Table of ContentsView AllTable of ContentsCausesSymptomsWhen to Seek Medical CareDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Causes
Symptoms
When to Seek Medical Care
Diagnosis
Treatment
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 thelarge intestinethat 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.
Verywell / Nusha Ashjaee
Hemorrhoids
Hemorrhoidsare 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:
Hemorrhoids often cause:
Sometimes a blood clot forms inside a hemorrhoid. This can cause sudden, severe rectal or anal pain.
Anal Fissure
When an anal fissure develops, the internalanalsphincter—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:
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 impactionoccurs when hard, dry stool gets lodged in the rectum. This causes pain and other symptoms like:
Levator Ani Syndrome
People withlevator anisyndromeexperience chronic rectal pain due to spasms of thepelvic 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:
Proctalgia Fugax
Proctalgia fugaxis 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.
Proctalgia fugax may occur at any age in males or females. It is rare before puberty.
Anal Fistula
An analfistulais 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:
Perianal Hematoma
Examples of the kinds of injury that might cause this include:
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 diseaseandulcerative 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:
Ulcerative colitis nearly always involves the rectum and lower colon. Sometimes the entire colon may be affected. Symptoms may include:
Proctitis
Proctitisis an inflammation of the lining of the rectum. Symptoms may include:
Some possible causes of proctitis include:
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:
The precise cause of this condition is unknown. Experts suspect it may stem from chronic constipation.
Other possible causes include:
Cancer
Rectal cancercan cause rectal pain, as can anal cancer. These cancers can also cause a feeling of fullness around the anus.
Bleeding is often the firstsign of anal cancer. Other possible rectal or anal cancer symptoms include:
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:
When Should I Seek Medical Care for Rectal Pain?
Seek medical attention right away if you have:
Schedule an appointment with or call your healthcare provider if you have:
How Rectal Pain Is Diagnosed
If you have rectal pain, you may see a primary care physician,gastroenterologist(a digestive specialist), or aproctologist(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:
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.
Pain Relievers
Oral and topical pain relievers can help reduce rectal pain. These include:
Stool Softeners or Laxatives
Stool softeners such asColace (docusate)help soften hard stools and alleviate constipation.They are often used to manage:
Laxativesmay also help constipation, especially in patients with:
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.
Complementary Therapies
Such therapies may include:
Procedures and Surgeries
Other medical therapies or office-based procedures may be used for various conditions.
For example,Botox injectionsmay help relax the anal sphincter and levator ani muscles.
Rubber-band ligationcan be used for some hemorrhoids. In this procedure, a rubber band cuts off the blood supply to a hemorrhoid, causing it to shrink.
Surgeryis often needed for these conditions:
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.
27 SourcesVerywell 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.National Institute of Diabetes and Digestive and Kidney Diseases.Definition & facts of hemorrhoids.Lohsiriwat V.Treatment of hemorrhoids: a coloproctologist’s view.World J Gastroenterol. 2015;21(31):9245-52. doi:10.3748/wjg.v21.i31.9245Gardner IH, Siddharthan RV, Tsikitis VL.Benign anorectal disease: hemorrhoids, fissures, and fistulas.Ann Gastroenterol. 2020;33(1):9–18. doi:10.20524/aog.2019.0438Rey E, Barcelo M, Jiménez Cebrián MJ, Alvarez-Sanchez A, Diaz-Rubio M, Rocha AL.A nation-wide study of prevalence and risk factors for fecal impaction in nursing homes.PLoS One. 2014;9(8):e105281. doi:10.1371/journal.pone.0105281Bharucha AE, Lee TH.Anorectal and pelvic pain.Mayo Clin Proc. 2016;91(10):1471–1486. doi:10.1016/j.mayocp.2016.08.011Son CG.Case report for a refractory levator ani syndrome treated with traditional Korean medication.JKM. 2017;38(2):73-77. doi:10.13048/jkm.17019American Society of Colon and Rectal Surgeons.Abscess and fistula expanded information.National Institute of Diabetes and Digestive and Kidney Diseases.Colonic & anorectal fistulas.Hardy A, Cohen C.The acute management of haemorrhoids.Ann R Coll Surg Engl. 2014;96(7):508-511. doi:10.1308/003588414X13946184900967Feuerstein JD, Cheifetz AS.Crohn disease: epidemiology, diagnosis, and management.Mayo Clin Proc. 2017;92(7):1088-1103. doi:10.1016/j.mayocp.2017.04.010Lichtenstein GR, Hanauer SB, Sandborn WJ.Emerging treatment options in mild to moderate ulcerative colitis.Gastroenterol Hepatol (N Y). 