Any discharge released from the anus that is neither gas nor stool is usually pus or mucus. It can be a very unpleasant problem, causing embarrassment and inconvenience. There are times that the discharge has a foul odor, like that of dead fish. Why is this happening? Why are you experiencing anal discharge and fishy smell?

What Causes the Smelly Anal Discharge?

If you are experiencing smelly discharge in your undies, it is best to speak with your doctor to diagnose the issue. Some possible causes can be:

1. IBD or Inflammatory Bowel Disease

IBD refers the inflammation in the large intestine, including ulcerative colitis and Crohn’s disease. The chronic inflammation can cause excess mucus production in the intestinal tract, which is excreted through the rectum. Crohn’s disease is especially blamed for anal discharge.

2. Proctitis

Some infections to the anal canal may cause inflammatory fluid to leak from the anus. This is pus-like and mucoid. There can be rashes, ulcers or growths as well as itchiness. The groin area tends to feel damp and discomfort may increase with movements. You may see pus or blood in your underwear. You may also run a fever or have pain in your lower abdomen.

3. Hemorrhoids

One of the more common causes of anal discharge and fishy smell is hemorrhoids. You will generally see this when you are wiping after passing a stool. With hemorrhoids, the veins in the rectum swell and cause immense pain. Bowel movements and wiping can be painful from acute inflammation. Both constipation and diarrhea can make the problem worse.

4. Anal Fissure

When small tears happen to the mucus lining of the anus, they are called anal fissures. Constipation is one of the leading causes of these small tears. Seeing blood in your stool or when you wipe is the first sign of this trouble. You may also see smelly discharge as well as itching.

5. Other Causes

Other causes of anal discharge can include gastroenteritis, fecal incontinence, irritable bowel syndrome, sexual transmitted diseases, food intolerance, anal cancer and more. You should check with your doctor if you suspect these.

When to Call the Doctor

There are cases when anal discharge and fishy smell may have other symptoms along with them. If you experience any of the following call 911 immediately:

• Loss of bowel or bladder control
• High fever
• Pus draining from anus
• Bloody stools (black, red or tarry in texture)
• Watery diarrhea
• Recurring diarrhea that includes blood or pus

How Can the Smelly Anal Discharge Be Treated?

It is important to keep the area dry. This will help to prevent maceration of the area and lower the chance for further infection. You can use liners or butterfly body pads to keep the area clean and dry. The following treatments are for the above conditions.

1. IBD

Surgery and medications are the common treatments. Some will prescribe drugs, starting mild and working up to more aggressive treatments.

• Corticosteroids
• Anti-inflammatory drugs
• Biologic therapies
• Immune suppressors

Other treatments for IBD may include:

• Antidiarrheal drugs
• Antibiotics
• Laxatives
• Mineral and vitamin supplements if nutritional deficiencies are suspected

There are instances where surgery may be recommended for IBD and the complications. If there are fistulas or a narrow bowel suspected, surgery will be ordered.

Some dietary changes will also need to happen, such as:

• Reducing the amount of dairy
• Eating less high fat foods
• Avoiding alcohol, caffeine, and spicy foods
• Eating more meals that are smaller instead of a few large ones
• Limiting fiber rich foods
• Drink enough water
• Mineral and vitamin supplements if you think there are deficiencies
• Keeping a food diary to see which foods cause problems

2. Proctitis

Your treatment will depend on what is causing your proctitis. Mild proctitis can be caused by radiation therapy and shouldn’t need treatment to resolve itself. Other causes may need:

• Antibiotics to help if there is a bacterial infection
• Antiviral medicine if there is a viral infection
• Anti-inflammatory medicine when there is swelling
• Antiulcer medicine. It may be taken as an enema, suppository or pill to help prevent further damage.
• Surgery to remove damaged tissue

3. Hemorrhoids

More often than not, simple changes can help in the case of hemorrhoid which causes the anal discharge and fishy smell.

• OTC or over-the-counter suppositories and creams with hydrocortisone can help. There are pads with witch hazel that can calm down the irritation as well.
• Bathe the area. Using warm water and then gently drying the area can help.
• Use cold compresses or ice packs. Applying these to the area can help with the swelling.
• Have sitz baths in warm water. These are usually placed over the toilet and you sit in them to relieve itching and burning.
• Use wet wipes instead of toilet paper.
• Take analgesics. Painkillers like acetaminophen, ibuprofen, or aspirin may relieve the discomfort.
• You can find most of your options OTC, such as suppositories, pads and ointments. Look for witch hazel and hydrocortisone as active ingredients.

If the patient can’t find relief from the various small procedures or if the hemorrhoids are larger, surgery may be recommended.

4. Anal Fissure

With anal fissures, there are home remedies that can give relief. Some of these are:

• Stool softeners
• More hydration
• Adding more fiber to your diet
• Taking warm baths such as sitz baths to relieve irritation and relax muscles as well as increase the blood flow
• Applying nitroglycerin ointment to the rectum for better blood flow or using steroid creams to reduce swelling
• Using topical pain relievers for discomfort

If you don’t find relief from your symptoms in a couple of weeks, you should see your doctor.