Table of ContentsView AllTable of ContentsAnatomyCauses of Rectal PainRectal Pain and CancerWhen to See a DoctorFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Anatomy
Causes of Rectal Pain
Rectal Pain and Cancer
When to See a Doctor
Frequently Asked Questions
Rectal pain is a common health condition that many people try to ignore in hopes that it will go away. However, delaying medical care for rectal pain puts you in harm’s way. Though a pain or itch often ends up being nothing more than hemorrhoid, there are other times when the causes are more serious.
Causes and Treatments of Rectal Pain
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Anatomy of the Rectum and Anus
The rectum and anus are distinct parts of the lower gastrointestinal tract with unique physiological functions.
What Can Affect the Perianal Area
Rectal pain may be a sign of something serious or something relatively minor; there is often no way to know until you see your doctor.
You may have bleeding along with pain. The color of the blood is a key sign as to where the bleeding is occurring. The longer blood remains in the intestines, the more thehemoglobinin blood will begin to oxidize and darken. Maroon or tarry stools suggest that bleeding is coming from higher up in the colon, while bright red blood suggests the bleeding is nearer the rectum and anus.
Anal Fissure
An anal fissure is a superficial tear in the thin, moistmucosal tissuesthat line the anus. They can develop due to chronic constipation, anal trauma, or surgery. Anal fissures can be acute (lasting for less than six weeks) or chronic (lasting for more than six weeks) and can affect people of any age group.
Treatment may be nonsurgical, involving topical anesthetics, topical nitroglycerin, blood pressure medications, or Botox injections. Sometimessurgicaltreatment includes a procedure that involves cutting the internal anal sphincter to reduce muscle tension in the anal area and allow blood to flow more freely, thus allowing the fissure to heal.
Anal Fissure Self-Care and Prevention
Rectal Abscess
On occasion, a large rectal abscess can spontaneously burst. If it’s not treated, a ruptured abscess can lead tocellulitisor a systemic infection.
The diagnosis typically involves adigital rectal exam (DRE)and sometimes blood tests to check for signs of infection. Occasionallycomputed tomography (CT),magnetic resonance imaging (MRI)scan, or transrectal ultrasound (TRUS) scan will be done if there is concern about a deep abscess that might not be apparent on physical examination.
Everything You Need to Know About Anorectal Manometry
Levator Ani Syndrome
Levator ani syndromeis a condition in which the levator ani muscle, which comprises a major part of the pelvic floor, will spontaneously begin to spasm. It is unclear why this happens, and the spasms often occur after long periods of sitting, after bowel movements, during or after anal sex, following surgery or childbirth, or in stressful situations.
The diagnosis of levator ani syndrome is based on a review of the clinical symptoms. There is no specific cure for the condition. Walking, warm baths, and rectal massage may help.Electrostimulation therapyandtherapeutic ultrasoundhave been proposed as treatments.
Hemorrhoids
Ahemorrhoidis a swollen vein, or collection of veins, in and around the rectum. Hemorrhoids can be internal or external, and they vary in size, ranging from a few millimeters to several centimeters. In some cases, a blood clot can form within an external hemorrhoid, resulting in athrombosed hemorrhoid.
Causes of hemorrhoids include bowel straining, pregnancy, anal sex, violent coughing, andcirrhosis, among others.
The diagnosis is based on a physical exam, DRE, oranoscopyif needed. Treatment options can include hemorrhoid creams, ice application, stool softeners,sitz baths, rubber band ligation,sclerotherapy, cauterization, and surgery.
How Hemorrhoids Are Treated
Proctalgia Fugax
With proctalgia fugax, the pain often occurs at night, causing spasms painful enough to awaken a person from sleep. In some cases, the spasms are misinterpreted as the need to defecate. While the cramping of the rectum and anus can be abrupt and severe, it tends to be short-lasting, resolving within minutes.
As with levator ani syndrome, the diagnosis is based purely on symptoms. There are no recommended treatments for proctalgia fugax, butcalcium channel blockers, topical nitroglycerin, Botox injections, and local anesthetic blocks have been proposed.
Colitis
Depending on the underlying cause, the symptoms of colitis can range in severity from mild to debilitating. Common symptoms include abdominal cramping, pain, diarrhea, bloody stools, and bloating. Severe cases can manifest with fever, fatigue, chills, joint pain, nausea, vomiting, and dehydration.