2015;11(3 Suppl 1):1-16MedlinePlus.Proctitis.Centers for Disease Control and Prevention.Proctitis, proctocolitis, and enteritis.Navarro-Sánchez A, Luri-Prieto P, Compañ-Rosique A, et al.Sexuality, quality of life, anxiety, depression, and anger in patients with anal fissure. A case-control study.J Clin Med. 2021;10(19):4401. doi:10.3390/jcm10194401Endometriosis Foundation of America.Endometriosis symptoms: painful sex (dyspareunia).Forootan M, Darvishi M.Solitary rectal ulcer syndrome: a systematic review and meta-analysis study protocol.Medicine (Baltimore). 2018;97:e10565. doi:10.1097/MD.0000000000010565American Cancer Society.Signs and symptoms of anal cancer.NHS.Anal pain.UCSF Health.Medical tests - rectal bleeding.UpToDate.Patient education: hemorrhoids (Beyond the Basics).Docherty MJ, Jones RCW, Wallace MS.Managing pain in inflammatory bowel disease.Gastroenterol Hepatol (N Y). 2011;7(9):592-601.Dykstra MA, Buie WD.Anal fissures.CMAJ. 2019;191(26):E737. doi:10.1503/cmaj.190074National Institute of Diabetes and Digestive and Kidney Diseases.Treatment for constipation.Centers for Disease Control and Prevention.Inflammatory bowel disease (IBD) basics.Gaj F, Biviano I, Candeloro L, Andreuccetti J.Anal self-massage in the treatment of acute anal fissure: a randomized prospective study.Ann Gastroenterol. 2017;30(4):438-441. doi:10.20524/aog.2017.0154Ooijevaar RE, Felt-Bersma RJF, Han-Geurts IJ, van Reijn D, Vollebregt PF, Molenaar CBH.Botox treatment in patients with chronic functional anorectal pain: experiences of a tertiary referral proctology clinic.Tech Coloproctol. 2019;23(3):239-244. doi:10.1007/s10151-019-01945-8Davis BR, Lee-Kong SA, Migaly J; Feingold DL, Steele SR.The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of hemorrhoids.Dis Colon Rectum. 2018;61(3):284–292. doi:10.1097/DCR.0000000000001030
27 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.National Institute of Diabetes and Digestive and Kidney Diseases.Definition & facts of hemorrhoids.Lohsiriwat V.Treatment of hemorrhoids: a coloproctologist’s view.World J Gastroenterol. 2015;21(31):9245-52. doi:10.3748/wjg.v21.i31.9245Gardner IH, Siddharthan RV, Tsikitis VL.Benign anorectal disease: hemorrhoids, fissures, and fistulas.Ann Gastroenterol. 2020;33(1):9–18. doi:10.20524/aog.2019.0438Rey E, Barcelo M, Jiménez Cebrián MJ, Alvarez-Sanchez A, Diaz-Rubio M, Rocha AL.A nation-wide study of prevalence and risk factors for fecal impaction in nursing homes.PLoS One. 2014;9(8):e105281. doi:10.1371/journal.pone.0105281Bharucha AE, Lee TH.Anorectal and pelvic pain.Mayo Clin Proc. 2016;91(10):1471–1486. doi:10.1016/j.mayocp.2016.08.011Son CG.Case report for a refractory levator ani syndrome treated with traditional Korean medication.JKM. 2017;38(2):73-77. doi:10.13048/jkm.17019American Society of Colon and Rectal Surgeons.Abscess and fistula expanded information.National Institute of Diabetes and Digestive and Kidney Diseases.Colonic & anorectal fistulas.Hardy A, Cohen C.The acute management of haemorrhoids.Ann R Coll Surg Engl. 2014;96(7):508-511. doi:10.1308/003588414X13946184900967Feuerstein JD, Cheifetz AS.Crohn disease: epidemiology, diagnosis, and management.Mayo Clin Proc. 2017;92(7):1088-1103. doi:10.1016/j.mayocp.2017.04.010Lichtenstein GR, Hanauer SB, Sandborn WJ.Emerging treatment options in mild to moderate ulcerative colitis.Gastroenterol Hepatol (N Y). 2015;11(3 Suppl 1):1-16MedlinePlus.Proctitis.Centers for Disease Control and Prevention.Proctitis, proctocolitis, and enteritis.Navarro-Sánchez A, Luri-Prieto P, Compañ-Rosique A, et al.Sexuality, quality of life, anxiety, depression, and anger in patients with anal fissure. A case-control study.J Clin Med. 2021;10(19):4401. doi:10.3390/jcm10194401Endometriosis Foundation of America.Endometriosis symptoms: painful sex (dyspareunia).Forootan M, Darvishi M.Solitary rectal ulcer syndrome: a systematic review and meta-analysis study protocol.Medicine (Baltimore). 2018;97:e10565. doi:10.1097/MD.0000000000010565American Cancer Society.Signs and symptoms of anal cancer.NHS.Anal pain.UCSF Health.Medical tests - rectal bleeding.UpToDate.Patient education: hemorrhoids (Beyond the Basics).Docherty MJ, Jones RCW, Wallace MS.Managing pain in inflammatory bowel disease.Gastroenterol Hepatol (N Y). 2011;7(9):592-601.Dykstra MA, Buie WD.Anal fissures.CMAJ. 2019;191(26):E737. doi:10.1503/cmaj.190074National Institute of Diabetes and Digestive and Kidney Diseases.Treatment for constipation.Centers for Disease Control and Prevention.Inflammatory bowel disease (IBD) basics.Gaj F, Biviano I, Candeloro L, Andreuccetti J.Anal self-massage in the treatment of acute anal fissure: a randomized prospective study.Ann Gastroenterol. 2017;30(4):438-441. doi:10.20524/aog.2017.0154Ooijevaar RE, Felt-Bersma RJF, Han-Geurts IJ, van Reijn D, Vollebregt PF, Molenaar CBH.Botox treatment in patients with chronic functional anorectal pain: experiences of a tertiary referral proctology clinic.Tech Coloproctol. 2019;23(3):239-244. doi:10.1007/s10151-019-01945-8Davis BR, Lee-Kong SA, Migaly J; Feingold DL, Steele SR.The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of hemorrhoids.Dis Colon Rectum. 2018;61(3):284–292. doi:10.1097/DCR.0000000000001030
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.
