Do I need a colonoscopy for tailbone and anal pain to rule out cancer?Gastroenterology Cancer Health Screening
I am a mostly sedentary guy in my late 20s, not obese, and I lift weights a few times a week. I began to get a brief dull pain near the tailbone occasionally when I get up from a chair and when I rock back while seated. I could not tell if it is muscle related, bone related, or anything deeper. I suspected bad sitting posture or some sort of injury to the coccyx, despite never experiencing direct trauma there before. I tried maintaining a neutral spine while seated, which seemed to reduce the times I felt the pain standing up. I still reliably feel the pain when I rock back.
After about a week I was woken up by a throbbing ache in my anus, similar to a mild urge for a normal bowel movement, except with slight pain. I could be wrong but the pain seemed to be situated on the right side. The sensation/pain lasted about 5 minutes. There was no blood or any other signs. I don’t know if the two cases are related but I have not experienced either before. Also, before you ask I have never inserted foreign objects up my rectum.
My dad survived a bout of colorectal cancer some years ago- I think that’s a risk factor for me. What should I do? Is this strange enough to require a colonoscopy or should I wait it out?
There is a clinical entity known as coccydynia which matches your description to some extent.
This condition is believed to be a result of tailbone (aka coccyx) inflammation presenting with local pain or dull ache and sometimes with a tender point at the upper portion of the buttock cleft some distance away from the anus; which explain your discomfort when rocking backwards.
Coccydynia can develop spontaneously without any significant trauma to the tailbone although previous trauma to the surrounding area predisposes you to coccydynia. In this case, avoiding pressure at the tailbone by leaning forward while sitting may help.
Depending on individual, the discomfort should go away within a few months with or without pain killers.
As to the transient throbbing anal pain which you felt more on the right, local cause such as a small anal fissure with spasm could be the reason although anal fissure pain usually last more than 5min.
May I suggest you watch the discomfort and your bowel movement. If there is now a constant urge to open your bowel with the discomfort worsening or a significant change in your stool consistency or stool caliber, seek medical help early.
- Dr Quan
The description of your symptoms appear to be proctalgia ani. While it literally translate to "pain in your anus", the persistence of your symptoms warrants a physical examination by a doctor.
The causes can range anywhere from an anal fissure (tear in your anus), to deep anal infections, to referred pain from somewhere else e.g. coccydynia / pelvic floor strain (from your weight lifting), and stress.
Statistically, this is unlikely to be cancer despite your family history but it is worthwhile getting your risk assessed accurately with a detailed history taking so that you can be counselled on when you should commence cancer screening. Take care.
From the sounds of it, you're most worried about cancer (which I can understand, given your father' s colorectal cancer) so let's address that first.
Dull pain near tailbone -> anal pain - could it be cancer?
Although doctors can very rarely say it's not X or Y with 100% certainty (much less online, without seeing you in person), the answer to your question is that it's less likely, given that:
- You are 20 - anal cancer is usually diagnosed in the 60s
- It's a very rare cancer in itself
- It's common among men who receive anal intercourse, and / or have HPV (human papilloma virus)
In other words, cancer will be pretty low down on a list of people with your story, although a doctor will need to ask you some further questions about you in person.
What's more common in your age group is haemorrhoids, which can be brought on by weight lifting if you are too much, without the correct breathing technique.
They are very common, and can cause a dull aching sensation around the anal area, just as you 've described.
I began to get a brief dull pain near the tailbone occasionally when I got up from a chair and when I rock back while seated. I could not tell if it was muscle related, bone related, or anything deeper. I do not know if the two cases are related but I have not experienced either before.
It's hard for a doctor to tell if these 2 are linked, without examining you. With your history of weight lifting, it's very likely that this could just be a musculoskeletal type injury too, which should recover over time with proper rest.
If this pain is prolonged, do see a doctor (or you can just highlight this issue to the GP, whom I recommend you see anyway to have your anal pain checked out)
What should I do? Is this what I need to wait for it out?
You should see a doctor just to have a look around your anal region. Your GP / polyclinic would be a good place to start.
Let him advise you on what you need next.
He MAY perform proctoscopy just to look at your rectal and anal region. If necessary, he will be the best person to decide if you also require a colonoscopy (which is to look at ALL of your bowels). You can read more about colonscopies in Singapore at this link.