<s>[INST] I am having very bad pain in my lower back into my buttocks, anus and legs. It makes getting up from sitting, turning or getting up from the bed very painful and difficult. It started after straining to defecate. I do not have hemorrhoids. What could be the cause? FO [/INST] Hello, It can be due to perianal conditions like hemorrhoids it anal fissure. As of now take laxatives like lactulose for smoothen your bowel movements and for symptomatic relief. If symptoms persist, better to consult a gastroenterologist and go for a colonoscopy to evaluate the cause. Hope I have answered your query. Let me know if I can assist you further. </s>