Pain occurring during defecation may be accompanied by a sensation of heat, swelling and congestion. In severe cases, there might be blood in the stools, constipation and problems in defecating as well. According to TCM theory, defecation pain can be caused by bad dietary habits, Dryness-Heat in the Large Intestine, downward flow of Damp-Heat in the Large Intestine, deficiency of Spleen-Qi and stagnation of Blood, etc. Defecation pain may be attributed to the following disorders in Western medicine: rectitis, dysentery, chronic constipation, rectalgia, rectostenosis, haemorrhoids, anusitis, anal fissures, prolapse of the rectum or rectum carcinoma.
Aetiology and pathology
Invasion of Wind-Heat
Lifestyle and dietary habits, such as exposure to Dryness or too-strong wind and eating seafood, may cause Wind-Heat to invade the Stomach and Spleen, which disturbs the circulation of Qi in the Middle Burner. This may impair the Spleen’s function of transportation and transformation of food, so food stagnates in the Large Intestine, and defecation pain will follow.
An invasion of Wind-Heat in the Large Intestine can also directly injure the collateral, and might cause bleeding. As a result there will be diarrhoea, blood in the stools and defecation pain.
Accumulation of Dry-Heat in the Large Intestine
Eating too much pungent, hot, sweet, greasy or deep-fried food, may cause Dry-Heat to form in the Large Intestine; that may consume the Body Fluids in the Intestines so that the transportation in the Large Intestine slows down. If Dryness-Heat persists over a longer period it will cause stagnation in the Large Intestine, leading to constipation, dry stools and defecation pain.
Downward flow of Damp-Heat in the Large Intestine
Consuming unhygienic or unhealthy food (too much sweet, pungent or greasy food), as well as drinking too much alcohol, may impair the Spleen and Stomach, so that Damp-Heat forms in the Middle Burner. Damp has the characteristics of viscosity, stagnation and downward flow, so when Damp-Heat forms in the Middle Burner it may flow downward to the Large Intestine causing the Qi and Blood there to stagnate, and defecation pain occurs. Also if Damp-Heat persists in the Large Intestine it may injure the collateral, resulting in blood in the stools and defecation pain.
Lack of personal hygiene in the genital and anal area can be another route for Damp-Heat to attack the Large Intestine. Moreover, anal sex may also damage the rectum, resulting in defecation pain.
Deficiency of Spleen-Qi
Spleen-Qi is a key energy in the body, as it keeps the Internal organs in their proper position. A weak constitution, malnutrition, physical exhaustion, irregular eating patterns and prolonged sickness may all weaken the Spleen-Qi, which may result in prolapse of the anus, so that defecation pain follows. Moreover, when the Spleen is weak, its function or transportation will also be weak, so that food stagnates in the Large Intestine, again causing defecation pain.
Stagnation of Blood
Stagnation of Qi, accumulation of Damp-Heat, stagnation of food in the Large Intestine and deficiency of Qi will all impair the circulation of Blood in the Large Intestine. This will lead to Blood stagnation and thus to defecation pain. Prolonged disease, as anusitis, perianal abscess and anal fissures, may also influence the circulation of Blood in the Large Intestine, resulting in its stagnation.
Physical trauma to the anus, or inappropriate operation, may directly damage the channels and the muscles, causing defecation pain due to stagnation of Blood.
Treatment based on differentiation
Differentiation
Differentiation of acute and chronic defecation pain
Occurrence of defecation pain is often related to heat in the Large Intestine or disorder of Qi and Blood.
— Acute cases of defecation pain are often caused by invasion of Wind-Heat or Dryness-Heat, frequently induced or aggravated by consumption of spicy food.
— Chronic defecation pain could be caused by deficiency of Spleen-Qi or stagnation of Blood. Usually these cases are caused by a chronic disease or an inappropriate operation.
Differentiation of character of the pain
— Acute defecation pain with fresh blood in the stool, accompanied by other symptoms such as
headache, fever, aversion to cold, or muscle pain, is usually caused by invasion of Wind-Heat. Invasion of Wind-Heat sometimes takes place after eating food such as fish, shrimps, pepper or onions.
— Defecation pain with a burning or pricking sensation, constipation, dry stools, or dry mouth with desire for cold drinks, is often caused by formation of Dryness-Heat in the Large Intestine. This type of defecation pain could be either the acute or chronic type of defecation pain.
