Rectal pain is common and has many possible causes, including hemorrhoids, fecal impaction, inflammatory bowel disease, and proctitis (inflammation of the rectum’s lining). Most cases are not serious, though some can be.
Technically, the rectum is the last few inches of the large intestine that terminates at the anus. However, because of the proximity of these two areas, conditions that affect the anus alone are often talked about as causes of rectal pain, too.
Fortunately, many conditions that cause rectal pain can be managed at home. It’s still important to know when to see a healthcare professional for rectal pain. Other, more urgent treatment may be required.
Hemorrhoids
Hemorrhoids are swollen veins in the rectum. They affect over half of American adults over 50 years.
Hemorrhoids are one of the most common causes of anal pain when sitting. A seated position puts pressure on swollen veins in the rectum. The longer you sit, the more pain you may feel.
Hemorrhoids are more common in certain people, including:
- Those who are pregnant
- Older people
- People who sit for long periods
- People who strain during bowel movements
Hemorrhoids often cause:
- Bright red blood after a bowel movement
- Itching around the anal area
- Discomfort during bowel movements or when sitting
Sometimes a blood clot forms inside a hemorrhoid. This can cause sudden, severe rectal or anal pain.
Anal Fissure
An anal fissure is a small tear in the skin at the opening of the anus. It is usually caused by straining and stretching of the anal canal when passing a large or hard stool.
When an anal fissure develops, the internal anal sphincter—the muscle that controls the anal opening—may spasm. If it does, it may become even harder to pass stools.
The pain of an anal fissure:
- Occurs with every bowel movement
- Often feels severe, sharp, and/or “ripping”
- May be dull or throbbing for minutes to hours after pooping
If you have an anal fissure, you may also see a small amount of bright red blood in your stool or on toilet paper when you wipe.
Fecal Impaction
Fecal impaction occurs when hard, dry stool gets lodged in the rectum. This causes pain and other symptoms like:
- Stool leakage
- Bloating
Fecal impaction is caused by chronic constipation. It often happens in older people who may not feel the urge to have a bowel movement. Limited fluid intake, a low-fiber diet, and an inactive lifestyle can also contribute.
Levator Ani Syndrome
People with levator ani syndrome experience chronic rectal pain due to spasms of the pelvic floor (levator) muscles. These episodes of aching or pressure-like pain high up in the rectum may last 30 minutes or longer.
This syndrome is more common in females. It tends to occur between 30 and 60 years of age.
The cause is unknown. Some research suggests it may have certain triggers, such as:
- Bowel movements
- Childbirth
- Sex
- Sitting for long periods
- Stress
Proctalgia Fugax
Proctalgia fugax is a condition that is similar to levator ani syndrome in that it can cause spasms in the pelvic floor muscles. Muscles in the rectum or the anal sphincter may also be affected.
Spasms in the rectum come on suddenly. The pain may feel like cramping or produce a “gnawing” sensation.
The pain is not related to bowel movements. On average, attacks last around 15 minutes. They may be triggered by stress or anxiety.
Proctalgia fugax may occur at any age in males or females. It is rare before puberty.
Anal Fistula
An anal fistula is an abnormal connection that forms between the anal canal and the skin of your buttocks.
Most people with this condition have had a perianal abscess (a collection of pus that forms in the anal canal) drained.
Symptoms of an anal fistula may include:
- Anal swelling
- Drainage of pus near the anal opening
- Fever and chills
- Pain
- Skin irritation around the anus
Perianal Hematoma
A perianal hematoma is a collection of blood that develops around the anus. It is caused by trauma or an injury that makes the veins in your anal area suddenly break open.
Examples of the kinds of injury that might cause this include:
- Forceful coughing
- Lifting heavy weights
- Straining during a bowel movement
Perianal hematomas are very painful and sometimes may be mistaken for external hemorrhoids.
Inflammatory Bowel Disease
Inflammatory bowel disease (IBD) is a general term for two disorders: Crohn’s disease and ulcerative colitis. Both cause chronic inflammation leading to pain and ulcers (sores) in the digestive system.
Crohn’s disease affects your digestive tract. It can occur anywhere between your mouth and your anus.
