What are the causes of anal pain? Learn about the various conditions that can lead to rectal or anal pain, including minor injury, sexually transmitted infections, hemorrhoids, anal fissures, muscle spasms, and more.

Understanding the Causes of Anal Pain

Experiencing anal or rectal pain can be a frustrating and uncomfortable experience, but it’s important to understand the underlying causes in order to seek the appropriate treatment. The Mayo Clinic has provided a comprehensive overview of the various conditions that can lead to anal pain, from minor injuries to more serious medical conditions.

Minor Injury or Trauma

One of the most common causes of anal pain is minor injury or trauma to the rectum or anus. This can occur during anal sex or masturbation, or from a hard fall or other physical activity. Additionally, individuals with significant constipation and hard stools may experience tears in the anal mucosa, known as anal fissures, which can be quite painful.

Sexually Transmitted Infections (STIs)

STIs can also spread to the rectum, causing pain, irritation, and other symptoms. Common STIs that can lead to anal pain include gonorrhea, chlamydia, herpes, and syphilis. In addition to rectal pain, these infections may also cause minor bleeding, itching, soreness, and discharge.

Hemorrhoids

Hemorrhoids are a very common cause of rectal pain. Internal hemorrhoids, which develop inside the rectum, may cause painless rectal bleeding, especially after bowel movements. External hemorrhoids, which arise from blood vessels outside the anus, can cause itching, swelling, and pain.

Anal Fissures

Anal fissures are small tears in the thin tissue that lines the opening of the rectum. They often develop when hard or large stools stretch and tear the delicate lining. Fissures can cause rectal pain, bright red blood on the stool or toilet paper, and a small lump or skin tag near the fissure.

Muscle Spasms

Rectal pain can also be caused by muscle spasms in the rectal muscles, a condition known as proctalgia fugax. This is similar to another type of anal pain, levator syndrome, and is more common in women between the ages of 30 and 60.

Anal Fistulas

Anal fistulas are small tunnels that connect an infected gland in the anus to an opening in the skin around the anus. They can cause rectal pain, swelling, difficult bowel movements, and the passage of blood or pus during bowel movements.

Other less common causes of anal pain include perianal hematomas, solitary rectal ulcer syndrome, thrombosed hemorrhoids, and tenesmus (rectal cramping often associated with inflammatory bowel diseases).

If you are experiencing persistent or severe anal pain, it’s important to consult with a healthcare professional to determine the underlying cause and receive appropriate treatment. Prompt diagnosis and treatment can help alleviate the discomfort and prevent the condition from worsening.

What is the most common cause of anal pain?

The most common cause of anal pain is minor injury or trauma to the rectum or anus, often from anal play during sex or masturbation, or from a hard fall or other physical activity.

Can sexually transmitted infections cause anal pain?

Yes, sexually transmitted infections (STIs) can spread to the rectum and cause anal pain, irritation, and other symptoms. Common STIs that can lead to anal pain include gonorrhea, chlamydia, herpes, and syphilis.

How do hemorrhoids cause anal pain?

Hemorrhoids, both internal and external, can cause a variety of anal symptoms, including pain, itching, swelling, and difficulty with bowel movements. Internal hemorrhoids may cause painless rectal bleeding, while external hemorrhoids can be quite painful due to their proximity to nerve endings.

What is the difference between an anal fissure and a hemorrhoid?

Anal fissures are small tears in the thin tissue that lines the opening of the rectum, often caused by hard or large stools. Hemorrhoids, on the other hand, are swollen blood vessels in the anus or lower rectum. While both can cause anal pain, fissures are more likely to cause bright red blood on the stool or toilet paper, while hemorrhoids may cause a lump or bulge around the anus.

Can muscle spasms in the rectum cause anal pain?

Yes, muscle spasms in the rectal muscles, a condition known as proctalgia fugax, can cause sudden, severe episodes of anal pain. This is similar to another type of anal pain caused by muscle spasms, levator syndrome, and is more common in women between the ages of 30 and 60.

Rectal (Anal) Pain: Causes and More

Minor injury or other trauma

In many cases, trauma or injury to the rectum or anus results from anal play during sex or masturbation. It can also result from a particularly hard fall or injury during other physical activity.

People who have significant constipation with hard stools may experience tears in the anal mucosa, also known as anal fissures. These can be quite painful.