An endoscopic exam is central to the diagnosis, involving eithercolonoscopy,sigmoidoscopy, orcapsule endoscopy. A stool sample will also be taken. Imaging studies, such as CT, MRI, or anabdominal ultrasound, may also be ordered.
The causes of colitis are varied, and the prescribed treatment can vary based on the cause. Treatments can include changes in diet, antibiotics, stress reduction, long-termimmunosuppressant therapy, or surgery.
Blood in Stool: When to Worry and How to Treat It
Anorectal Fistula
Ananorectal fistulais a small tunnel that develops between the end of the bowel and the skin near the anus or rectum. A fistula is usually the aftermath of an anorectal abscess in which the drainage of pus can leave behind an abnormal channel. Sexually transmitted infections, inflammatory bowel diseases, andradiation therapyare among the common causes.
Depending on the location of the fistula, symptoms may include itching, discomfort, anal swelling, pain with defecation, and a mucus- or pus-like discharge. The symptoms are similar to those of an anorectal abscess and difficult to differentiate without a medical evaluation.
Although the diagnosis of a fistula is similar to that of an anorectal abscess, fistulas are typically treated withfistulotomy, a surgical procedure used to open and drain the channel. While most fistulas are treated this way, smaller ones may heal with a course of antibiotics.
Tenesmus
Among the conditions that cause tenesmus are:
The treatment of the underlying cause will usually resolve the symptoms of tenesmus.
Perianal Hematoma
Symptoms tend to develop abruptly and cause pain and pressure ranging from mild to severe. The initial pain can be sharp but generally subsides over a period of days, during which there can be itching, throbbing, pain with defecation, and the formation of a visible lump. You can expect some bleeding at first, but this too will quickly subside once a blood clot forms.
Sexually Transmitted Infections
There are many sexually transmitted infections (STIs) that a person can get from anal sex, includingchlamydia,genital herpes,gonorrhea,HIV,human papillomavirus (HPV), andsyphilis. Some cause noticeable symptoms, and others may cause little to no symptoms at all.
Common symptoms of anal STIs include:
Do I Need an Anal STD Screen?
Rectal Injury or Trauma
Rectal trauma can occur for many reasons, including medical procedures, anal sex (including anal toys), sports, or injuries sustained during motorcycle or cycling accidents.
Gunshot wounds are among the most common cause of rectal injuries in emergency rooms in the United States.
Rectovaginal Endometriosis
Rectovaginal endometriosis (RVE) is a severe form ofendometriosisaffecting around 4% of people with the disease. With RVE, the overgrowth of tissue infiltrates the vagina, rectum, and the connective tissues that support them (called the rectovaginal septum).
The diagnosis of RVE may involve a transvaginal ultrasound,laparoscopy, MRI, CT, or colonoscopy. Hormone therapy can improve symptoms in the majority of people with RVE, but for those with severe symptoms and deep infiltration, surgery may be needed to remove the tissue overgrowth.
How Endometriosis Is Treated
Different types of cancers can cause rectal pain, includinganal cancerandrectal cancer. By and large,colon canceris associated more with abdominal pain than rectal pain or discomfort.In addition to rectal pain, there may be anal itching, rectal discharge, tenesmus, a palpable mass, bleeding, and bloody stools.
Although certain symptoms are red flags for cancer, it is important to remember that other conditions can cause the same symptoms as well. In the end, only a doctor can determine whether or not cancer is the cause.
How Colorectal Cancer Is Diagnosed
Rectal pain may be a sign of something serious or something relatively benign. By and large, it warrants an appointment to see your doctor.
There are times when immediate action is needed, particularly if the rectal pain is associated with a severe infection or is causing severe bleeding.
Call 911 or seek emergency care if:
A Word From Verywell
The important thing to remember is that rectal pain can be a sign of something serious (including anal cancer, which disproportionately affectsgay and bisexual men with HIV).
If you have anal or rectal pain, don’t let nervousness prevent you from getting it looked at. In the end, your rectal health is every bit as important as your heart, lungs, brain, and bones.
Frequently Asked QuestionsWhen rectal pain is sharp, it may be due to an anal fissure, which typically causes jarring pain during bowel movements, orproctalgia fugax, a condition that can cause acute episodes of stabbing pain or cramps.Even large hemorrhoids or a perianal abscess can cause sharp pains during a bowel movement, particularly if you have constipation.
