Scott Thornton, MD

A: Many adults occasionally experience painful bowel movements with some blood.

The pain and the blood can be due to many things, most of which are not worrisome.

The pain is likely caused by an anal fissure. An anal fissure is a small tear in the lining of the anus. A tiny fissure can be extremely painful and the pain can last for hours after a bowel movement. Itching and bleeding may also accompany the pain. Fissures are usually due to straining during a bowel movement (constipation). Most anal fissures heal on their own, especially when a patient starts to take daily fiber supplements (such as Metamucil® or Citrucel®) to reduce straining. In the meantime, your doctor may be able to recommend topical creams or suppositories to provide pain relief. For some patients, an anal fissure becomes a painful sore that is constantly re-injured or torn with each bowel movement. To help prevent anal fissures and to help them heal, avoid constipation by eating high-fiber foods, drinking fluids and exercising regularly. Minor surgery, which is not very painful, is very effective if the fissure does not heal on its own.

Hemorrhoids also cause bleeding and occasional pain during a bowel movement. You may see drops of bright red blood in the toilet or streaks of blood on the toilet paper. Hemorrhoids are swollen veins in the anus and lower rectum and are usually due to constipation or from the increased pressure on these veins during pregnancy and/or childbirth. Treatment for hemorrhoids usually involves taking steps on your own, such as eating a high-fiber diet and using fiber supplements. Soaking in a warm bath can help reduce pain. Sometimes medications can help relieve hemorrhoid symptoms. Hemorrhoids that do not get better on their own will often go away after a painless office procedure, such as banding. Banding cuts off the blood supply to the hemorrhoid which then falls off painlessly.

In both cases, because these symptoms may be serious, you should talk to your doctor. Your doctor may refer you to a gastroenterologist or a colon and rectal surgeon for further care.

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