Why Does It Burn When I Poop?

Experiencing a burning sensation when you poop can be uncomfortable and worrisome. While it’s often due to a minor, temporary issue, sometimes it points to an underlying medical condition that requires treatment. Below, we’ll explore the most common causes, how they’re diagnosed, and what you can do about them.

Common Causes of Burning During Bowel Movements

1. Anal Fissures

   • Small tears in the lining of the anus.
   • Often caused by passing hard or large stools.
   • Symptoms: sharp pain during and after pooping, possibly some bright red blood on the toilet paper.
   • Treatment: stool softeners, warm sitz baths, topical anesthetics, and increasing dietary fiber.

2. Hemorrhoids

   • Swollen veins in the lower rectum or around the anus.
   • Can be internal (inside the rectum) or external (under the skin around the anus).
   • Symptoms: itching, irritation, pain when pooping, and sometimes bleeding.
   • Treatment: over-the-counter creams or suppositories, warm baths, dietary changes, and in severe cases medical procedures.

3. Skin Irritation and Contact Dermatitis

   • Caused by harsh soaps, wet wipes with fragrances, or prolonged moisture.
   • Symptoms: itching, redness, and burning around the anus.
   • Treatment: switch to gentle, unscented cleansers; pat dry thoroughly; use barrier creams.

4. Infections

   • Bacterial (e.g., shigella, salmonella), viral (e.g., herpes simplex), or parasitic (e.g., pinworms).
   • Sexually transmitted infections such as gonorrhea, chlamydia, or syphilis can also cause anorectal discomfort.
   • Symptoms: burning, itching, discharge, or unusual stools.
   • Treatment: specific antibiotics, antivirals, or antiparasitic medications as prescribed by a doctor.

5. Anal Abscess or Fistula

   • Abscess: a painful collection of pus near the anus.
   • Fistula: a tunnel that forms between the abscess and the skin.
   • Symptoms: deep throbbing pain, fever, swelling, discharge, and burning during bowel movements.
   • Treatment: surgical drainage of abscess, corrective surgery for fistula.

6. Inflammatory Bowel Disease (IBD)

   • Crohn’s disease or ulcerative colitis can affect the rectal area.
   • Symptoms: diarrhea mixed with blood or mucus, urgency, cramping, and burning.
   • Treatment: anti-inflammatory medications, immunosuppressants, dietary adjustments, and sometimes surgery.

7. Bile Salt Malabsorption

   • Occurs when bile acids reach the colon, irritating its lining.
   • Can happen after gallbladder removal or in certain liver diseases (see Tsochatzis et al., 2014).
   • Symptoms: watery diarrhea, urgency, and burning.
   • Treatment: bile acid binders (e.g., cholestyramine), dietary changes.

8. Functional Anorectal Disorders

   • Conditions like dyssynergic defecation (poor coordination of pelvic floor muscles) or rectal hypersensitivity.
   • According to Rao et al. (2016), these can lead to straining, incomplete evacuation, and discomfort.
   • Symptoms: feeling of obstruction, pain or burning when passing stool.
   • Treatment: biofeedback therapy, pelvic floor exercises, and lifestyle modifications.

9. Food Sensitivities and Spicy Foods

   • Capsaicin in spicy foods can pass through undigested and irritate the anal canal.
   • Other triggers: high acidity foods (tomatoes, citrus), caffeine, and alcohol.
   • Management: identify and limit trigger foods, increase water intake.

When to Seek Medical Help

While many causes of burning during bowel movements are benign and self-limited, certain red flags warrant prompt medical evaluation:

• Severe, unrelenting pain
• High fever or chills
• Heavy bleeding (soaking more than one pad per hour)
• Persistent diarrhea or vomiting
• Signs of dehydration (dizziness, dry mouth, scant urine)
• A new lump, mass, or severe swelling around the anus

If you’re concerned or experiencing any of the above, talk to your doctor right away. For initial guidance, you might consider doing a free, online “symptom check for” hemorrhoids, fissures, and other causes and follow up with your healthcare provider.

Diagnosing the Cause

Your doctor will start with a detailed history and physical exam, including a careful inspection of the anal area. Additional tests may include:

• Anoscopy or Proctoscopy: Small scope used to view the anal canal and rectum.
• Blood Tests: Look for signs of infection, inflammation, or anemia.
• Stool Tests: Identify infections, blood, or malabsorption issues.
• Endoscopy/Colonoscopy: May be recommended if inflammatory bowel disease or cancer is suspected.
• Diagnostic Imaging: In cases of suspected abscess or fistula, an MRI or ultrasound may be used.

Treatment Strategies

Self-Care Measures

• Dietary Fiber: Aim for 25–30 grams per day from fruits, vegetables, and whole grains.
• Hydration: Drink at least 8 glasses of water daily to keep stools soft.
• Warm Sitz Baths: Soak the anal area in warm water for 10–15 minutes, 2–3 times per day.
• Gentle Hygiene: Use unscented, alcohol-free wipes or water to clean; pat dry rather than rubbing.
• Trigger Avoidance: Note any foods or products that worsen burning and eliminate them.

Over-the-Counter and Prescription Options

• Stool Softeners: (e.g., docusate sodium) to ease stool passage.
• Topical Treatments: Hydrocortisone creams, lidocaine gels, or zinc oxide ointments to calm irritation.
• Fiber Supplements: Psyllium husk or methylcellulose.
• Prescription Medications: Antibiotics for infections, bile acid binders for malabsorption, or anti-inflammatory drugs for IBD.

Minimally Invasive and Surgical Procedures

• Rubber Band Ligation: For hemorrhoids that do not respond to conservative therapy.
• Fissure Surgery (Lateral Internal Sphincterotomy): For chronic anal fissures.
• Drainage of Abscess: Immediate procedure to relieve pain and prevent complications.
• Fistula Repair: Surgical correction to close the abnormal tunnel.

Preventing Future Episodes

• Maintain regular bowel habits: don’t delay pooping when you feel the urge.
• Keep a balanced diet rich in fiber and fluids.
• Exercise regularly to promote healthy digestion.
• Avoid excessive straining and use proper bathroom posture (feet elevated on a small stool).
• Practice good anal hygiene without over-washing or using harsh products.

When to Talk to Your Doctor

Even if your symptoms improve, follow up with your healthcare provider if:

• Burning returns or worsens
• You notice changes in bowel habits (diarrhea, constipation) lasting more than two weeks
• You find blood in your stool or see black, tarry stools
• You develop new symptoms such as weight loss, fatigue, or anemia

If you experience any life-threatening signs—such as severe bleeding, high fever, or intense pain—seek medical attention immediately. Always “speak to a doctor” about symptoms that could be serious.

References:

• Rao SS, Bharucha AE, & Chiarioni G. (2016). Functional anorectal disorders. Gastroenterology. PMID: 27842128.
• Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. Lancet. PMID: 24613364.
• Sandrin L, Fourquet B, & Hasquenoph JM. (2003). Transient elastography: a new noninvasive method for assessment of liver fibrosis. Ultrasound Med Biol. PMID: 15076102.