Dull pain rectal area. Understanding Rectal Pain: Causes, Symptoms, and Treatment Options

07.02.202316.07.2023 by alexxlab

What are the common causes of rectal pain. How can you identify different types of rectal discomfort. When should you seek medical attention for anal pain. What are effective treatments for various rectal conditions.

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Common Causes of Rectal Pain

Rectal pain can be a distressing symptom with various underlying causes. Understanding the potential reasons for this discomfort is crucial for proper diagnosis and treatment. Here are some of the most common causes of rectal pain:

Hemorrhoids
Anal fissures
Prostatitis
Levator syndrome
Proctalgia fugax
Rectal prolapse
Endometriosis

Each of these conditions can present differently, with pain occurring at various times and in different intensities. Let’s explore these causes in more detail.

Hemorrhoids: A Leading Cause of Rectal Discomfort

Hemorrhoids are a prevalent cause of rectal pain, affecting millions of people worldwide. But what exactly are hemorrhoids? They are swollen veins in the lower rectum and anus, similar to varicose veins in the legs. Hemorrhoids can be internal (inside the rectum) or external (under the skin around the anus).

External Hemorrhoids

External hemorrhoids often cause the most discomfort. They can lead to:

Pain or ache when sitting
Anal itching
Hard, sensitive lumps around the anus
Bleeding during bowel movements

How long do external hemorrhoid symptoms typically last? According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), symptoms usually resolve within a few days.

Internal Hemorrhoids

Internal hemorrhoids are usually painless unless they prolapse or extend outside the anal opening. Prolapsed hemorrhoids can cause:

Rectal discomfort
Pain
Pressure
Bleeding from the rectum

Is it possible for internal hemorrhoids to cause pain without prolapsing? Generally, internal hemorrhoids that have not prolapsed are not painful, but they may still cause bleeding.

Thrombosed Hemorrhoids

A thrombosed hemorrhoid occurs when a blood clot forms within an external hemorrhoid. The American Society of Colon and Rectal Surgeons (ASCRS) notes that these can be particularly painful, causing discomfort when:

Walking
Sitting
Having a bowel movement

How quickly does the pain from a thrombosed hemorrhoid develop? The pain often worsens during the first 48 hours but then begins to ease over the following few days.

Prostatitis: When Rectal Pain Meets Urinary Symptoms

Prostatitis, an inflammation of the prostate gland, can be a source of both rectal and urinary discomfort. The prostate gland, located below the bladder and in front of the rectum, plays a crucial role in producing seminal fluid. When it becomes inflamed, often due to bacterial infection, it can cause a range of symptoms.

Symptoms of Prostatitis

The symptoms of prostatitis can be quite diverse and may include:

Pain when urinating
Rectal pain or pressure
Throbbing sensations in the rectal area
Frequent urge to urinate
Low urine output
Burning or stinging sensation during urination
Pain in the pelvis or lower back
Erectile dysfunction

How does prostatitis differ from other causes of rectal pain? Unlike conditions that primarily affect the rectum or anus, prostatitis often combines rectal discomfort with urinary symptoms, making it a unique diagnostic challenge.

Levator Syndrome and Proctalgia Fugax: Mysterious Muscle Spasms

Two less common but often distressing causes of rectal pain are Levator Syndrome (LS) and Proctalgia Fugax (PF). Both conditions are believed to be related to muscle spasms in the pelvic floor area.

Levator Syndrome

Levator Syndrome causes episodic pain in the rectum or the bony structures at the base of the spine. The exact cause remains unclear, but it’s likely due to spasms of the levator muscles in the pelvic floor. Symptoms of LS include:

Pain or dull ache in the rectum, anus, or tailbone
Worsening of symptoms when sitting or lying down
Pain that may occur after bowel movements

Why does Levator Syndrome tend to worsen when sitting or lying down? The pressure on the pelvic floor muscles in these positions may trigger or exacerbate muscle spasms, leading to increased discomfort.

Proctalgia Fugax

Proctalgia Fugax is characterized by sudden, intense pain in the rectum that typically lasts for several minutes. Key features of PF include:

Pain often occurring at night, potentially waking the person from sleep
Episodes can also happen during the day
Likely caused by spasms in the rectum or pelvic floor muscles

How frequently do episodes of Proctalgia Fugax typically occur? The frequency can vary greatly among individuals, with some experiencing episodes rarely and others having them more frequently.

