Differential Diagnosis for Recurrent Anal Pain with Hard, Formed Stools

• Single most likely diagnosis
  • Anal Fissure: This condition is characterized by a tear in the lining of the anus, which can cause severe pain during and after bowel movements, especially with hard stools. The pain is often described as sharp and stabbing.
• Other Likely diagnoses
  • Hemorrhoids: Although more commonly associated with soft or bloody stools, hemorrhoids can also cause pain, especially if they are thrombosed. The pain from hemorrhoids can be exacerbated by hard stools.
  • Proctalgia Fugax: This condition involves sudden, severe anal pain that can occur at any time, including during bowel movements with hard stools. However, the pain is typically fleeting.
  • Levator Ani Syndrome: Characterized by chronic pain in the anal region, this condition can be exacerbated by bowel movements, including those with hard stools.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Rectal Cancer: Although less common, rectal cancer can present with anal pain, especially if the tumor is large enough to cause obstruction or if it ulcerates. Hard stools could exacerbate the pain.
  • Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause anal pain, among other symptoms, and can be associated with changes in stool consistency, including hard stools.
• Rare diagnoses
  • Anal Cancer: A rare condition that can cause anal pain, among other symptoms. It might be associated with changes in bowel habits, including hard stools.
  • Coccygodynia: Pain in the coccyx (tailbone) area can sometimes be referred to the anal region and could be exacerbated by straining during bowel movements with hard stools.
  • Pudendal Neuralgia: A condition involving pain from the pudendal nerve, which can cause chronic pain in the anal region, potentially worsened by bowel movements.