In addition to rectal pain, minor injury can cause:

• bleeding
• swelling
• difficult bowel movements

Sexually transmitted infection (STI)

STIs may spread from the genitals to the rectum, or the infection can be transmitted during anal sex.

STIs that may cause rectal pain include:

• gonorrhea
• chlamydia
• herpes
• syphilis
• human papillomavirus infection (HPV)

In addition to rectal pain, anal STIs can cause:

• minor bleeding
• itching
• soreness
• discharge

Hemorrhoids

Hemorrhoids are a very common cause of rectal pain. The symptoms you experience depend on where the hemorrhoid is.

Internal hemorrhoids can develop on the inside of the rectum, but they can protrude through the rectum if they’re sufficiently large. Internal hemorrhoids usually are inside of the anus, and most people aren’t aware of them. They can sometimes manifest with painless rectal bleeding, especially after having bowel movements.

External hemorrhoid arise from blood vessels that are external and from a point where there are nerve connections, which is why people may feel them itching, swelling, and causing pain.

In addition to rectal pain, hemorrhoids can cause:

• itching or irritation
• swelling around the anus
• difficult bowel movements
• a lump or cyst-like bump near the anus

Anal fissures

Anal fissures are small tears in the thin tissue that lines the opening of the rectum. They’re very common, especially in infants and people who’ve given birth.

Fissures develop when hard or large stools stretch the delicate lining of the rectum and tear the skin. They heal slowly because any bowel movement can further irritate and inflame the tissue.

In addition to rectal pain, anal fissures can cause:

• bright red blood on stool or toilet paper
• itching around the anus
• a small lump or skin tag that develops near the fissure

Muscle spasm (proctalgia fugax)

Proctalgia fugax is rectal pain caused by muscle spasms in the rectal muscles. It’s similar to another type of anal pain caused by muscle spasms, levator syndrome.

This condition affects twice as many women as men and usually occurs in people between 30 and 60 years old. One study estimates that 8 to 18 percent of Americans experience this.

In addition to rectal pain, proctalgia fugax can cause:

• sudden, severe spasms
• spasms that last for a few seconds or minutes, or even longer

Anal fistula

The anus is surrounded by small glands that secrete oils to keep anal skin lubricated and healthy. If one of these glands becomes blocked, an infected cavity (abscess) may form.

Some abscesses around the anus develop into fistulas, or small tunnels that connect the infected gland to an opening in the anus skin. A fistula is more likely to develop if an abscess is untreated.

In addition to rectal pain, anal fistulas can cause:

• swelling around the anus and anal opening
• difficult bowel movements
• passing blood or pus during bowel movements
• fever

Perianal hematoma

A perianal hematoma occurs when a collection of blood drains into the tissues around the anal opening. When the blood pools, it causes a lump to form at the anal opening.

In addition to rectal pain, perianal hematoma can cause:

• a lump at the anus
• bleeding or spotting on tissue paper
• difficult bowel movements
• difficulty sitting or walking

Solitary rectal ulcer syndrome

Solitary rectal ulcer syndrome is a condition that leads to the development of ulcers in the rectum. Ulcers are open sores that can bleed and drain.

It’s not clear what causes this rare syndrome, but some researchers believe it may be related to chronic constipation.

In addition to rectal pain, solitary rectal ulcer syndrome can cause:

• constipation
• straining when passing stool
• bleeding or other discharge
• feeling fullness or pressure in the pelvis
• feeling as if you’re unable to empty all stool from your rectum
• inability to control bowel movements

Thrombosed hemorrhoid

Hemorrhoids are very common. Occasionally, a blood clot can develop in an external hemorrhoid. This is known as thrombosis.

The external clot may feel like a hardened lump that’s tender to the touch. Although these clots aren’t dangerous, they can be extremely painful.

In addition to rectal pain, a thrombosed hemorrhoid can cause:

• itching and irritation around the anus
• swelling or lumps around the anus
• bleeding when passing stool

Tenesmus

Tenesmus is rectal pain caused by cramping. It’s often associated with inflammatory bowel diseases (IBDs), such as Crohn’s disease and ulcerative colitis.

However, it can occur in people who don’t have a diagnosed IBD. In these cases, specific movement or motility disorders of the GI tract may be to blame. Common motility disorders are constipation and diarrhea.