Rectal Prolapse: When Internal Structures Protrude

Rectal prolapse is a condition where the rectum falls out of place and drops through the anus. This can be a source of significant discomfort and other symptoms. Understanding rectal prolapse is crucial for early detection and treatment.

Symptoms of Rectal Prolapse

The symptoms of rectal prolapse can be quite distressing and may include:

Feeling of a bulge from the anus when straining
Pressure and pain in the rectum or anus
Mucus in stool
Bleeding from the rectum or anus
Constipation
Inability to control bowel movements

When is rectal prolapse most noticeable? The bulge from the anus is often most apparent during activities that increase abdominal pressure, such as coughing, sneezing, or heavy lifting.

Causes and Risk Factors

Several factors can contribute to the development of rectal prolapse:

Chronic constipation or straining during bowel movements
Weakened pelvic floor muscles
Nerve damage
Previous pelvic surgery
Pregnancy and childbirth

Is rectal prolapse more common in certain age groups? While it can occur at any age, rectal prolapse is more frequently seen in older adults, particularly women over 50.

Endometriosis: A Hidden Cause of Rectal Pain in Women

Endometriosis is a condition where tissue similar to the lining of the uterus grows in abnormal locations outside the uterus. When this tissue develops in or near the rectum, it can cause significant rectal pain and other symptoms.

Rectal Endometriosis Symptoms

When endometriosis affects the rectal area, it can lead to various symptoms:

Rectal pain
Painful bowel movements
Constipation
Back pain
Pressure on the rectal wall

How does rectal pain from endometriosis differ from other causes? Pain from endometriosis often correlates with the menstrual cycle, typically worsening during menstruation or ovulation.

Diagnosis and Treatment

Diagnosing rectal endometriosis can be challenging and may require:

Detailed medical history
Physical examination
Imaging studies (ultrasound, MRI)
Laparoscopy for definitive diagnosis

Treatment options for rectal endometriosis may include:

Hormonal therapies
Pain management
Surgical intervention in severe cases

Is it possible to completely cure rectal endometriosis? While there is no definitive cure for endometriosis, treatments can significantly reduce symptoms and improve quality of life.

When to Seek Medical Attention for Rectal Pain

While occasional mild rectal discomfort can be normal, certain symptoms warrant immediate medical attention. It’s important to recognize these signs to ensure timely diagnosis and treatment of potentially serious conditions.

Red Flag Symptoms

Seek medical care promptly if you experience:

Severe, persistent rectal pain
Rectal bleeding, especially if it’s dark or accompanied by clots
Changes in bowel habits lasting more than a few days
Unexplained weight loss
Fever accompanying rectal pain
Pain that interferes with daily activities

How quickly should you seek medical attention for these symptoms? If you experience any of these red flag symptoms, it’s advisable to contact your healthcare provider within 24-48 hours.

Diagnostic Processes

When you consult a healthcare provider for rectal pain, they may perform various diagnostic procedures:

Digital rectal examination
Anoscopy or proctoscopy
Colonoscopy in some cases
Blood tests to check for infection or inflammation
Imaging studies such as CT scans or MRI

What should you prepare before your medical appointment? It’s helpful to keep a symptom diary noting when the pain occurs, its severity, and any associated symptoms or triggers.

Treatment Options for Rectal Pain

The treatment for rectal pain depends on its underlying cause. Here are some common treatment approaches for various conditions:

Hemorrhoid Treatments

For hemorrhoids, treatment options may include:

Over-the-counter creams and suppositories
Sitz baths
Increased fiber intake and hydration
In severe cases, surgical procedures like hemorrhoidectomy

How long does it typically take for hemorrhoid treatments to show effect? Many people experience relief within a week of starting conservative treatments, but healing times can vary.

Prostatitis Management

Treatment for prostatitis often involves:

Antibiotics for bacterial prostatitis
Anti-inflammatory medications
Alpha-blockers to relax prostate muscles
Lifestyle changes, including dietary modifications

What is the typical duration of antibiotic treatment for bacterial prostatitis? Antibiotic courses for acute bacterial prostatitis usually last 2-4 weeks, while chronic cases may require longer treatment.

