What causes painful bowel movements without bleeding?

Pain in the anus during bowel movements without bleeding may have several possible causes: 1. Heat accumulation ("shanghuo"): Long-term consumption of spicy or irritating foods may lead to dry, hard stools, which can irritate the anus during defecation and cause pain. 2. Hemorrhoids: Poor lifestyle habits or excessive stress may contribute to hemorrhoids; straining too much during bowel movements can irritate the hemorrhoids and cause pain. 3. Anal fissure: Chronic constipation may cause tearing of the skin around the anus, resulting in an anal fissure and subsequent pain during defecation. 4. Other conditions: Such as perianal abscess, anal sinusitis, or proctitis may also cause anal pain during bowel movements, though bleeding may not necessarily occur. To address these potential causes, it is recommended to maintain healthy dietary habits, avoid spicy and irritating foods, and ensure regular, smooth bowel movements. If the pain persists or worsens, prompt medical evaluation is advised to rule out other underlying conditions.