In addition to rectal pain, tenesmus can cause:

• cramping in and near the rectum
• feeling the need to have a bowel movement, even after you’ve had one
• straining harder but producing a smaller amount of stool

Inflammatory bowel disease (IBD)

IBD is a group of intestinal disorders that can cause inflammation, pain, and bleeding in the digestive tract, including the rectum.

The two most common IBDs are Crohn’s disease and ulcerative colitis (UC). Those two conditions affect nearly 3 million American adults.

Symptoms of IBD depend largely on the type of IBD you have. The symptoms can also change over time, as the condition worsens or improves.

In addition to rectal pain, IBDs like Crohn’s disease and UC can cause:

• abdominal pain and cramping
• blood in stool
• constipation
• diarrhea
• fever
• reduced appetite
• unintended weight loss

Proctitis

Proctitis causes inflammation in the lining of the rectum. Although it’s common in people with IBD, it can affect anyone. STIs can also cause proctitis, and it can even be the result of radiation therapy for cancer.

In addition to rectal pain, proctitis can cause:

• diarrhea
• feeling of fullness or pressure in the rectum
• feeling as if you need to pass stool, even when you just had a bowel movement
• bleeding or other discharge

Perianal or perirectal abscess

The rectum and anus are surrounded by glands or cavities. If bacteria, fecal matter, or foreign matter get into the cavities, they can become infected and fill with pus.

If the infection grows worse, the gland may develop a tunnel through the nearby tissue and create a fistula.

In addition to rectal pain, perianal or perirectal abscess can cause:

• redness of the skin around the anus
• fever
• bleeding
• swelling around the anus and in the rectum
• painful urination
• difficulty starting a urine stream

Fecal impaction

Fecal impaction is a common GI problem that can lead to rectal pain. Chronic constipation can lead to impacted feces, which is a mass of hardened stool in the rectum.

Although fecal impaction is more common in older adults, it can occur at any age.

In addition to rectal pain, fecal impaction can cause:

• abdominal pain
• distention or bloating in the abdomen and rectum
• nausea
• vomiting

Rectal prolapse

Rectal prolapse occurs when your body loses the attachments that hold the rectum in place in your GI tract. When this happens, the rectum may protrude out from the anus.

Rectal prolapse is rare. It’s most common in adults, and women over age 50 are six times more likely to develop this condition than men. However, the average age of a woman with rectal prolapse is 60, while the age is 40 for men.

In addition to rectal pain, rectal prolapse can cause:

• a mass of tissue extending from the anus
• stool or mucus passing freely from the anal opening
• fecal incontinence
• constipation
• bleeding

Levator syndrome

Levator syndrome (levator ani syndrome) is a condition that causes aching or pain in and around the anus. The pain is a result of muscle spasms in the pelvic floor muscles.

Although women are more likely to be affected, it’s still possible for men to develop the syndrome.

In addition to rectal pain, levator syndrome can cause:

• pain on the left side of the abdomen
• pain in the vagina
• bloating
• bladder pain
• pain with urination
• urinary incontinence
• painful intercourse

Anal, colorectal, and colon cancers are usually painless in the beginning. In fact, they may cause no symptoms at all. The first signs of pain or discomfort may come if the tumors grow large enough to push on tissue or an organ.

The most common symptoms of rectal cancer include rectal bleeding, itching, and feeling a lump or mass near the anal opening.

But these symptoms are more commonly caused by other conditions, including abscesses and hemorrhoids. If you have any concerns, it’s always wise to check with your doctor. They can assess your symptoms and advise you on any next steps.

Occasional rectal pain is rarely a cause for immediate concern. But if you’re experiencing rectal pain with regularity, it’s always a good idea to make an appointment to see your doctor.

You should see your doctor right away if you’re experiencing rectal pain that worsens or spreads into the lower half of your body. You should also see your doctor if you have:

• fever
• chills
• anal discharge
• consistent bleeding

6 Causes of Anal Pain | How to Get Relief

6 most common causes

Crohn’s Disease

Anal Fissure

Hemorrhoids

Illustration of a person thinking with cross bandaids.

Anal or rectal cancer

Chlamydia Infection

Disseminated Gonococcal Infection

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Anal pain is pain or discomfort in the last part of lower gastrointestinal tract, the anus, where bowel movements leave the body.

