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Excessive arterial blood flow causing dilations and congestions that culminate in enlarged veins at the junction of the rectum and anus. This can be very painful, particularly while passing stool.
Sometimes in the area between the end of the bowel and the skin near the anus a small, infected channel develops, usually as a result of an infection in the anal gland. This is called anal fistula.
Chronic constipation resulting in passing of large, hard stood over a period of time can lead to a small tear or crack in the lining of the anus, making the action of passing stool very painful. This needs surgical repair.