When rectal pain is sharp, it may be due to an anal fissure, which typically causes jarring pain during bowel movements, orproctalgia fugax, a condition that can cause acute episodes of stabbing pain or cramps.Even large hemorrhoids or a perianal abscess can cause sharp pains during a bowel movement, particularly if you have constipation.
What to Do for Anal Pain
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24 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kim BS, Li BT, Engel A, et al.Diagnosis of gastrointestinal bleeding: A practical guide for clinicians.World J Gastrointest Pathophysiol.2014;5(4):467-78. doi:10.4291/wjgp.v5.i4.467Jahnny B, Ashhurst JV.Anal fissures. In:StatPearls [Internet].MedlinePlus.Anorectal abscess.Sigmon DF, Emmanuel B, Tuma F.Perianal abscess. In:StatPearls [Internet].Chiaroni G.Treatment of levator ani syndrome: update and future developments.Recenti Prog Med. 2011 May;102(5):196-201.Chiarioni G, Asteria C, Whitehead WE.Chronic proctalgia and chronic pelvic pain syndromes: new etiologic insights and treatment options.World J Gastroenterol. 2011;17(40):4447–4455. doi:10.3748/wjg.v17.i40.4447Mott T, Latimer K, Edwards C.Hemorrhoids: diagnosis and treatment options.Am Fam Physician. 2018;97(3):172-9.Jeyarajah S, Purkayastha S.Proctalgia fugax.CMAJ. 2013 Mar 19;185(5):417. doi:10.1503/cmaj.101613Jeyarajah S, Purkayastha S.Proctalgia fugax.Can Med Assoc J. 2012;185(5):417. doi:10.1503/cmaj.101613Azer SA, Sun Y.Colitis. In:StatPearls [Internet].Jimenez M, Mandava N.Anorectal fistula. In:StatPearls [Internet].MedlinePlus.Tenesmus.Sabry AO, Sood T.Rectal bleeding. In;StatPearls [Internet].Centers for Disease Control and Prevention.Chlamydia - CDC fact sheet (detailed version).Centers for Disease Control and Prevention.Genital herpes - CDC fact sheet.Centers for Disease Control and Prevention.Gonorrhea - CDC fact sheet (detailed version).Weledi WP.Human immunodeficiency virus and the anorectum.Alexandria J Med.2013 Jun;49(2):163-7. doi:10.1016/j.ajme.2012.12.001American Society of Colon and Rectal Surgeons.Anal warts and anal dysplasia expanded information.Centers for Disease Control and Prevention.Syphilis - CDC fact sheet.Clemens MS, Peace KM, Yi F.Rectal trauma: evidence-based practices.Clin Colon Rectal Surg.2018 Jan:31(1):17-23. doi:10.1055/s-0037-1602182Moawad NS, Caplin A.Diagnosis, management, and long-term outcomes of rectovaginal endometriosis.Int J Womens Health.2013;5:753-63. doi:10.2147/IJWH.S37846Centers for Disease Control and Prevention.What are the symptoms of colorectal cancer?American Cancer Society.Signs and symptoms of anal cancer.Cleveland Clinic.Rectal bleeding.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Kim BS, Li BT, Engel A, et al.Diagnosis of gastrointestinal bleeding: A practical guide for clinicians.World J Gastrointest Pathophysiol.2014;5(4):467-78. doi:10.4291/wjgp.v5.i4.467Jahnny B, Ashhurst JV.Anal fissures. In:StatPearls [Internet].MedlinePlus.Anorectal abscess.Sigmon DF, Emmanuel B, Tuma F.Perianal abscess. In:StatPearls [Internet].Chiaroni G.Treatment of levator ani syndrome: update and future developments.Recenti Prog Med. 2011 May;102(5):196-201.Chiarioni G, Asteria C, Whitehead WE.Chronic proctalgia and chronic pelvic pain syndromes: new etiologic insights and treatment options.World J Gastroenterol. 2011;17(40):4447–4455. doi:10.3748/wjg.v17.i40.4447Mott T, Latimer K, Edwards C.Hemorrhoids: diagnosis and treatment options.Am Fam Physician. 