Can a past internal hemorrhoid (internal hemorrhoid) cause lower left quadrant (LLQ) pain during physical exertion like pushups?

Left Lower Quadrant Pain During Push-ups: Unlikely to be Related to Past Internal Hemorrhoid

Left lower quadrant pain during physical exertion like push-ups is unlikely to be caused by a previous internal hemorrhoid, and further evaluation is recommended to determine the actual cause.

Understanding Hemorrhoids and Their Symptoms

• Internal hemorrhoids originate above the dentate line in the anal canal and typically cause rectal bleeding, discomfort, and tissue prolapse, but not left lower quadrant abdominal pain 1
• Hemorrhoidal pain is typically localized to the anal region, not the left lower quadrant of the abdomen 2, 1
• When hemorrhoids do cause pain, it is usually due to thrombosis (blood clot formation), which presents as acute-onset anal pain with a palpable perianal lump 2
• Pain from hemorrhoids is generally confined to the perianal region and does not radiate to the left lower quadrant of the abdomen 1, 3

Common Causes of Left Lower Quadrant Pain

• Left lower quadrant pain is more commonly associated with conditions affecting the sigmoid colon, such as diverticulitis 2
• Diverticulitis occurs in 10-20% of people with diverticulosis and can cause left lower quadrant pain that worsens with physical exertion 2
• The classic triad for diverticulitis includes left lower quadrant pain, fever, and leukocytosis 2
• Other potential causes of left lower quadrant pain include irritable bowel syndrome, constipation, or musculoskeletal issues that may be exacerbated by physical activities like push-ups 2

Evaluation of Left Lower Quadrant Pain

• If left lower quadrant pain persists or worsens during physical activity, imaging may be necessary to determine the cause 2
• Computed tomography (CT) with contrast is the preferred imaging modality for evaluating left lower quadrant pain of unclear etiology, with a rating of 8/9 on the American College of Radiology Appropriateness Criteria 2
• Abdominal ultrasound may be considered in certain cases, particularly for women of childbearing age 2
• A thorough physical examination should distinguish between anal/rectal pain (which could be hemorrhoid-related) and true left lower quadrant abdominal pain (which suggests other pathology) 1, 4

Management Recommendations

• For persistent left lower quadrant pain during physical exertion:

  • Temporarily avoid activities that exacerbate the pain, such as push-ups 4
  • Seek medical evaluation to determine the underlying cause, as this is unlikely to be related to a previous hemorrhoid 2
  • Consider CT imaging if symptoms persist or worsen, especially if accompanied by fever or other systemic symptoms 2

• If you do have hemorrhoid-related symptoms (separate from the LLQ pain):

  • Increase dietary fiber and water intake 1, 3
  • Avoid straining during defecation 1
  • Consider over-the-counter topical treatments for symptomatic relief 1, 5

Important Considerations and Pitfalls

• Assuming that all anorectal or lower abdominal symptoms are due to hemorrhoids can lead to missed diagnoses of more serious conditions 1
• Left lower quadrant pain during physical exertion could indicate musculoskeletal issues, hernia, or inflammatory bowel conditions that require different treatment approaches 2
• Pain that occurs specifically during physical exertion like push-ups suggests a mechanical or muscular component that would not typically be associated with hemorrhoids 4
• If left lower quadrant pain is accompanied by fever, significant bleeding, or changes in bowel habits, prompt medical evaluation is necessary 2