Are painful bowel movements a cause for concern? I feel like someone is putting a knife in me every time I go.

Sue

There are several possible causes of painful bowel movements. The most common reason is constipation, because passing hard stools can be painful. If this occurs, a doctor may recommend stool-softening agents.

Certain problems involving the anus can also be responsible for painful bowel movements. These include anal fissures, which are tears in the lining of the anus. Fissures may occur as a result of straining to pass hard stools. However, they can also be caused by inflammatory conditions of the anus such as Crohn's disease or certain infections. Hemorrhoids, which are enlarged veins in the anus or rectum, typically cause only irritation and minor bleeding. However, if a blood clot forms within a hemorrhoid, it can become very tender and lead to severe pain, especially during bowel movements. The therapy for painful hemorrhoids is often surgical removal.

Another potential cause for pain on defecation is an abscess on or near the anus. Such an abscess begins at the skin near the anus (often at the site of a fissure or hemorrhoid) and can spread into other tissues. Surgical drainage may be necessary, and antibiotics are often given to help clear the infection.

Finally, painful bowel movements may stem from an obstruction of the rectum or anus due to cancer or other growths. So, it is important that doctors perform a digital rectal examination in patients suffering from severe or chronic pain while moving their bowels. If no obvious cause for pain is found, then it is prudent to perform an endoscopic exam to fully evaluate the rectum and sigmoid colon to rule out an obstructing mass. In addition to cancer, polyps of the rectum can also grow large enough to obstruct the anus, leading to pain with bowel movements. The risk of cancer is a greater in an older person, but all people with painful defecation should see a doctor to evaluate this condition.