Levator Syndrome and Proctalgia Fugax Therapies

Management strategies for these conditions may include:

Pelvic floor relaxation techniques
Biofeedback therapy
Muscle relaxants
Botox injections in some cases

How effective are these treatments for managing symptoms? Many patients find significant relief with these therapies, but response can vary, and a combination of approaches may be necessary.

Rectal Prolapse Treatment

Treatment options for rectal prolapse include:

Dietary changes to prevent constipation
Pelvic floor exercises
Surgical procedures to repair the prolapse

Is surgery always necessary for rectal prolapse? While surgery is often the most effective long-term solution, some mild cases may be managed conservatively, especially in patients who are poor surgical candidates.

Endometriosis Management

For rectal endometriosis, treatment approaches may include:

Hormonal therapies to suppress estrogen production
Pain management medications
Surgical excision of endometrial tissue
In severe cases, bowel resection surgery

How does the choice of treatment for endometriosis impact fertility? This is an important consideration, as some treatments may affect fertility. Discussing family planning goals with your healthcare provider is crucial when deciding on a treatment approach.

In conclusion, rectal pain can stem from various conditions, each requiring a specific approach to diagnosis and treatment. While some causes of rectal pain are benign and self-limiting, others may indicate more serious underlying conditions. Recognizing the symptoms, understanding when to seek medical attention, and following appropriate treatment plans are key to managing rectal pain effectively. Always consult with a healthcare professional for persistent or severe rectal pain to ensure proper diagnosis and treatment.

Causes, remedies, and when to contact a doctor

Rectal pain can result from injury, inflammation, or infections that affect the rectum or anus. Hemorrhoids, prostatitis, and endometriosis are among many possible causes. Treatment will depend on the cause.

The rectum is a part of the digestive system that begins at the lower part of the large intestine and ends at the anus.

People may experience rectal pain at particular times, such as when sitting, walking, or during bowel movements. Depending on the underlying cause of the pain, people may experience additional symptoms, such as constipation, rectal bleeding, or pressure in the pelvic area.

There are many possible causes of rectal pain, so it is important for people to contact a healthcare professional for a diagnosis and appropriate treatment.

This article lists some potential causes of rectal pain according to when the pain is likely to occur. We also list remedies for rectal pain and possible accompanying symptoms. Finally, we provide information on diagnosis and when to contact a doctor.

Below are some potential causes of rectal pain. In some cases, they may occur alongside the appearance of symptoms.

When sitting

Hemorrhoids, also called piles, are swollen and inflamed veins around the anus or in the lower rectum. They can be external or internal.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), external hemorrhoids can cause rectal pain or ache when sitting.

Other possible symptoms include:

anal itching
hard, sensitive lumps around the anus
anal ache or pain

The NIDDK states that the symptoms of external hemorrhoids typically resolve within a few days.

When an internal hemorrhoid bulges out into the rectum, it becomes a prolapsed hemorrhoid. This is a common cause of rectal discomfort, pain, and pressure.

Internal hemorrhoids that have not prolapsed are usually not painful, but people may experience bleeding from the rectum.

When walking

A thrombosed external hemorrhoid is a blood clot that occurs in an external hemorrhoid.

According to the American Society of Colon and Rectal Surgeons (ASCRS), large, thrombosed external hemorrhoids can cause pain when walking, when people sit, or during a bowel movement.

People may have an anal mass that appears suddenly and causes pain. According to the ASCRS, the pain may worsen during the first 48 hours but then ease off over the following few days. If the skin covering the blood clot opens, people may also experience bleeding.

When urinating

Prostatitis is inflammation of the prostate gland. The prostate gland is located below the bladder and in front of the rectum. Its primary function is to make seminal fluid.

Prostatitis occurs when the prostate becomes infected with bacteria from the urine or rectum. The condition may cause pain when urinating, along with rectal pain or pressure.

Other possible symptoms of prostatitis include:

throbbing sensations in the rectal area
frequent need to urinate
low urine output
a burning or stinging sensation when urinating
pain in the pelvis or lower back
erectile dysfunction

When lying down

Levator syndrome (LS) is a condition that causes episodic pain in the rectum or bony structures at the base of the spine. Experts do not know the exact cause of LS. However, it is likely due to the spasm of the levator muscles in the pelvic floor. People may experience spasms for no clear reason or after having a bowel movement.

LS can cause pain or a dull ache in the rectum, anus, or tailbone. According to the ASCRS, sitting or lying down can worsen LS symptoms.

