Anorectal pain Assessment Questionnaire

Questions Your Doctor May Ask - and Why!

During a consultation, your doctor will use various techniques to assess the symptom: Anorectal pain. These will include a physical examination and possibly diagnostic tests. (Note: A physical exam is always done, diagnostic tests may or may not be performed depending on the suspected condition) Your doctor will ask several questions when assessing your condition. It is important to openly share any pertinent information to help your doctor make an accurate diagnosis.

It is also very important to bring an up-to-date list of all of your all medical conditions, medications including dosages, and names of numbers of any specialist you see.

Create your printable checklist by answering questions that your doctor may ask below:

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How long have you had the anorectal pain- determine if acute or chronic
Was there an event that caused the anorectal pain to appear initially?
Why: perianal haematoma may appear following straining at toilet or some other effort involving strain ; episode of constipation can predispose to anal fissure ; unsafe sex may increase risk of anal herpes.
Is the anorectal pain there all the time or does it come and go? -Proctalgia fugax is rectal pain lasting 3-30mins often waking person at night, Pain from anal fissure settles minutes to hours after defecation
If the anorectal pain occurs intermittently, what causes it to appear?
Why: e.g. pain from anal fissure is precipitated by defecation; prolapse occurs during bowel evacuation, anal itch can occur with hot weather, exercise or sweating.
Medical history of Inflammatory bowel disease?
Why: may indicate increased risk of perianal abscess.
Medical history of Diabetes?
Why: may indicate increased risk of perianal abscess.
History of Sexually transmitted infections?
Why: may indicate increased chance of anal herpes or acute salpingitis.
Family history?
Why: Colorectal cancer or polyps? (may indicate increased risk of rectal cancer, perianal abscess); endometriosis.
When do you experience this pain?
Why: Pain when you move your bowels can indicate an anal fissure. Pain which is caused by a perianal hematoma may have begun whilst you were straining/"pushing" whilst sitting on the toilet.
Do you ever experience constipation?
Why: This can aggravate and result in pain when you pass your bowels in several anorectal conditions, such as anal fissure.
Can you tell me about your normal diet and bowel habit?
Why: Whilst seemingly unrelated to the experience of anorectal pain, it is important for your health professional to know what is "normal" for you and to assess if there has been any recent significant change. Additionally there are some specific dietary trends which may place you at higher risk of some conditions which can cause anorectal pain.
After moving your bowels do you ever have the sensation they have not been completely emptied (tenesmus), i.e., you feel that you may need to go again straight away?
Why: Along with anal pain on defecation, this can be a symptom of anal fissure. Tenesmus can also occur in other conditions such as irritable bowel syndrome, prostate cancer, anorectal cancer/bowel cancer, hemorrhoids and constipation.
Has anyone in your family ever had bowel cancer, breast cancer or ovarian cancer?
Why: If anyone in your family has had any of these cancers (or in fact any type of cancer) then it is important that you tell your health professional. Associated with these specific cancers are several inheritable genetic conditions which may predispose you to have bowel cancer, which may in turn cause anorectal pain.
Can you describe the anorectal pain?
Why: There are many different descriptions offered by patients for different types of anorectal pain. Some can strongly suggest certain underlying conditions. For example pain that is severe, "sharp", and which can last for lengthy periods of time can occur in anal fissure. Anorectal pain which is mild or spasm-like may be levator ani spasm (proctalgia fugax). Anorectal pain which is described as being more "tender" may be the result of a perianal hematoma. If the pain is felt to be constant (i.e., not waxing and waning), severe or to have a throbbing quality then it may be caused by a perianal abscess.
Do you feel the pain anywhere else, or do you feel that it "moves"?
Why: Some causes of anorectal pain can be associated with pain that is additionally felt in other locations. In anal fissure the pain may be felt to radiate down the legs.
Does the pain wake you from sleep?
Why: A description of anorectal pain which wakes you from sleep may be caused by levator ani spasm (proctalgia fugax).
How long does the pain last?
Why: The amounts of time which anorectal pain can last varies from condition to condition. In levator ani spasm (proctalgia fugax) anorectal pain may be relatively short lived, whilst in anal fissure it may last for hours.
Can you tell me a little about what's been happening in your life lately?