Symptoms may include:
- Diarrhea
- Crampy abdominal pain
- Rectal soreness and fullness
- Tiredness
- Fever
- Weight loss
Ulcerative colitis nearly always involves the rectum and lower colon. Sometimes the entire colon may be affected. Symptoms may include:
- Bleeding
- Diarrhea
- Cramping abdominal pain
- Rectal soreness
Proctitis
Proctitis is an inflammation of the lining of the rectum. Symptoms may include:
- Rectal soreness
- A sensation of rectal fullness
- Bloody bowel movements
- Diarrhea
- Abdominal cramping
- Passing mucus
Some possible causes of proctitis include:
- Inflammatory bowel disease
- Sexually transmitted infections (STIs) passed through anal sex, including gonorrhea, chlamydia, syphilis, and HIV
- Trauma (e.g., if an object is inserted into the anus)
- Cancer radiation therapy
- Foodborne illnesses, including salmonella and shigella
- Antibiotics, which can kill helpful bacteria in the rectum and allow harmful bacteria to grow
Sexual Activity
Anal sex can cause pain in the rectum, usually from anal fissures.
Endometriosis—a disease in which uterine tissue grows outside of the uterus and often on the bowel—is another cause of rectal pain for females during vaginal or anal sex.
Solitary Rectal Ulcer Syndrome
This is an uncommon and poorly understood disorder. People with this condition have redness or sores in the lining of the rectum.
Symptoms include:
- Rectal bleeding and pain
- Pelvic fullness
- Tenesmus, the feeling that you can’t fully empty your bowels
- Straining during bowel movements
- Passing mucus
The precise cause of this condition is unknown. Experts suspect it may stem from chronic constipation.
Other possible causes include:
- An uncoordinated rectal muscle problem
- Rectal prolapse, where the rectum protrudes through the anus
Cancer
Rectal cancer can cause rectal pain, as can anal cancer. These cancers can also cause a feeling of fullness around the anus.
Bleeding is often the first sign of anal cancer. Other possible rectal or anal cancer symptoms include:
- Itching or a lump at the anal opening
- Anal discharge
- Fecal incontinence
- Swollen lymph nodes in the anal area or groin region
- A change in bowel habits
- Unusual fatigue
- Unintended weight loss
Common Symptoms With Rectal Pain
Depending on the cause, rectal pain can be pressure-like, gnawing, sharp, and more. The cause also factors into other symptoms that may be present.
In general, rectal pain often occurs along with:
- Bleeding
- Diarrhea or constipation
- Irritation, itchiness, or swelling of the skin around the anus
- Passage of mucus
- Tenesmus
When Should I Seek Medical Care for Rectal Pain?
Seek medical attention right away if you have:
- Rectal pain that is severe or getting worse
- Rectal pain with fever, chills, or anal discharge
- Significant rectal bleeding, especially if you feel dizzy or lightheaded
Schedule an appointment with or call your healthcare provider if you have:
- Rectal pain that is recurrent or constant and doesn’t get better with at-home remedies
- Rectal pain with a change in bowel habits or mild bleeding
- Unintended weight loss
- Unusual fatigue
How Rectal Pain Is Diagnosed
If you have rectal pain, you may see a primary care physician, gastroenterologist (a digestive specialist), or a proctologist (also called a colon and rectal surgeon or a colorectal surgeon).
They will ask about your medical history and do a physical exam. Other tests and procedures can help confirm a diagnosis, including:
- Blood tests: A complete blood count may be ordered to check for anemia or infection.
- Imaging tests: An abdominal X-ray or computed tomography (CT) scan may be ordered to look for masses, enlarged lymph nodes, or stool.
- Digital rectal exam: During this exam, the healthcare provider will insert a gloved, lubricated finger into your rectum. This is a simple way to check for blood, discharge, and abnormal masses.
- Anoscopy/proctoscopy: A thin, rigid tool with a light on the end is inserted a few centimeters into the anus. This helps a provider see the inside of your anus/rectum. A tissue sample, called a biopsy, may also be taken.
- Sigmoidoscopy/colonoscopy: During this procedure, a long, thin instrument with a tiny video camera attached to it is inserted through your rectum. It is guided up into your large intestine. Biopsies may also be taken.
