NAPWA

What's going on back there?

Lars from Queensland writes:
Sometimes there is blood on the toilet paper after I’ve been to the loo. I put this down to haemorrhoids, which I’ve had for years, but wonder whether it could be something else?

Dr Louise replies:
Anorectal problems are quite common but not talked about very much, so thank you for your question.

Symptoms can include discomfort, itchiness or pain, discharge or bleeding, lumps, bumps, ulcers or sores. They can present on the surrounding perianal skin, in the anal canal itself or further up the rectum.

The difficulty is accurately detecting what is going on. It is not easy to see what’s happening yourself and even a well-meaning friend is unlikely to be able to help you.

So, if you have any of these symptoms, it is important to get them checked out as soon as possible. It is not wise to assume all rectal bleeding is caused by haemorrhoids, so do yourself a favour and seek professional advice.

I’ll try and list some of the infections that can cause anorectal symptoms.

Sexually Transmitted Infections (STIs[Sexually Transmissible (or Transmitted) Infection] Infections spread by the transfer of organisms from person to person during sexual contact. Also called venereal disease (VD) (an older public health term) or sexually transmitted diseases (STDs). ) are one possibility.

Chlamydia (and the less common LGV which is caused by a different strain[HIV strain] Any subgroup of the HIV species. Because HIV mutates very easily, there are many different strains (and may be multiple strains within a single person). of Chlamydia) can cause pain, discharge and anal discomfort. Most often Chlamydia infections don’t cause symptoms but they can increase the chance of transmitting other STIs, including HIV.

Gonorrhea often presents with a discharge, this might be profuse and also causes discomfort.

Herpes can cause an ulcer which may cause pain particularly when you go to the toilet. This may reoccur in the same location on each occasion. Again, it is important to have a diagnosis as medication can reduce the number of recurrences, the pain and duration of ulceration.

Syphilis may appear as a chancre (or primary ulcer) at the site of infection but this may not be visible to the naked eye. Usually a blood test is required to diagnose syphilis.

Warts manifest as lumps or bumps around or in the anal canal. These can itch, but they are usually painless.

Accurate diagnosis is important, so make sure you get them checked out. Warts can be treated with liquid nitrogen or sometimes topical preparations, but they can be difficult to treat and there is no magic cure.

Sometimes, the presence of the wart virusA small infective organism which is incapable of reproducing outside a host cell. (HPV) is only detectable from doing an anal smear test. This helps to detect the strains of wart virus that may cause cellular changes in the anal canal. This test is not yet routinely done, but may be offered by your clinician.

Remember, not all STIs cause symptoms which is why we routinely recommend anal screening tests for Chlamydia and gonorrhea and regular blood tests for syphilis.

Also remember that STIs like to move together. So if you have one, you are more likely to contract or transmit another. Keep this in mind and have your tests done regularly.

There are also plenty of anorectal conditions that are not sexually transmitted.

Abscesses, sinuses (furrows within the anal canal), and skin conditions such as dermatitis, psoriasis and contact dermatitis can also all affect the perianal area.

Anal fissures or tears can cause a sharp knife-like pain particularly when you’re going to the toilet.

Haematomas, unlike haemorrhoids, occur externally and are caused by a small vein rupturing. This may manifest as a small, exquisitely tender lump on the edge of the anus.

Sometimes these can be lanced which will relieve the pressure and feels better.

Haemorrhoids are bulging internal blood vessels. They may bleed spontaneously or during or after defecation.

Many people assume that any bleeding from their bottom is caused by haemorrhoids but more serious causes include polyps and cancers. That’s why a professional diagnosis is always advised.

Quite simply, if you have any of these symptoms, the best idea is to go and see a doctor. If you feel it would be difficult to speak with your regular GP, try another clinic or present to a gay-friendly or sexual health service.

If there is any chance that you could have contracted a STI, then please mention this when you go. People have had colonoscopies for rectal symptoms which turn out to be caused by syphilis. This may have been prevented if the clinician had known about the possibility that an STI could be causing the symptoms.

Any discomfort you are having in that area is always unpleasant. Your doctor understands and may well have the answer to what’s going on back there.

Keep your questions under 100 words and email them to pl@napwa.org.au.

Dr Louise Owen’s advice is not meant to replace or refute any advice given by your own doctor as your individual medical circumstances are best dealt with by your own practitioner.

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