There are several common reasons for anal distension and pain with a downward sensation: First, if the patient is constipated for a long time, there is a large amount of fecal retention in the rectum, retention for a long time will lead to the formation of fecal stones, and in this case, it generally manifests as anorectal distension and pain with a feeling of swelling, and rectal finger diagnosis can be made clearly. Secondly, if the patient drinks a lot of alcohol or eats stimulating food and has long-term diarrhea, it will easily lead to anal gland infection, which will spread around and lead to anorectal abscess, which will also show anal distension and pain with a feeling of falling, and can be clearly diagnosed with perianal ultrasound. Thirdly, if the patient has mixed hemorrhoids, the long-term increase in abdominal pressure or constipation can easily lead to swelling of the hemorrhoid nucleus, making the anal cushion pathologically hypertrophy downward, thus forming a downward sensation in the anus. If the hemorrhoid vein is stagnant and forms a thrombus, it will also show a feeling of anal swelling and pain, which can be clearly diagnosed by general visual examination, rectal diagnosis and anoscopy.