It can range from itchy irritation to sharp pain that may be worse during bowel movements. Although most causes of anal pain are harmless, the level of pain can be severe because the anus has a lot of nerve endings.

Causes range from irritation from skin trauma and external hemorrhoids to internal pain caused by inflammatory bowel disease and cancer.

Depending on the cause, treatment can be as simple as starting a stool softener or more invasive procedures such as colonoscopy or even surgery may be needed.

Pro Tip

It is important to describe the type of pain (dull, sharp, burning, etc) and for how long it has been going on. It is also important to note whether you have noticed any bleeding from your anus during or after bowel movements. Finally, family history is important as well. Let the doctor know if any of your immediate family members (mother, father, siblings) has had any cancers of the digestive tract or inflammatory bowel disease. —Dr. Jonathan Xia

Causes

1. External hemorrhoids

Symptoms

• Dull pain and itchiness near the anus
• A lump can usually be felt in the area around the anus
• You may see bleeding, mainly after bowel movements

External hemorrhoids are swollen veins that can form near the anus. They are usually caused by constipation and straining during bowel movements. Sometimes a blood clot can form in them and this can cause dull pain, itchiness, or tingling sensations in the anus. You may feel a painful lump near the anus. They may bleed as well, mainly after bowel movements.

Treatment includes increasing fiber in your diet and using stool softeners to prevent constipation. You can apply over-the-counter steroid creams, such as hydrocortisone, to the hemorrhoid to reduce pain and swelling.

2. Anal fissure

Symptoms

• Sharp tearing, ripping, or burning pain that occurs in the anus
• Pain is worse during a bowel movement.
• You may see light bleeding when wiping after bowel movements.

Anal fissures are tears in the lining of the anus. They are caused by constipation and hard stools. They can cause sharp pain that is worse after bowel movements.

Treatment includes increasing fiber or taking stool softeners to keep your stools soft.   Medications that help relax the anal sphincter muscle can also be used to help the tear heal.  You can also soak your buttocks in 2 to 3 inches of warm water in a process called taking a “sitz bath.” This can help relieve pain by relaxing the anus.

3. Pruritus ani (anal itch)

Symptoms

• Tingling and itchiness in the anus or area around it
• May cause a burning pain or soreness

Pruritus ani is itching or burning pain in the anus or area around it. It can affect up to 5% of the population, according to a study in the journal Surgical Clinics of North America.

It is often caused by irritation from fecal matter that gets stuck to the skin around the anus. It’s more likely to happen if you have soft stool. Trauma from wiping after bowel movements can cause it as well.

It can be treated with anti-itch ointments such as over-the-counter hydrocortisone. You can also use talcum powder on the skin around the anus to keep it clean and dry.

4.

Sexually transmitted infections

Symptoms

• Sharp burning pain in the anus or around it
• Pain may be worse with bowel movements
• Mucous discharge can come from the anus
• Bleeding can occur as well
• Fevers and chills

Sexually transmitted infections (STIs), such as chlamydia, gonorrhea, anal warts, and HIV,  can cause sharp burning pain in the anus and surrounding areas. This can sometimes cause mucous discharge and bleeding in the area as well. This is more likely to occur in people who are having anal receptive intercourse.

Treatment includes identifying the type of STI and treating it with the appropriate antibiotic. You should stop having anal intercourse until you are treated. It’s also required to notify your sexual partners if you have an STI.

5. Anal or rectal cancer

Symptoms

• Sharp pain in the anus
• Changes in bowel (constipation or diarrhea)
• Sensation of mass or lump in the anus or surrounding areas
• Bleeding from the anus (either spontaneously or during a bowel movement)
• Weight loss and decreased appetite

Cancers of the anus or rectum develop when the normal cells lining the anus change into abnormal cells and grow unchecked.

People with human papillomavirus (HPV), an STI, are at increased risk of anal cancer. HPV is considered the most common cause of anal cancers, according to the National Cancer Institute.

Depending on the type of cancer and how advanced it is, treatment can range from surgery to chemotherapy and radiation therapy.