Why: This is a deliberately ill-defined question which may be used to gauge if you have been experienced high levels of stress. Whilst you may feel that your life events and experiences are unrelated to your anorectal pain, they may in fact be intimately related to it and require resolution before your experience remission. One such seemingly unrelated association is that between professional adult males and anorectal pain caused by levator ani spasm (proctalgia fugax). Similarly, individuals who suffer from psychological complaints or stress may suffer from anorectal pain as a result of this condition of a functional bowel disorder/irritable bowel syndrome.
Do you feel as if there may be "lump" in your anus/rectum which prevents you from being able to move your bowels?
Why: You may feel odd about saying that you think there is something in your anus or rectum which is stopping you from being able to properly defecate, however this can be a symptom experienced in solitary rectal ulcer syndrome which can result in anorectal pain.
Do you notice any blood and mucus (hematochezia, mucorrhea) coming from your anus?
Why: Blood and mucus coming from your anus may indicate the sometimes painful solitary rectal ulcer syndrome.
Have you ever had a colonoscopy?
Why: A colonoscopy is a common procedure which is performed to examine the anus, rectum and large bowel. If you have had one before then its results may assist your health professional in making a diagnosis and management plan. On the other hand, your health professional may recommend you have a colonoscopy performed in light of your anorectal pain and this is a general question they might use to broach the subject.
Have you noticed any anal lump or swelling around your anus, and if so is it painful?
Why: These symptoms can be caused by many anorectal conditions, some of which are painful or unpleasant. An example of these are hemorrhoids, and perianal abscess. A lump caused by a perianal abscess may be described as very tender, feeling hot/warm to the touch, and it may not fluctuate in size as other abscesses do.
Have you ever experienced this before?
Why: Some conditions such as perianal hematoma where one of the veins near your anus ruptures, may recur. If you have experienced this pain before, then it is important that you describe exactly what had occurred in that circumstance. For in stance in perianal hematoma the anorectal pain tends to last for roughly five days before spontaneously resolving.
Do you have hemorrhoids, and if so have they been much more painful recently?
Why: Anorectal discomfort and/or pain can be caused by hemorrhoids; however a new occurrence of anorectal pain which occurs on a background of hemorrhoids may be caused by strangulation of one or more of them.
Have you experienced any fevers, or been feeling unwell (malaise)?
Why: Anorectal pain may be caused by an infective process such as a Perianal Abscess. Similarly to other serious infections, these can result in fever, a general feeling of being ill, and they may spread to cause sepsis if left untreated.
Have you noticed any swelling or pain in your buttocks?
Why: Along with many of the symptoms experienced with perianal abscess, an ischiorectal abscess can cause anorectal pain and much more widespread pain and swelling.
Have you ever been diagnosed before with a pilonidal sinus?
Why: This is a condition which results in small infection prone tracts to be formed in the tissue surrounding your anus. It can cause anorectal pain, and may result in perianal abscess formation as well.
Have you ever had a perianal abscess?
Why: Despite being painful conditions in themselves, these can also result in anorectal pain some time after they have been treated. This is as a result of the formation of post-infective perianal fistulas which can be prone to infection and inflammation.
Have you recently partaken in anal intercourse or used sex toys that penetrate the anus?
Why: Trauma to the anus can cause pain/swelling to anorectal region.
Have you ever been diagnosed with Ulcerative Colitis or $Inflammatory Bowel Disease?
Why: Anorectal pain may be caused by ulcers in the large bowel that continue into the rectum and anus.
Rectal bleeding or blood on the toilet paper?
Why: may indicate ruptured perianal haematoma, haemorrhoids, rectal or anal cancer, rectal polyp, anal fissure, rectal prolapse or intussusception.
Purulent (pus-like) discharge?
Why: may indicate fistula and perirectal abscess.
Constipation?
Why: predisposes to hemorrhoids, perianal haematoma, rectal prolapse.
Passage of mucous?
Why: may occur with benign or malignant rectal tumors.
Fever?
Why: may indicate perianal abscess.
Perianal itch?
Why: may indicate hemorrhoids, anal fissure, fistula.
Weight loss?
Why: may indicate malignancy.
Prostate symptoms? May indicate prostate condition, but usually causes a feeling of rectal fullness
Menstrual pain, pain with intercourse, pelvic pain
Why: may indicate endometriosis which may cause rectal pain especially before and during menstruation.

Conditions listing medical symptoms: Anorectal pain:

The following list of conditions have 'Anorectal pain' or similar listed as a symptom in our database. This computer-generated list may be inaccurate or incomplete. Always seek prompt professional medical advice about the cause of any symptom.

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Conditions listing medical complications: Anorectal pain:

The following list of medical conditions have 'Anorectal pain' or similar listed as a medical complication in our database.

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