— Slight defecation pain with intermittent occurrence, prolapse of the anus, fatigue, a pale complexion, poor appetite, or history of chronic diarrhoea or dysentery, is often caused by deficiency of Spleen-Qi.
— Long-term defecation pain with a stabbing feeling, history of trauma or operation to the large intestine or anus, purplish blood mixed with the stool, diarrhoea or constipation, is usually caused by stagnation of Blood.
Treatment
INVASION OF WIND-HEAT
Symptoms and signs
Acute onset of the pain, which is aggravated by foods such as fish, shrimps, pepper or onions, with fresh blood in the stools, a sore throat, a dry mouth, coughing, abdominal pain with the urge to defecate, dry stools or diarrhoea and an itching sensation in the anus. External symptoms include headache, fever, an aversion to cold and pain in the entire body, a red tongue with a dry yellow coating and a rapid pulse.
Principle of treatment
Dispel Wind-Heat and relieve the pain.
HERBAL TREATMENT
Prescription
DI YU SAN
Sanguisorba Powder Di Yu Radix Sanguisorbac 12 g Qian Cao Radix Rubiae 12 g Huang Qin Radix Scuteiiariae 9 g Huang Lian Rhizoma Coptidis 9 g Zhi Zi Fructus Gardenias 9 g Fu Ling Poria 15 g
Explanations
• Di Yu and Qian Cao clear Wind-Heat and stop the bleeding.
• Huang Qin, Huang Lian and Zhi Zi clear Heat and eliminate Toxin from the Large Intestine.
• Fu Ling activates the Spleen and eliminates Damp.
Modifications
1. If there are external symptoms, add Jing Jie Herba Schizoncpetae 10 g, Fang Feng Radix Ledebouriellae 10 g and Su Ye Folium Perillae 6 g to dispel Wind, stop the itching and relieve the External symptoms.
2. If there is diarrhoea, add Ge Geng Radix Puerariae IOg and Hua Shi Talcum 10 g to eliminate Damp and to relieve the diarrhoea.
3. If there is constipation, add Da Huang Radix et Rhizoma Rhei 6 g and Lu Hui Pasta Aloes 10 g to eliminate Heat in the Large Intestine and relieve the constipation.
4. If there is a sore throat, add Yin Hua Flos Lonicerae 10 g and Pu Gong Ying Herba Taraxaci 10 g to clear Wind-Heat in the Upper Burner and relieve the sore throat.
Patent remedy
Ge Gen Qin Lian Pian Kudzu, Coptis and Scutellaria Tablet
ACUPUNCTURE TREATMENT
GV-I Changqiang, BL-25 Dachangshu, BL-36 Chengfu, SP-3 Taibai and ST-37 Shangjuxu. Reducing method is used on these points.
Explanations
• GV-1, the Connecting point of the Governing Vessel and a patent point for anal disorders, harmonises the collateral and relieves defecation pain.
• BL-25, the Back Transporting point of the Large Intestine, clears Wind-Heat in the Large Intestine, promotes its physiological function and relieves defecation pain.
• BL-36 is the patent point for treating disorders of the anus.
• SP-3, the Stream and Source point of the Spleen channel, eliminates Wind-Heat in the Middle Burner and relieves the defecation pain.
• ST-37, the Lower Sea point of the Large Intestine, clears Wind Heat and relieves defecation pain.
Modifications
1. If there is constipation, add ST-25, the Front Collecting point of the Large Intestine, to promote defecation and relieve the constipation.
2. If there is diarrhoea, add SP-9, the Sea point of the Spleen channel, and ST-40, the Connecting point of the Stomach channel, to regulate the Spleen and Stomach and stop the diarrhoea.
3. If there is loss of bright red blood, add SP-10 and BL-57 to stop the bleeding.
4. If there is abdominal pain, add ST-34, the Accumulation point, and ST-36, the Sea point of the Stomach channel, to regulate the circulation of Qi and relieve the pain.
Case history
A 31-year-old woman had been suffering from defecation pain during the past month, which had started with diarrhoea after eating some sea fish. She was diagnosed by the doctor as having acute colitis, for which she was treated with antibiotics. There had been some improvement in her diarrhoea, but the defecation pain persisted. As well as pain when defecating, she had pain in her left lower abdomen, a sore throat, a burning sensation in her anus, thirst, sometimes a fever, dark yellow urine, a red tongue with a thin yellow coating and a rapid pulse.
Diagnosis
Invasion of Wind-Heat in the Large Intestine.
Principle of treatment
Dispel Wind, clear Heat and relieve the pain.
