"Burning sensation when defecating
Question
When I go to the toilet (faeces) I get a burning sensation during and for a short time afterwards in my anus. It is very painful and I am beginning to get it quite regularly. I do not eat much spicy food and I am not a heavy drinker, although I may have a couple of pints of Guinness a few nights a week after work. I am fond of onions and spring onions, although I still get the pain even if I haven’t eaten them for a few days. I believe I must be lacking something in my diet, but am unsure as to what it is. Please help.
Answer
I think this problem is very unlikely to be directly to do with your diet. Pain in this area is called proctalgia and the commonest cause is an anal fissure. This is like a small split in the margin of the anus, and will cause pain on defecation and afterwards. Sometimes there is also a little blood seen, but not always. The cause is often episodes of constipation with a hard stool that stretches the anus a little too much.
In milder cases the split can heal up and things are OK again, and so the pain goes away until the split opens up again.
The thing to do next is to make sure that you eat plenty of fibre and fruit and try and keep your stool as soft as possible so that it can heal properly. Keep the area as clean as possible and if possible, wash your anal area after defecation - if you have a bidet this makes it easier. A mild antiseptic rectal ointment such as Anusol, available over the counter, may help.
If things don’t settle down, or if you have any bleeding, then you should go to your doctor to get this checked out and for further treatment and advice, but I hope this will do the trick.
Yours sincerely
Dr Keith Barnard, GP"