2018;97(3):172-9.Jeyarajah S, Purkayastha S.Proctalgia fugax.CMAJ. 2013 Mar 19;185(5):417. doi:10.1503/cmaj.101613Jeyarajah S, Purkayastha S.Proctalgia fugax.Can Med Assoc J. 2012;185(5):417. doi:10.1503/cmaj.101613Azer SA, Sun Y.Colitis. In:StatPearls [Internet].Jimenez M, Mandava N.Anorectal fistula. In:StatPearls [Internet].MedlinePlus.Tenesmus.Sabry AO, Sood T.Rectal bleeding. In;StatPearls [Internet].Centers for Disease Control and Prevention.Chlamydia - CDC fact sheet (detailed version).Centers for Disease Control and Prevention.Genital herpes - CDC fact sheet.Centers for Disease Control and Prevention.Gonorrhea - CDC fact sheet (detailed version).Weledi WP.Human immunodeficiency virus and the anorectum.Alexandria J Med.2013 Jun;49(2):163-7. doi:10.1016/j.ajme.2012.12.001American Society of Colon and Rectal Surgeons.Anal warts and anal dysplasia expanded information.Centers for Disease Control and Prevention.Syphilis - CDC fact sheet.Clemens MS, Peace KM, Yi F.Rectal trauma: evidence-based practices.Clin Colon Rectal Surg.2018 Jan:31(1):17-23. doi:10.1055/s-0037-1602182Moawad NS, Caplin A.Diagnosis, management, and long-term outcomes of rectovaginal endometriosis.Int J Womens Health.2013;5:753-63. doi:10.2147/IJWH.S37846Centers for Disease Control and Prevention.What are the symptoms of colorectal cancer?American Cancer Society.Signs and symptoms of anal cancer.Cleveland Clinic.Rectal bleeding.
Kim BS, Li BT, Engel A, et al.Diagnosis of gastrointestinal bleeding: A practical guide for clinicians.World J Gastrointest Pathophysiol.2014;5(4):467-78. doi:10.4291/wjgp.v5.i4.467
Jahnny B, Ashhurst JV.Anal fissures. In:StatPearls [Internet].
MedlinePlus.Anorectal abscess.
Sigmon DF, Emmanuel B, Tuma F.Perianal abscess. In:StatPearls [Internet].
Chiaroni G.Treatment of levator ani syndrome: update and future developments.Recenti Prog Med. 2011 May;102(5):196-201.
Chiarioni G, Asteria C, Whitehead WE.Chronic proctalgia and chronic pelvic pain syndromes: new etiologic insights and treatment options.World J Gastroenterol. 2011;17(40):4447–4455. doi:10.3748/wjg.v17.i40.4447
Mott T, Latimer K, Edwards C.Hemorrhoids: diagnosis and treatment options.Am Fam Physician. 2018;97(3):172-9.
Jeyarajah S, Purkayastha S.Proctalgia fugax.CMAJ. 2013 Mar 19;185(5):417. doi:10.1503/cmaj.101613
Jeyarajah S, Purkayastha S.Proctalgia fugax.Can Med Assoc J. 2012;185(5):417. doi:10.1503/cmaj.101613
Azer SA, Sun Y.Colitis. In:StatPearls [Internet].
Jimenez M, Mandava N.Anorectal fistula. In:StatPearls [Internet].
MedlinePlus.Tenesmus.
Sabry AO, Sood T.Rectal bleeding. In;StatPearls [Internet].
Centers for Disease Control and Prevention.Chlamydia - CDC fact sheet (detailed version).
Centers for Disease Control and Prevention.Genital herpes - CDC fact sheet.
Centers for Disease Control and Prevention.Gonorrhea - CDC fact sheet (detailed version).
Weledi WP.Human immunodeficiency virus and the anorectum.Alexandria J Med.2013 Jun;49(2):163-7. doi:10.1016/j.ajme.2012.12.001
American Society of Colon and Rectal Surgeons.Anal warts and anal dysplasia expanded information.
Centers for Disease Control and Prevention.Syphilis - CDC fact sheet.
Clemens MS, Peace KM, Yi F.Rectal trauma: evidence-based practices.Clin Colon Rectal Surg.2018 Jan:31(1):17-23. doi:10.1055/s-0037-1602182
Moawad NS, Caplin A.Diagnosis, management, and long-term outcomes of rectovaginal endometriosis.Int J Womens Health.2013;5:753-63. doi:10.2147/IJWH.S37846
Centers for Disease Control and Prevention.What are the symptoms of colorectal cancer?
American Cancer Society.Signs and symptoms of anal cancer.
Cleveland Clinic.Rectal bleeding.
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