*Welcome to the OutUK series looking at gay men and their health brought to you in association with the NHS* website.**
	Each week we'll tackle a different topic in our A to Z of Gay Health. We'll have features and advice on everything from relationships, sexual health, mental and physical conditions and how to stay fit. You can follow any of links provided below for more information direct from the NHS website, or see this week's feature L: Laxatives.

Anal Pain

Anal pain (pain in the bottom) is common. There are things you can do to ease it, but see a GP if you're in a lot of pain or it does not get better.

Common causes of anal pain

Anal pain has many different causes.

Your symptoms might give you an idea of what is causing anal pain. Do not self-diagnose, see a GP if you're worried.

Symptoms	Possible cause
Pooing less than normal for you and pain when pooing	Constipation
Itchy anus, feeling a lump around the anus, blood on the paper after wiping	Piles (haemorrhoids)
Sharp pain when pooing, burning pain after doing a poo and blood on the paper after wiping	Anal fissures
Constant throbbing pain, pus and blood on the paper after wiping, high temperature	Anal fistulas and abscesses

Less often, anal pain can be caused by something else like a sexually transmitted infection (STI) or fungal infection. Rarely, it can be a sign of something serious like anal cancer.

How you can ease or prevent anal pain

Do

drink lots of fluid and eat plenty of fibre to keep your poo soft
exercise regularly
wipe your bottom with damp toilet paper
take paracetamol
take a warm bath to ease itching and pain
put an ice pack (or bag of frozen peas) in a towel on the painful area for up to 20 minutes every 2 to 3 hours

Don't

do not scratch around your anus
do not ignore the urge to poo
do not push too hard when pooing
do not use fragranced products, such as shower gels or soaps around your anus
do not eat spicy food or drink alcohol and caffeine
do not lift or carry anything heavy
do not take ibuprofen if your anus is bleeding

A pharmacist can help with anal pain

A pharmacist can recommend medicines to reduce constipation and anal pain such as:

painkillers like ibuprofen or paracetamol
creams or suppositories (medicines you put into your bottom) to ease itching, pain and swelling
medicines that help make it easier to poo (laxatives)

Many pharmacies have private areas if you do not want to be overheard.

Find a pharmacy

See a GP if:

anal pain is severe
the pain does not improve after a few days
you've had blood in your poo or bleeding from your bottom for 3 weeks

Do not feel embarrassed to see a GP. Anal pain is a common problem that they're used to treating.

What we mean by severe pain

Severe pain:: always there and so bad it's hard to think or talk
you cannot sleep
it's very hard to move, get out of bed, go to the bathroom, wash or dress
Moderate pain:: always there
makes it hard to concentrate or sleep
you can manage to get up, wash or dress
Mild pain:: comes and goes
is annoying but does not stop you doing daily activities

Ask for an urgent GP appointment or get help from NHS 111 if:

you have severe anal pain and you have a high temperature or feel hot and shivery
your poo is black or dark red

You can call 111 or get help from 111 online.

What we mean by severe pain

Severe pain:: always there and so bad it's hard to think or talk
you cannot sleep
it's very hard to move, get out of bed, go to the bathroom, wash or dress
Moderate pain:: always there
makes it hard to concentrate or sleep
you can manage to get up, wash or dress
Mild pain:: comes and goes
is annoying but does not stop you doing daily activities

Go to A&E or call 999 if:

you're bleeding non-stop from your bottom
there's a lot of blood coming from your bottom - for example, the toilet water turns red or you see large blood clots

Find your nearest A&E

Treatment for anal pain

Treatment for anal pain depends on what's causing it.

A GP will examine you and may prescribe:

a cream or ointment to ease your pain
laxatives to help you poo more easily
antibiotics if you have an infection

The GP may also recommend changes to your diet or arrange for tests to look for a cause of the anal pain.

Sometimes surgery or other treatments may be needed if the pain is caused by severe anal fissures, piles or fistulas.

OutUK's A to Z of Gay Health continues and you can read this week's feature L: Laxatives. We have covered many subjects in this series and you can catch up with all of our Previous A to Z Features. If you want to find out more about this particular topic you can visit the Original article on the NHS website. If you are worried by any aspect of your health make sure you go and see your doctor or book an appointment at your local clinic.
Photos: LightFieldStudios and one of VladOrlov, Stockcube, darak77, ajr_images or rawpixel.com.