Here’s how to handle a real pain in the butt! When I say “pelvic floor,” what do you envision? Most people think of a vagina, but the pelvic floor isn’t the vagina. Rather, it’s “a group of muscles and tissues that support important organs like the bladder, urethra, anus—and in women—the uterus, cervix and vagina,” according to the FDA.
So yes, the pelvic floor involves your back door. And while you may not want to bring up back door pain, bleeding or discomfort to your pelvic floor therapist (because you think of her as the vagina expert), she might just be the key to solving it, or at least understanding it better!
And what exactly can cause this? Let’s explore.
Levator Ani Syndrome
Let’s start with levator ani syndrome. Levator ani syndrome is caused by muscle spasms and is a type of pelvic floor dysfunction. Getting its name from the levator ani itself, it’s a group of muscles located around your butt and vagina. They can range from mild pelvic or rectal pain to something way more intense than “pain in the butt”. It can even cause you to awaken from a dead sleep! It can also feel like pressure that mimics “sitting on a ball,” according to the Cleveland Clinic.
What causes it? There are theories: Everyday activities can be likely culprits, from prolonged sitting while working or traveling, to sex, to life stress, to painful bowel movements. But a definitive cause hasn’t been found.
Pelvic floor physical therapy can treat this condition, along with muscle relaxers, warm baths and rectal dilation (ideally taught to you by your awesome pelvic floor PT!).
Hemorrhoids
You’re probably pretty familiar with hemorroids already, maybe a little too familiar! What you may not know is that there are three types – internal, external and thrombosed, as the Mayo Clinic explains.
Hemorrhoids are just another way of saying your veins are swollen. Internal and external are exactly like they sound, either in the rectum (internal), which is the last stoop for stool on its way from the large intestine to the toilet, or external, typically viewable from the outside, where the anus is. Both can involve bleeding and pain. Thrombosed hemorrhoids may be located externally or internally, according to the Cleveland Clinic. The pain can be much worse and you develop a clot.
The same causes of pelvic floor dysfunction can also cause hemorrhoids – aging, pregnancy and/or constipation. Do your best to avoid constipation, whether that means more water, more fiber or exercising. Never strain to have a bowel movement.
There are many hemorrhoid prevention exercises, like Child’s Pose and pelvic floor contractions that your physical therapist may be able to help you master. The Mayo Clinic recommends over-the-counter cream, Tylenol and warm baths to treat.
Fissure
A fissure is a tear in tissue around the anus. And again, constipation is often the culprit. Bowel movements may not be the simple process they were before you had the fissure, as now you’ll experience pain and bleeding. You may also experience spasms near the anal sphincters. The good news? It doesn’t take much to treat this condition – a warm bath and avoiding constipation can do the trick.
Anal Fistula
An anal fistula is a connection that has sprung up between your anus and the external skin, according to the Cleveland Clinic. This leads to pain, swelling and possibly pus. Most often, the cause is a perianal abscess which typically happens when an anal gland is infected. Surgery is the main way to treat anal fistulas. An MRI that shows the pelvic floor may be needed in the diagnosis stage. There is also a rectovaginal fistula, which, according to the Mayo Clinic, is an unnatural connection bonding the rectum or anus and vagina. Stool or gas is then able to emerge from the vagina once this happens. Childbirth, Chron’s disease, surgery and radiation are a few causes.
Rectal Prolapse
In a rectal prolapse, a person’s rectum leaves their anus and is actually visible. It is part of a larger category known as POP or pelvic organ prolapse. In more severe cases, you may even see pink tissue emerging from the anus. Fecal incontinence, constipation, bleeding and incomplete emptying of the rectum are all symptoms, says the Mayo Clinic. As with hemorrhoids and pelvic floor dysfunction, advanced age (over 50) and constipation could be to blame. Treatment might be as simple as a laxative or as complex as surgery.
While many of us don’t want to think about anything related to the anus, as the symptoms tend to be uncomfortable and private, it is important to listen to our bodies when they speak to us. Colon and anal cancer are real risks. Screening is important if your doctor recommends it. Take care of that pain in the butt now before it becomes a bigger one later. And that’s … the bottom line.