Why does it hurt when I poo? 8 causes of bowel pain

Last updated:
Reviewed by:
Dr Bryony Henderson, Lead GP at Livi
Toilet with pain signals
Does it hurt when you poo? Find out about the possible different causes and when to seek help

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What causes pain before, during or after you poo? It’s something many of us want to know, but are too embarrassed to ask.

Almost everyone experiences a painful bowel movement every once in a while. Often it goes away on its own. But ongoing or severe pain before or during a poo could signal an underlying condition that may need checking out by a doctor.

Remember, always get checked out by a doctor if you experience bright red or dark blood in your poo.

Why does it hurt when I poo?

Painful bowel movements can happen before, during or after you poo. You might experience pain either in your bowel, your lower abdomen, your anus (opening of your bottom) or your lower back.

If it hurts when you poo, it could be due to several factors.

1. You’re constipated

Constipation can feel painful and uncomfortable, particularly when you do have a poo.

The most common causes of constipation are:

  • Not having enough fibre in your diet
  • Not drinking enough fluids
  • Taking certain medications like painkillers
  • Not getting enough physical activity
  • Anxiety, depression or stress

You’re likely to have constipation if:

  • You haven’t had a poo at least 3 times in the last week
  • Your poo is hard and lumpy and you’re straining when you go to the toilet
  • You may also have abdominal pain and feel bloated or sick

What to do:

To make your poo softer and easier to pass, eat a fibre-rich diet and drink plenty of fluids to keep you regular. Try to increase your physical activity and never ignore the urge to go.

If diet and lifestyle changes aren’t helping, speak to a pharmacist who may suggest taking a laxative.

2. You have piles

Piles (haemorrhoids) are swollen veins inside the rectum or under the skin around the opening of your bottom.

Factors that make piles more likely include:

  • Pregnancy
  • Heavy lifting
  • Constipation or severe diarrhoea
  • Pushing too hard when pooing

As well as pain during bowel movements, symptoms of piles include:

  • Discomfort, itching or bumps in or around your anus
  • Bright red blood or mucus after wiping your bottom
  • Feeling like your bowels haven’t fully emptied after going to the toilet

What to do:

To prevent and treat the symptoms of piles, drink plenty of fluids and increase your fibre intake to make your poo softer. The good news is that piles aren’t usually serious, but if you’re in pain, speak to a pharmacist who can recommend over-the-counter medication.

If your symptoms don’t pass or you’re in severe pain, speak to a doctor.

3. You have an anal tear

An anal tear (anal fissure) is a small cut or open sore on the inside or around your anus. Although anal tears are common and aren’t usually serious, they can be especially painful during or after you poo.

They’re often caused by passing a hard or large poo, but can also be due to pregnancy and childbirth, persistent diarrhoea, anal sex, unusually tight anal sphincter muscles, inflammatory bowel disease and sexually transmitted infections (STIs).
Anal tears can cause a sharp pain when you poo, followed by a deep burning or stinging sensation up to a few hours after. You may also see bright red blood in your stool or when you wipe your bottom.

What to do:

Make an appointment to see a doctor if you think you have an anal tear. Most tears heal themselves, but self-help measures, like eating enough fibre, drinking plenty of fluids and exercising regularly, can help ease the symptoms as well as prevent them from recurring.

4. You have an inflammatory bowel disease

Inflammatory bowel disease (IBD) is a name used to describe two types of conditions that cause chronic inflammation in the intestinal tract, including Crohn’s disease and ulcerative colitis.

IBD causes abdominal pain and cramps before, during or after a bowel movement. Excessive diarrhoea can also lead to irritation and pain.

The other symptoms of IBD include:

  • Feeling the urge to poo very suddenly
  • Blood or mucus in your poo
  • Tiredness and fatigue

What to do:

If you have any of these symptoms, speak to a doctor. IBD requires treatment, which can include symptom management, medication and surgery.

5. You have proctitis

Proctitis is inflammation of the lining of the rectum. Proctitis is common in people who have IBD or STIs like chlamydia and syphilis. It can also be a side effect of radiotherapy.

Proctitis can cause cramping and pain in the left side of your abdomen and in your anus, which may occur during bowel movements.

Other symptoms include:

  • Blood or mucus in your poo
  • Diarrhoea
  • A continuous feeling that you need to have a bowel movement

What to do:

If you have any symptoms of proctitis, make an appointment with a doctor. Your treatment will depend on the type of proctitis you have and its causes.

6. You have endometriosis

Endometriosis is a painful condition where cells similar to the ones in the lining of the uterus grow in other places, like your bowel, ovaries and pelvis.

As well as pain when pooing, common symptoms of endometriosis are:

  • Heavy periods
  • Pain during or after sex
  • Fatigue and lack of energy
  • Severe period pain
  • Lower back or tummy pain
  • Feeling sick
  • Constipation and diarrhoea

What to do:

Endometriosis is a condition that can have a significant impact on your life. It’s essential to speak to a doctor, who can recommend specific treatments to ease your symptoms.

7. You have a skin condition

Skin conditions, like psoriasis and eczema, can affect the skin around your anus. As well as causing pain before, after and during a bowel movement, you may also experience bleeding, severe itching and splitting of the skin.

Psoriasis on or near the anus can appear non-scaly and red and become sore, weepy and itchy. Eczema around the opening of the anus and the skin between the cheeks of the buttocks (perianal eczema) can be red, inflamed, dry and sore.

What to do:

A doctor will usually be able to diagnose eczema or psoriasis when they’re examining you. A small skin sample (biopsy) may be taken for analysis if there’s any doubt about what it may be.

8. You have anal cancer

Anal cancer is a rare condition, which can cause bowel changes and pain around the anus. But don't panic, the symptoms are very similar to other conditions, including piles and anal tears.

Keep an eye out for other symptoms of anal cancer, including:

  • Itching around the anus
  • Bleeding or discharge from the bottom
  • Lumps or sores inside or around the anus
  • Needing to poo more often

What to do:

If you have any of these symptoms, speak to a doctor. Remember, most of these symptoms can be caused by other conditions, and it doesn’t necessarily mean you have cancer.

When should I speak to a doctor about a painful poo?

When it comes to your poo, it’s important to know what’s normal for you. It can feel awkward talking about your bowel habits, but remember that we all poo and doctors are there to help and support, rather than judge.

If you have bleeding or pain around your bottom or there’s a change to your normal bowel pattern, make an appointment to speak to a doctor.

Always speak to a doctor if:

  • There's blood in your poo, including bright red through to black
  • You have persistent abdominal pain
  • You have unexplained weight loss
  • Any change in your normal bowel habit

This article has been medically approved by Dr Bryony Henderson, Livi Lead GP.

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