Pro Tip

Most patients believe that anal pain or anal pain with bleeding is always a sign of cancer in the lower digestive tract. However, this is not true. There are many benign conditions that can have similar symptoms and are significantly more common. —Dr. Xia

6. Inflammatory bowel disease (IBD)

Symptoms

• Sharp pain in the anus or surrounding areas
• Bleeding during bowel movements
• Diarrhea
• Abnormal drainage from the anus or surrounding areas
• Fever

Inflammatory bowel disease (IBD) is a gastrointestinal disease that affects about 1% of the population in the U.S., according to the Centers for Disease Control and Prevention. It includes both ulcerative colitis and Crohn’s disease. It is a disease where your body has an overactive immune system that attacks your own gut.

Symptoms can include pain in the anus and surrounding areas, bleeding during bowel movements, diarrhea, and abnormal pus-like drainage from the anus or surrounding areas.

IBD is usually treated with medications that control the overactive immune response. In serious cases,  surgery may be necessary to remove the inflamed areas of the colon.

Other possible causes

A number of other conditions can also cause symptoms of anal pain:

• Prolapsing rectal tissue
• Bartholin cyst
• Skin infections of the buttocks
• Prostate infections
• “Tail-bone” fracture
• Proctalgia fugax

When to call the doctor

• Any type of bleeding you notice during or after bowel movements will require a thorough evaluation as it’s important to rule out cancer.
• Weight loss
• Changes in bowel movements, either worsening constipation or new diarrhea
• Sensation of a mass, lump, or abnormal growth in the anus or surrounding areas
• Fevers and chills

Should I go to the ER?

You should go to the emergency department if you have any of these signs of a more serious problem:

• Heavy bleeding from the anus that is ongoing
• Bleeding that occurs with the symptoms of lightheadedness and dizziness
• Anal pain that is not controlled by over-the-counter medications
• Anal pain along with fever

Treatments

At-home care

• Stool softeners
• Over-the-counter steroid cream such as hydrocortisone
• Dietary fiber supplement
• Over-the-counter pain medications such as acetaminophen (Tylenol)
• Sitz baths (shallow warm water soaks)

Other treatment options

• Colonoscopy
• Surgery
• Antibiotics
• Immunosuppression medications

Dr. Rx

I understand that it may be difficult to disclose such private issues but the majority of times they can be fixed easily. Therefore, don’t hesitate, and contact your healthcare providers if you are having ongoing issues. —Dr. Xia

Jonathan Xia, MD.

Dr. Xia earned his undergraduate degree from Washington University in St. Louis, MO. He received his MD degree from the University of Texas Southwestern Medical Center and completed his residency at McGraw Medical Center of Northwestern University. Dr. Xia is currently completing his fellowship at Northwestern University Feinberg School of Medicine.

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Paraproctitis – Clinic 29

Paraproctitis is a purulent inflammation of the fatty tissue around the rectum and anal sphincter. Purulent paraproctitis is acute and chronic. Acute paraproctitis consists in the formation of abscesses (limited cavities with pus) of fatty tissue. Chronic paraproctitis is manifested by pararectal (near-rectal) and perianal (around the anus) fistulas, which often occur after acute paraproctitis. Paraproctitis is the most common disease of the rectum after hemorrhoids.

The clinical picture of paraproctitis varies significantly depending on the location of the purulent focus. At the onset of the disease, there is a short period with malaise, weakness and headache. There is an increase in temperature above 37.5 ° C with chills.

With subcutaneous paraproctitis , when the abscess is located near the anus under the skin, the symptoms are the most striking: a painful swelling in the anus, with reddening of the skin above it. The pains gradually increase, acquiring an intense pulsating character, making it difficult to sleep, sit, defecation becomes extremely painful, softening appears over the tumor. This form of paraproctitis is the most common.

Submucosal abscess is located under the rectal mucosa. Symptoms with this type of location are similar to subcutaneous paraproctitis, however, pain and skin changes are less pronounced.

With ischiorectal abscess , the purulent focus is located above the levator ani muscle. Due to the deeper location of the abscess, local symptoms are more vague: dull throbbing pains in the pelvis and rectum, aggravated by defecation. Changes in the skin in the form of redness, swelling, swelling occur later on 5-6 days from the onset of pain. The general state of health is severe: the temperature can rise to 38 ° C, intoxication is pronounced.

