the strain on the abdomen, back and rectum can be minimized which in turn reduces pain.

Read more on exercise for bowel movement.

Avoid Painkillers

Painkillers may be used to ease the pain associated with constipation. However, these drugs should be avoided as far as possible. Many painkillers can slow down bowel activity and contribute to constipation. Painkillers hould be used as prescribed by a doctor. If it contributes to constipation then it is important to first discuss this side effect with a doctor before stopping the drug.

Use a Sitz Bath

A sitz bath can help to alleviate the pain and discomfort associated with constipation as a result of hemorrhoids (piles). It is simply a bath of warm to cool water that allows for the area up to the hips to be immersed in water when in the sitting position. Salt or baking soda may be added to the water. These treatments should be done over 15 to 20 minutes.

Apply Warmth

Many people report some relief of abdominal pain by applying warmth on the abdomen. A hot water bottle or microwave heat bag as well as electric blanket can be used to achieve this effect. It should not be hot by warm to very warm, depending on individual comfort. This warm application may sometimes also be helpful for lower back pain.

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