At night

Proctalgia fugax (PF) is sudden and intense pain in the rectum that can last for several minutes at a time. The condition typically occurs at night and may wake a person from sleeping. However, it can also happen during the day.

PF likely occurs as a result of spasms in the rectum or pelvic floor muscles.

When coughing

Rectal prolapse is the medical term for when the rectum falls out of place and drops through the anus. A person who has a rectal prolapse may feel a bulge from their anus when straining, such as when coughing, sneezing, or heavy lifting.

Rectal prolapse can cause pressure and pain in the rectum or anus. Other symptoms may include:

mucus in stool
bleeding from the rectum or anus
constipation
an inability to control bowel movements

During ovulation

Some people may experience uncomfortable or painful symptoms during the ovulation phase of their menstrual cycle. In certain cases, severe pain can be a sign of an underlying health condition, such as endometriosis.

Endometriosis is a condition in which tissue similar to the uterus lining grows in abnormal places, such as the bowels. If endometriosis is present in the rectal area, it can cause pressure on the rectal wall, resulting in the following symptoms:

rectal pain
painful bowel movements
constipation
back pain

During a period

During menstruation, the body releases chemicals called prostaglandins. High levels of prostaglandins can cause the bowel wall to contract, causing pain, cramping, and diarrhea.

People with irritable bowel syndrome (IBS) may experience changes in their symptoms throughout the menstrual cycle, and these may correspond to natural hormone fluctuations. According to the Canadian Society of Intestinal Research, studies have found that people with IBS may experience an increase in rectal sensitivity during their period.

During pregnancy

A 2018 study assessed anal pain in 94 females in weeks 19–25 of pregnancy. Participants filled out a questionnaire reporting on anal symptoms throughout the following stages of pregnancy:

the second and third trimester
the postpartum period
three months postpartum

According to the results, 68% of participants experienced anal symptoms, with anal pain being the most common. Other anal symptoms included:

constipation
an inability to control bowel movements
hemorrhoidal complications
anal fissures

Risk factors for anal symptoms included constipation and medical history of anal problems.

After a hysterectomy

A hysterectomy is a medical term for the removal of the uterus. In some cases, a hysterectomy can weaken the connective tissue between the rectum and the vagina. This can cause a rectocele, a type of prolapse in which the rectum pushes into the vagina.

People may experience symptoms of a rectocele in the rectum, vagina, or both. Symptoms may include:

pressure in the pelvis
pain in the abdomen or lower back
a sensation of something falling down within the pelvis
feeling a mass within the vagina
vaginal bleeding that is not due to the menstrual cycle
constipation
difficulty having bowel movements
bowels not feeling empty after a bowel movement
in some cases, the inability to control a bowel movement

Standing up may worsen symptoms, whereas lying down may ease them.

Before or after a bowel movement

An anal fissure is a small tear in the lining of the anal canal, which is the end of the large intestine between the rectum and anus.

Anal fissures can cause sharp pain, which may begin with a bowel movement and can continue for a few minutes to hours. Other symptoms may include bright red blood in the stool or on toilet paper after having a bowel movement or a skin tag, or a small lump that appears near the anal fissure.

After a colonoscopy

A colonoscopy is a medical procedure that involves inserting a flexible tube called an endoscope into the anus and through the rectum to the colon. The scope has a camera attached, which allows a doctor to see inside the colon.

People may experience some mild pain or pressure during a colonoscopy. However, a doctor can provide a sedative to help reduce any discomfort.

Gentle movement and walking may help to alleviate any anal, rectal, or gas pains after the procedure.

During or after receptive anal intercourse or instrumentation

The skin around the rectum is very sensitive. Friction from sexual activity involving the anus or inserting objects into the rectum can cause injury, irritation, swelling, or bleeding.

Anal sex is mostly safe. If a person experiences pain during or after anal sex, they may need to increase lubrication.

Individuals who engage in unprotected anal intercourse are at a greater risk of anorectal infections. The most common symptom is a frequent or continuous urge to have a bowel movement. Other symptoms may also include anorectal pain or discomfort.

Learn about how to practice anal sex safely here.

Other medical conditions that can cause rectal pain include:

Inflammatory bowel disease

Inflammatory bowel disease (IBD) is a term for two conditions: Crohn’s disease and Ulcerative colitis (UC). These conditions cause chronic inflammation of the gastrointestinal tract.