The most severe course is pelviorectal abscess . This is a rare form of acute paraproctitis, when the purulent focus is located above the muscles that form the pelvic floor, a thin layer of peritoneum separates it from the abdominal cavity. At the onset of the disease, severe fever, chills, and joint pain predominate. Local symptoms: pain in the pelvis and lower abdomen. After 10-12 days, the pain intensifies, there is a delay in stool and urine.

Separate group necrotic paraproctitis . This form of paraproctitis is characterized by a rapid spread of infection, accompanied by extensive necrosis of soft tissues and requires their excision, after which large skin defects remain that require skin grafting.

Chronic paraproctitis is manifested by purulent fistulas. The mouths of the fistulous passages can be located near the anus of the rectum or at a distance from it on the buttocks. Pain is usually not expressed. From the mouth of the fistula, pus is often released with an admixture of feces. During the development of chronic paraproctitis, the fistula opening can close, pus is retained, abscesses develop, new tissue defects appear, pus breaks through and flows into the rectum and out, necrotization and other tissue changes that greatly complicate fistulas. Thus, complex fistula systems arise with fistula tract ramifications, cavitary depots and many openings.

In the department of purulent surgery of GKB29 you can get emergency round-the-clock surgical care for any form of acute paraproctitis. Planned hospitalization for surgical treatment for chronic paraproctitis is also possible. You can find out about the need for surgical treatment at a consultation with the specialists of the department at the CDC GKB29.

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Anal sphincter pneumodivulsion

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Proctologists of the medical center “KDS Clinic” perform pneumosphincter divulsion – a simplified form of sphincterotomy. The technique is based on dosed and controlled stretching of the anal sphincter with special pneumocylinders (the so-called pneumodivulsion), which relieves spasm of the anal sphincter for 3-4 weeks.

A technique used to treat anal fissures. The technique has been tested, improved and implemented in the State Research Center of Coloproctology and a number of other medical institutions. According to the resolution of the III All-Russian Congress of Coloproctologists of Russia, “In the treatment of anal fissures, the operation of choice is balloon pneumodivulsion of the anal sphincter with excision of the anoderm defect. The method of treatment eliminates the spasm of the internal sphincter without damaging the muscle tissue, which eliminates the risk of developing anal incontinence.”

To relieve spasm of the anal sphincter, instead of a pneumoballoon, we use a special cone (conusodivulsion), which has advantages over a pneumoballoon. With conodivulsion, the degree of stretching of the sphincter is controlled and dosed. The technique contributes to the prevention of edema of the anal area, especially with concomitant hemorrhoids.

The price of pneumo-divulsion

The price of pneumo-divulsion of the sphincter is placed in a special section. The factor that determines the cost is the category of complexity of the intervention. Our price list reflects the full financial costs of the patient, including the procedure, preliminary examination of the surgeon and tests, hospital stay, medications and consumables.

How a pneumo-divulsion works

Our surgeons use a new method of pneumo-divulsion with the use of pneumocylinders or special cones, the cone divulsion technique, to remove an anal fissure. This procedure relieves spasm from the muscles of the anus. The operation is performed under spinal or caudal anesthesia.

A pneumatic balloon or cone is inserted into the anal canal, corresponding to the diameter of the patient’s canal. The duration of the manipulation does not exceed 6-7 minutes, after which the balloon is removed, and the crack is excised or evaporated (using the fulguration method) using a radio wave scalpel. The operation itself to excise the anal fissure is simple, lasts 10-15 minutes and is easily tolerated by patients.

Pneumodivulsion has advantages over other methods of anal fissure elimination:

• effective relief of spasm of the internal sphincter;
• no damage to muscle tissue;
• exclusion of the risk of incontinence.

KDS Clinic surgeons innovate and use a special dilator cone that has the following advantages:

1. Controls and doses the degree of sphincter stretch during anal fissure surgery.
2. Minimizes the risk of swelling in the anal area.

Conusodivulsion is considered a rational technique.

Over the past ten years, proctologists from our clinic staff have performed thousands of these types of surgeries.

Preparation for pneumodivulsion

At the initial consultation, the proctologist will tell the patient in detail about the preparation for the manipulation. Before the operation, laboratory and instrumental analyzes are performed, in the presence of concomitant pathologies or diseases, an examination of surgeons and therapists of the profile direction is provided.