Painful bowel movements

My name is Aimee and I am 18 years old. When I was 3, I had an accident which resulted in me having dissolvable stitches between my vagina and back passage. When I gave birth to my son in February 09, I had 2 stitches due to a perineal tear. Since his birth, I have found it painful to open my bowels no matter how soft my stools are. I also bleed during and for a short time afterwards. The area is very sore for a day or 2 afterwards. I’ve been referred to a gynaecologist, but my appointment isn’t for another 3 weeks. I cannot stand the pain and would rate it very close to that of childbirth itself! I get drowsy and dizzy and sometimes even feel sick. The pain isn’t just in the back passage, sometimes I get pains in/around my front passage and these last up to a week. What could this be???

Painful bowel movements and perineal pain

Perineal pain (pain in the area of the anus and vagina) is not uncommon Aimee. There are lots of reasons for this, some physical and some psychological. When you have a tear like this, the nerves in the area can be affected and these dont always heal. It would have been very traumatic for you as a child to have experienced this and your body and psyche would have automatically wanted to do anything to prevent the pain occurring. We see this lot and it is often an issue with constipation, trying to hold the stool in subconsciously. There needs to be retraining of your stool pattern and there are some specialist centres that have nurses and psychologists that help with this.

Also, when healing occurs, scars occur and this can constrict the anal area as well as the vaginal area. I dont know whether you have had any problems with painful sex or dyspareunia, but this is quite common too. Anal fissures can occur (tear in the anus) and this can be very painful and bleed, which is what I think you are experiencing. The area will need to be examined to confirm this though. There are treatments for anal fissure though, in the form of topical applications that numb the area, ointments such as Rectogesic or GTN ointment which are muscle relaxants that you apply twice a day for 6 weeks. Alternatively Diltiazem ointment or Nifedipine ointment work in a similar way. Sometimes the topical treatments don?t work and a Lords stretch? surgical procedure to open up the anal area is performed to ease passage of stool or alternatively, Botox can be injected into the area to relax the anal sphincter.

You mention your stools are soft, but sometimes a high fiber intake plus the use of stool bulking agents and drinking plenty of fluids can help. Exercise is also important.

I think its great that you are going to see a gynaecologist and hopefully they will help you. If not, ask your doctor to refer you to a gastroenterologist or surgeon who has an interest in this area. A bit of psychological support may also help you too. Good luck!