Pain during evacuation. Can it be hemorrhoids?


Getting to the point, yes. However, it is important to note that various diseases and problems that affect the anus can lead to pain during evacuation. Let’s talk a little about each one of them and what to do in each case.

Hemorrhoids vs Hemorrhoidal Disease (HD)

First, although widely used, the term hemorrhoids is not the most correct to refer to the disease that everyone knows and fear. That’s because everyone has hemorrhoids. Yes, that’s right. Hemorrhoids are small blood vessels, usually veins and arteries that communicate either superficially, just below the skin that lines the outside of the anus, either internally, in the anal canal itself.

In this case, when we have some type of alteration in these vessels, we have what is called hemorrhoidal disease (HD), which can affect both external and internal hemorrhoids, or even both at the same time (mixed hemorrhoidal disease).


The main symptoms of hemorrhoidal disease are the feeling that the hemorrhoids have been out of the anal canal, especially at the time of evacuation, and bleeding, which can appear in the stool or at the time of cleaning, most often without pain. However, a hemorrhoid can thrombose, meaning a clot can form inside it, which generates inflammation and creates a painful local process. This happens more often in external hemorrhoids.

That is, not every hemorrhoidal disease generates pain. Remember that even those who do not have HD can have anal bleeding, especially in combination with a great effort to evacuate, because we all have hemorrhoids that can bleed in case of trauma.


But what causes hemorrhoidal disease? The exact cause of this disease is unknown, but some factors are predisposing to its onset. We can mention prolonged effort during evacuation, weakness of the anal muscles and age. Genetic factors are also postulated as a cause, without consensus, however.


The main treatment for hemorrhoidal disease, especially in its early stages, is lifestyle change. Change on eating habits, like adding more fiber and liquids to the diet. Other measures, such as sitting baths with warm water, painkillers and anti-inflammatory drugs and local ointments tend to decrease or even eliminate symptoms, but do not cure the disease.

There are some outpatient procedures (ie, performed in the office) and non invasive surgical techniques for the correction of hemorrhoids that do not respond to clinical treatment or are in more advanced stages of the disease. We highlight the elastic ligation of hemorrhoids and techniques such as PPH and THD. In the section of diseases and treatments in our site you can find more detailed information about it.

Other Causes of Pain When Evacuating

Although widespread the idea that pain when evacuating is caused by hemorrhoids, or as we have seen, hemorrhoidal disease, in fact, pain when evacuating can be generated by numerous conditions, among them:

  • Anal fissures: it is the main cause of pain when evacuating, caused by the effort and hardened stools that in fact traumatize the edge of the anus, generating pain and bleeding;
  • Muscle spasms on the anal sphincter;
  • Perianal abscess caused by bacterial infections;
  • Fungal infection;
  • Anal tumors;
  • Perianal fistulas;
  • Anal ulcer;
  • Sexually transmitted diseases (STDs): such as gonorrhea, chlamydia or herpes;
  • Skin diseases.

As we have seen above, pain when evacuating can be caused by several different conditions. Therefore, it is very important to seek a coloproctologist for proper investigation and diagnosis of the case when noticing any symptoms, rather it is pain, bleeding, or any other sign of discomfort when evacuating.

Early diagnosis is critical to the effectiveness of treatment. The treatment will depend on each case, from lifestyle changes and eating habits, to the use of specific medications or surgery procedures.

At Colono, your Digestive System Clinic, you will find highly trained professionals waiting for you!

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