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hello. I’m Dr. Sangchul Hwang, who studies and treats autonomic nerves. There are many people who feel uncomfortable because they have a heavy, stabbing pain inside the anus or a residual feeling of feces that lingers after a bowel movement, even though they don’t seem to have hemorrhoids. If applying ointments or taking sitz baths doesn’t make a difference, you should consider other causes other than simple anal diseases. In this case, anal sphincter syndrome is a condition that is often encountered in clinical practice.
What is anal sphincter syndrome?
Anal sphincter syndrome is a functional pain condition in which the levator ani muscle, one of the deep pelvic floor muscles that supports the anus and rectum, becomes overstrained and irritates surrounding nerves, causing pain. It is characterized by recurrent heaviness or stabbing pain deep inside the anus with no visible wounds, inflammation, or masses. Although examinations may reveal no abnormalities, the patient often feels obvious discomfort and complains of frustration.
Why it feels like sphincter pain
The levator ani muscle is located very close to the anal sphincter and is closely connected to the inferior rectal nerve, a branch of the pudendal nerve. When this muscle is tense, it compresses the nerve, causing pain signals to be exaggerated or distorted. The result is that it often feels like the sphincter itself is hurting, or is perceived as similar to hemorrhoid pain, when the real problem is muscle and nerve tension.
Summarize common symptoms
Symptoms of anal sphincter syndrome vary from person to person, but there are some commonalities. A feeling of residual stool lingering after a bowel movement and a heavy or stabbing pain inside the anus that increases the longer you sit. It is relatively comfortable when lying down and tends to get worse when stressed or straining. Some patients report that the pain is not limited to the anus but radiates to the buttocks, back of the thighs, or perineum.
Is it just a case of sitting too much?
A sedentary lifestyle is certainly a contributing factor, but it is not the only explanation. In practice, we see it more often in people who are sensitive to stress, have a tendency to tense up, have a sympathetic nervous system that is easily triggered, and have tight pelvic and hip muscles. Because mental tension tenses not only the shoulders and neck, but also the pelvic floor muscles at the same time, the muscles around the anus are also affected.
Nerves and autonomic nerves, the core cause of anal sphincter syndrome
At the heart of this condition is an imbalance of nerves and autonomic nerves, rather than the muscles themselves. When the sympathetic nerves are overactive, the muscles are unable to relax and remain in a constant state of contraction. These stiffened muscles impede blood and lymphatic circulation, and as a result, the nerves become easily irritated and over-send pain signals, resulting in recurrent pain despite no structural abnormality.
What conditions need to be differentiated
In addition to hemorrhoids, anal retentive syndrome can be associated with lumbar disc disease, spinal stenosis, piriformis syndrome, pudendal neuralgia, and overactive bladder. In some cases, anal pain may be accompanied by urinary frequency or discomfort, so it’s important to look beyond the anus to the pelvis, spine, and nerve flow for a differential diagnosis.
Anorectalis Syndrome: How to Treat it at an Oriental Medicine Clinic
This condition is often difficult to treat with ointments or sitz baths alone. Instead of looking only at the anus, TCM looks at the nerve and muscle tension that runs from the spine to the pelvis to the anus. Acupuncture and moxibustion are used to relieve overly tense pelvic floor muscles and irritation around the pudendal nerve, and chuna treatment is used to correct the alignment of the pelvis and sacrum to reduce nerve compression. At the same time, we work to restore autonomic balance so that the muscles don’t tighten again under stress.
If you don’t have hemorrhoids and they still hurt
Anal pain is embarrassing and difficult to talk about, so it’s easy to ignore, but if it’s recurring, there’s a good reason. If you’re experiencing a loose feeling after a bowel movement, deep anal pain that worsens when you sit for long periods of time, or worsens with stress, you may be suffering from diastasis recti. The road to recovery is wide open if you understand exactly what’s causing it and start a treatment that releases both nerve and muscle tension.
