Pain when pooing: Fistula, Fissure or Haemorrhoids?

Pain during bowel movements is common – and treatable. If you’re experiencing discomfort, here’s what you need to know

Pain when going to the toilet isn’t something most people talk about — but if you’re noticing sharp, stinging, or burning discomfort during or after a bowel movement, it’s worth getting checked. While some symptoms may settle on their own, ongoing or severe anal pain can point to an underlying issue such as a fissure, fistula, or haemorrhoids.

While most causes of anal pain or bleeding when passing stool are benign — such as fissures, fistulas, or haemorrhoids — it’s important to be aware that, in some cases, these symptoms can be a sign of something more serious, including anal or bowel cancer. Persistent pain, bleeding, a lump, or a change in your bowel habits should never be ignored. Early assessment is key, and seeing a specialist can help rule out more serious conditions and ensure you receive the right treatment.

These are common conditions that affect people of all ages. At St John & St Elizabeth Hospital in London, we offer fast access to expert diagnosis and treatment — with care that is discreet, compassionate, and consultant-led. We spoke to Mr Kapil Sahnan, an experienced Colorectal & General Surgeon, about what each condition means, how to tell them apart, and when to seek help, whether it’s for a chronic anal fissure, a recurring fistula, or swollen veins linked to haemorrhoids.

What causes pain when pooing?

There are several reasons you may feel discomfort during or after a bowel movement. The most common causes include:

Anal fissure

An anal fissure is a small tear in the skin around the anus, often caused by passing a hard or large stool. It may result in sharp, cutting pain during or after a bowel movement, and you might notice bright red blood on the toilet paper. Some people also describe a lingering raw or sore sensation that can last for hours.

Fissures can be incredibly debilitating. The best treatment focuses on avoiding straining and seeking specialist input. Options include topical ointments, Botox injections, and, in some cases, minor surgery.

Anal fistula

A fistula is a small tunnel that develops between the anal canal and the skin near the anus, usually following an abscess or infection. It can cause pain, swelling, and discharge or leakage. Fistulas rarely heal on their own and typically require surgical treatment.

Some fistulas are linked to underlying conditions such as Crohn’s disease or other forms of inflammatory bowel disease. In these cases, managing the underlying condition alongside the fistula is essential.

Haemorrhoids (piles)

Haemorrhoids are swollen blood vessels in the lower rectum or anus. They can cause bleeding during bowel movements, itching, pressure, and sometimes discomfort. Mild cases often improve with lifestyle changes and self-care, but persistent symptoms may require medical treatment.

Treatment for anal fissures, fistulas, and haemorrhoids

At our private hospital in St John’s Wood, we tailor care plans to your specific needs and symptoms. If your condition doesn’t improve with at-home measures, we offer a range of safe, effective treatments to restore comfort and quality of life.

Treatment for anal fissures

If a fissure becomes chronic or fails to heal, your specialist colorectal doctor may recommend:

• Topical treatments to relax the muscle and promote healing
• Botox injections to the sphincter complex to reduce spasm and discomfort
• Lateral internal sphincterotomy — a minor surgical procedure that lowers anal canal pressure and allows the fissure to heal

Most treatments are carried out as day cases, with full recovery expected within a few weeks.

Treatment for anal fistulas

The surgical approach depends on the depth and complexity of the fistula. Options include:

• Fistulotomy — opening the tunnel to allow it to heal from the inside out
• Seton placement — a soft surgical thread to encourage drainage and gradual healing
• Sphincter-preserving techniques — used for more complex or recurrent fistulas. Several options exist, and the expertise lies in selecting the most appropriate one for each case

All procedures are performed by experienced colorectal surgeons, and comprehensive recovery support is part of your care.

Haemorrhoid treatment options

We offer a range of minimally invasive and surgical options depending on severity:

• Banding — for smaller haemorrhoids, performed quickly in the outpatient clinic
• Laser haemorrhoid ablation — a modern, gentle technique using laser energy to shrink swollen tissue
• Haemorrhoidectomy — a surgical option for larger or more symptomatic haemorrhoids that haven’t responded to other treatments

Our goal is to relieve symptoms, prevent recurrence, and help you return to normal life as comfortably and quickly as possible.

Could it be something more serious? When to seek help

Most cases of anal pain, bleeding, or discomfort are caused by common, treatable conditions like fissures, fistulas, or haemorrhoids. However, it’s important to be aware that some symptoms may signal something more serious — including colorectal (bowel) cancer.

You should speak to your GP or a specialist if you notice:

• Bleeding from your bottom, especially if it’s persistent or not related to straining
• A change in your bowel habits lasting more than a few weeks — such as looser stools, going more frequently, or feeling like your bowel isn’t fully emptying
• Ongoing or sharp anal pain
• A lump or swelling near or inside the anus or abdomen
• Discharge or leakage from the back passage
• Abdominal pain or bloating, particularly after eating
• Unexplained weight loss or fatigue without a clear cause (which may be linked to low iron levels)

These symptoms don’t always mean cancer — but it’s important to get them checked, especially if they persist. Early diagnosis makes a real difference, and simple tests can often provide quick answers.

At St John & St Elizabeth Hospital, we offer fast-track access to colorectal diagnostics, including endoscopy and consultant-led assessment, all in a discreet and supportive environment.

Contact Us

If you’re experiencing pain when pooing, anal pain, or painful pooping that doesn’t go away, don’t wait for things to get worse. Whether it’s a sharp pain, ongoing chronic pain, or symptoms of anal conditions like fissures, fistulas or haemorrhoids, we can help you feel better with personalised care.

Our hospital in NW8 offers prompt access to specialist support for people across North West London, including NW3 and NW6.

FAQ about pain when you poo

How long does it take to recover from an anal fissure or fistula?

• Most fissures heal within a few weeks with early treatment. Chronic fissures may take longer and may require minor surgery. Fistula recovery depends on the complexity of the condition, but your consultant will support you throughout the process.

Can an anal fissure heal on its own?

• Yes, many fissures do heal on their own — especially with dietary adjustments, warm baths, and avoiding straining. But if the fissure persists or recurs, it’s best to seek help early to avoid long-term discomfort.

Are haemorrhoids always painful?

• Not necessarily. Some haemorrhoids cause itching or bleeding without pain, while others — particularly external ones — can be quite uncomfortable. If they’re affecting your daily life, treatment is available.

What if I’m embarrassed to talk about it?

• We completely understand. These are common issues, and our team treats every patient with empathy, respect, and professionalism. You won’t be the first — or the last — person we’ve helped with these symptoms.