What is behind anal disorders

Pain in the anus? Strange feeling when defecating? Why it is important to overcome shame if you have problems and see a doctor if you have anal discomfort

In his practice in Nittendorf in the Upper Palatinate, Frederik Mader sometimes sees extraordinary selfies - from a region of the body that is not an everyday sight: the anus. Anyone who has problems there wants to know what's going on. You need a mirror or a smartphone for this.

What the cell phone camera records is then presented to the doctor. Mostly they are swollen lumps with congested blood the size of a cherry stone on the anus. Those affected can often hardly sit in the pain and are in a state of turmoil. Is that a tumor? How do you get rid of those things on your buttocks? General practitioner Mader can usually reassure "a harmless story that will pass again". And many patients are doing better with that.

Dr. Frederik Mader, general practitioner from Nittendorf

© W & B / Ulrike Frömel

Anal vein thrombosis: harmless blood clot on the anus

The nodules are anal vein thromboses, often incorrectly referred to as hemorrhoids. They make up about a quarter of all diagnosed anus disorders. There are harmless blood clots in the vessels that almost always appear suddenly. Mader: "You can just wait for it to go away on its own and take anti-inflammatory, pain-relieving ointments and pills for as long."

However, if the anal vein thrombosis becomes larger, they should be removed. "This is done under local anesthesia," explains Mader. The wound then remains open so that the secretion can drain away. The area is showered after each bowel movement. This should fix the problem after a few days.

Prevent anal pain with loose stools

The cause of the thrombosis cannot be precisely clarified. Probably a difficult session in the bathroom was preceded by a lot of pressing. Strong pressure stops blood flow in the veins, causing a clot.

The only possible preventive measure is to keep the stool soft - generally the best tip for preventing anal disorders. "People who eat more fiber-rich diets, that is, eat less meat and more vegetables, have fewer rectal problems. Many anal disorders are typical of our affluent society," says the Freiburg coloproctologist Dr. Bernhard Strittmatter. Low-fiber foods lead to thick stools. The same applies to too little sport and exercise in everyday life.

But even with an optimally designed chair, not all anal complaints can be avoided. If the hemorrhoids, the vascular cushions in the last centimeters of the rectum, enlarge, 80 percent of this is due to a genetic tissue weakness and can simply be a symptom of old age, as Strittmatter explains.

Anal fissures cause sharp pain during bowel movements

More painful than many hemorrhoid problems are anal fissures, which also make up about a quarter of all anal complaints. The small cracks in the "anoderm", the sensitive skin in the anus, occur mainly in younger patients.

For example with students during the stressful exam period. They often eat poorly, drink too little, make stools hard, and press on the toilet. The anal skin tears, and the pain increases tension in the sphincter. This reduces blood flow to the rectum and prevents tiny wounds from healing.

"A hard particle in the manure then cuts very easily, and the crack gets bigger and bigger," explains Mader. As a result, every bowel movement causes sharp pain. Ointments can alleviate the pain somewhat and promote healing. Other rare risk factors for anal fissures are antibiotic and chemotherapy, which make the skin more sensitive, and anal intercourse.

Go to the doctor early

Regardless of the anal discomfort: If blood is discovered on the toilet paper or in the toilet, those affected should see a doctor. Women who are familiar with similar examinations from gynecologists are more likely than men to do so. "The latter only come when it no longer works. The shame is great," says Strittmatter.

But it pays to overcome inhibitions. This shortens the ordeal because the therapy can begin sooner. And the examination is largely painless for most anal disorders.

Many doctors examine people lying on their side on a couch. Like his specialist colleagues, Mader is equipped with a gynecological chair and special instruments. The doctor first feels with his finger, and if he has to use an instrument, he can lightly numb the anal canal or, if the pain is more severe, sedate the patient.