Acupuncture treatment
BL-58, BL-36, LI-4, TE-5, ST-25 and ST-37 were selected. Reducing method was used on these points. She was treated daily.
Explanations
• BL-36 is the patent point for anal disorders.
• BL-58, the Connecting point of the Bladder channel, harmonises the collateral, dispels Wind-Heat and relieves defecation pain.
• LI-4 and TE-5 dispel Wind-Heat and relieve External symptoms.
• ST-25, the Front Collecting point, and ST-37, the Lower Sea point of the Large Intestine, clear Wind-Heat and regulate the Large Intestine in order to relieve defecation pain.
After a week of treatment the pain had stopped. Upon follow-up a year later she reported she had been free of the defecation pain since the last acupuncture treatment.
ACCUMULATION OF DRYNESS-HEAT IN THE LARGE INTESTINE
Symptoms and signs
Defecation pain with a burning or pricking sensation, swelling and redness of the anus, constipation, dry and hard stools, blood in the stools, thirst, a preference for cold drinks, a bitter taste in the mouth, deep yellow urine, a red tongue with a dry and yellow coating and a rapid pulse.
Principle of treatment
Moisten the Large Intestine, clear Heat and relieve the pain.
HERBAL TREATMENT
Prescription
ZENG YE CHENG QI TANG
Increase the Fluids and Order the Qi Decoction Xuan Shen Radix Scrophulariae 15 g
Sheng Di Huang Radix Rehmanniae Recens 15 g
Mai Dong Radix Ophiopogonis 15 g
Da Huang Radix et Rhizoma Rhei 6 g
Mang Xiao Natrii Sulfas 10 g
Explanations
• Sheng Di Huang nourishes Yxn and clears Dryness-Heat in the Lower Burner.
• Xuan Shen and Mai Dong moisten the Large Intestine and clear Heat.
• Da Huang and Mang Xiao clear Dryness-Heat and promote defecation.
Modifications
1. If there is blood in the stools, add Bai Tou Weng Radix Pulsatillae 10 g and Chi Shao Radix Paeoniae Rubra 10 g to cool the Blood and to stop the bleeding.
2. If there is a thirst, add Han Hua Fen Radix Trichosanthis 10 g and Lu Gen Rhizoma Phragmitis 10 g to promote the formation of Body Fluids and relieve the thirst.
3. If there is a bitter taste in the mouth, add Huang Lian Rhizoma Coptidis 5 g and Huang Qin Radix Scutellariae 10 g to clear the Heat and relieve the bitter taste.
Patent remedies
Fang Feng Tong Sheng Wan Ledebouriella Powder that Sagely Unblocks
Er Zhi Wan Two-Ultimate Pill
ACUPUNCTURE TREATMENT
GV-I Changqiang, BL-25 Dachangshu, BL-58 Feiyang,
KI-10 Yingu and SP-6 Sanyinjiao. GV-I, BL-25 and
BL-58 are needled with reducing method; KI-10 and
SP-6 are needled with reinforcing method.
Explanations
• GV-I is the Connecting point of the Governing Vessel and the patent point for disorders of the anus. It harmonises the collateral and relieves defecation pain.
• BL-25, the Back Transporting point of the Large Intestine, clears Dry-Heat in the Large Intestine, promotes its physiological function and relieves defecation pain.
• BL-58, the Connecting point of the Bladder channel, harmonises the collateral and relieves defecation pain.
• KI-10, the Sea point of the Kidney channel, and SP-6, the crossing point of the three Yin channels of the foot, nourish the Yin, moisten the Large Intestine and clear Dryness-Heat.
Modifications
1. If there is a thirst, add LU-9 to clear Dryness-Heat and relieve the thirst.
2. If there is anal soreness, add BL-56 and BL-57 to relieve this.
3. If there is constipation, add ST-25 and ST-37 to dear Dryness-Heat in the Large Intestine and promote defecation.
4. If there is blood in the stools, add SP-10 and SP-I to clear Heat in the Blood and stop the bleeding.
DOWNWARD FLOW OF DAMP-HEAT IN THE LARGE INTESTINE
Symptoms and signs
Defecation pain, a burning sensation in the anus, oozing from the anus with local swelling and redness, an itching and pyogenic anus, constipation, tenesmus, blood in the stools, a red tongue with a sticky and yellow coating and a slippery and rapid pulse.
Principle of treatment
Eliminate Damp, clear Heat and relieve the pain.