Crohn’s most often affects the portion of the small intestine before the large intestine and colon. UC is a long-term condition where the colon and rectum become inflamed.

However, if UC only affects the rectum, it is called proctitis. People with this condition may experience pain in the rectal area.

Other symptoms include:

tenesmus, a frequent desire to pass feces
bloody diarrhea
bleeding in the rectal area

Research has shown that proctitis has also resulted from medical procedures. Chronic radiation proctitis is a side effect that affects 5–20% of people receiving radiation treatment for cancer. A case report from 2000 also demonstrates that one person developed ulcerative proctitis 10 months after a fecal microbiota transplant.

Stercoral ulcers

Stercoral ulcers occur when a person has chronic constipation leading to stagnation of fecal matter.

Multiple areas of ulceration can present in the colon. The most common locations of ulceration are in the sigmoid colon and the rectum.

Anorectal cancer

Anorectal cancer refers to any cancer that affects the anus or rectum.

With anal cancer, a person may not experience symptoms straightaway. They may notice anal bleeding, which people often mistake for hemorrhoids.

Other symptoms of anal cancer include:

rectal itching
a lump where the anus opens
a feeling of fullness or pain at the anus
changes in bowel movements, including narrower stools
anal discharge
swollen lymph nodes at the anus or groin
difficulty controlling bowel movements

Many of these symptoms may have causes that are not related to anorectal cancers. However, if a person notices these symptoms, it is important they contact a doctor.

The treatment options for rectal pain may vary depending on the underlying cause.

To relieve general pain around the rectum and anus, people can try the following:

taking a sitz bath or sitting in warm water for a few minutes
gently washing the area with lukewarm water, particularly after a bowel movement or sweating
avoiding using any irritating detergents or soap
wearing breathable, cotton underwear
wearing loose, comfortable clothing
avoiding sitting for long periods
sitting on a cushion or rubber ring to relieve pressure
taking over-the-counter pain medication to alleviate pain
using a stool softener, making stools easier to pass
eating a diet high in fiber and drinking plenty of water to prevent constipation and straining during a bowel movement
taking any medications according to the prescribing doctor’s instructions

Some conditions may require surgical treatment if a person experiences severe or persistent symptoms that do not respond to more conservative treatment. Examples include:

severe fissures
severe fistulas
severe hemorrhoids

A person who experiences rectal pain may also experience accompanying symptoms. Depending on the cause of the rectal pain, these may include:

a feeling of pressure in the anal, rectal, or pelvic area
a sensation of the bowels not emptying fully after a bowel movement
difficulty having bowel movements
gas and gas pains
leakage or an inability to control bowel movements
rectal or anal bleeding

A doctor may carry out a rectal examination to diagnose the cause of rectal pain.

During a rectal examination, a person will lie down on their left side, with their knees curled towards their chest. A doctor will then insert a lubricated, gloved finger into the rectum to feel for any problems. People may need to squeeze around the finger to test muscle function.

Depending on the person’s symptoms, a doctor may also carry out additional tests. These may include:

Endorectal ultrasound: This allows a doctor to see images of the rectal wall and surrounding areas. It can be useful in showing rectoceles or rectal prolapse.
Anorectal manometry: This test assesses the function and strength of muscles around the rectum.
Videodefecogram: This is a specialized X-ray to show muscle function during bowel movements.

People who experience any of the following symptoms will need to contact a doctor:

rectal pain that does not ease or eases and then returns
severe pain or other symptoms
ongoing rectal bleeding
a visible or palpable mass that does not improve
recent trauma to the anus

People may experience rectal pain for a variety of reasons, including pregnancy, hemorrhoids, and muscle spasms. Depending on the cause, symptoms may ease or worsen with a change of position, such as sitting, lying down, or walking.

People may be able to ease rectal pain with home remedies, such as taking a warm bath, sitting on a cushion, or taking pain relief medication.

A person will need to contact a doctor if they experience persistent or worsening rectal pain, rectal bleeding, or any other concerning symptoms.

Causes, remedies, and when to contact a doctor

The rectum is a part of the digestive system that begins at the lower part of the large intestine and ends at the anus.

There are many possible causes of rectal pain, so it is important for people to contact a healthcare professional for a diagnosis and appropriate treatment.

Below are some potential causes of rectal pain. In some cases, they may occur alongside the appearance of symptoms.