At-Home Rectal Pain Treatment
The treatment of rectal pain depends on the underlying cause. Sitz baths, diet changes, and/or enemas may be enough to help some cases of rectal pain at home. However, certain conditions require medications or procedures.
- Sitz baths: Taking sitz baths two or three times a day for 15 minutes can help soothe pain from hemorrhoids, anal fissures, perianal hematomas, levator ani syndrome, and proctalgia fugax.
A sitz bath is a bath filled with a few inches of warm water only, or with other ingredients added (e.g., Epsom salts, witch hazel, or sea salt). As another option, a special sitz tub that fits over a toilet is available in most drugstores and online. The bath works by improving blood flow and relaxing the muscles around your anus. - Fiber-rich diet: A diet rich in fiber can help soften stool, making bowel movements less painful. Aim for 20 to 35 grams of fiber per day. Foods high in fiber include whole grains, beans, and berries. A high-fiber diet can help manage solitary rectal ulcer syndrome. It can also prevent recurrent fecal impaction.
- Enemas: An over-the-counter (OTC) enema kit consists of a small bag or bottle that is filled with a water and salt mixture or mineral oil. It is attached to a nozzle that you insert into the anus. When you squeeze the container, the liquid goes up into the rectum and releases the feces.
Pain Relievers
Oral and topical pain relievers can help reduce rectal pain. These include:
- Nonsteroidal anti-inflammatory medications like Advil (ibuprofen)
- Tricyclic antidepressants like Elavil (amitriptyline)
- Muscle relaxants
- Topical numbing agents like lidocaine lotion
- Hemorrhoid creams containing ingredients like hydrocortisone or witch hazel
Stool Softeners or Laxatives
Stool softeners such as Colace (docusate) help soften hard stools and alleviate constipation. They are often used to manage:
- Hemorrhoids
- Anal fissures
- Perianal hematomas
Laxatives may also help constipation, especially in patients with:
- Fecal impaction
- Anal fissures
- Solitary rectal ulcer syndrome
Note that stool softeners and stimulant laxatives are not usually recommended for long-term use.
Other Medication
Aside from pain relievers, stool softeners, and laxatives, other OTC or prescription medications can be used to manage certain causes of rectal pain.
- Antibiotics/antivirals: If your rectal pain is related to bacteria, you may receive antibiotics. Gonorrhea and chlamydia are examples of bacterial causes of rectal pain. If you have a virus like herpes or HIV, you may receive antivirals.
- Steroids and Immunosuppressants: Inflammatory bowel disease may be treated with steroids and/or immunosuppressants. These medicines can help slow the progression of the disease.
Complementary Therapies
Complementary therapies can be used if you have chronic anal pain caused by:
- Levator ani syndrome
- Proctalgia fugax
- Solitary rectal ulcer syndrome
- Anal fissures
Such therapies may include:
- Biofeedback: Monitoring equipment is used to measure bodily functions, such as muscle tension. A practitioner teaches you how to control these functions based on the results.
- Sacral nerve stimulation: Electrical impulses are transmitted through a device to affect nerves that control the rectum.
- Physical therapy: PT is used for conditions that affect the pelvic floor muscles.
- Anal self-massage: This can help anal fissures.
Procedures and Surgeries
Your healthcare provider may use an enema in their office in cases of fecal impaction (or if you are uncomfortable doing one yourself at home). In severe cases, hard stool may need to be manually removed by a practitioner.
Other medical therapies or office-based procedures may be used for various conditions.
For example, Botox injections may help relax the anal sphincter and levator ani muscles.
Rubber-band ligation can be used for some hemorrhoids. In this procedure, a rubber band cuts off the blood supply to a hemorrhoid, causing it to shrink.
Surgery is often needed for these conditions:
- Anal fistula
- Anal/rectal cancer
- Severe cases of proctitis caused by IBD or hemorrhoids
- Solitary rectal ulcer syndrome with rectal prolapse
Summary
There are many potential causes of rectal pain including hemorrhoids, anal fissures, inflammation from IBD, infection, and trauma. Cancer is also a potential cause, but it’s much less common.
Rectal pain is often easily diagnosed and managed. At-home treatment may be all that is needed, but be sure to follow the advice of your healthcare provider.