National Institute of Diabetes and Digestive and Kidney Diseases.Definition & facts of hemorrhoids.Lohsiriwat V.Treatment of hemorrhoids: a coloproctologist’s view.World J Gastroenterol. 2015;21(31):9245-52. doi:10.3748/wjg.v21.i31.9245Gardner IH, Siddharthan RV, Tsikitis VL.Benign anorectal disease: hemorrhoids, fissures, and fistulas.Ann Gastroenterol. 2020;33(1):9–18. doi:10.20524/aog.2019.0438Rey E, Barcelo M, Jiménez Cebrián MJ, Alvarez-Sanchez A, Diaz-Rubio M, Rocha AL.A nation-wide study of prevalence and risk factors for fecal impaction in nursing homes.PLoS One. 2014;9(8):e105281. doi:10.1371/journal.pone.0105281Bharucha AE, Lee TH.Anorectal and pelvic pain.Mayo Clin Proc. 2016;91(10):1471–1486. doi:10.1016/j.mayocp.2016.08.011Son CG.Case report for a refractory levator ani syndrome treated with traditional Korean medication.JKM. 2017;38(2):73-77. doi:10.13048/jkm.17019American Society of Colon and Rectal Surgeons.Abscess and fistula expanded information.National Institute of Diabetes and Digestive and Kidney Diseases.Colonic & anorectal fistulas.Hardy A, Cohen C.The acute management of haemorrhoids.Ann R Coll Surg Engl. 2014;96(7):508-511. doi:10.1308/003588414X13946184900967Feuerstein JD, Cheifetz AS.Crohn disease: epidemiology, diagnosis, and management.Mayo Clin Proc. 2017;92(7):1088-1103. doi:10.1016/j.mayocp.2017.04.010Lichtenstein GR, Hanauer SB, Sandborn WJ.Emerging treatment options in mild to moderate ulcerative colitis.Gastroenterol Hepatol (N Y). 2015;11(3 Suppl 1):1-16MedlinePlus.Proctitis.Centers for Disease Control and Prevention.Proctitis, proctocolitis, and enteritis.Navarro-Sánchez A, Luri-Prieto P, Compañ-Rosique A, et al.Sexuality, quality of life, anxiety, depression, and anger in patients with anal fissure. A case-control study.J Clin Med. 2021;10(19):4401. doi:10.3390/jcm10194401Endometriosis Foundation of America.Endometriosis symptoms: painful sex (dyspareunia).Forootan M, Darvishi M.Solitary rectal ulcer syndrome: a systematic review and meta-analysis study protocol.Medicine (Baltimore). 2018;97:e10565. doi:10.1097/MD.0000000000010565American Cancer Society.Signs and symptoms of anal cancer.NHS.Anal pain.UCSF Health.Medical tests - rectal bleeding.UpToDate.Patient education: hemorrhoids (Beyond the Basics).Docherty MJ, Jones RCW, Wallace MS.Managing pain in inflammatory bowel disease.Gastroenterol Hepatol (N Y). 2011;7(9):592-601.Dykstra MA, Buie WD.Anal fissures.CMAJ. 2019;191(26):E737. doi:10.1503/cmaj.190074National Institute of Diabetes and Digestive and Kidney Diseases.Treatment for constipation.Centers for Disease Control and Prevention.Inflammatory bowel disease (IBD) basics.Gaj F, Biviano I, Candeloro L, Andreuccetti J.Anal self-massage in the treatment of acute anal fissure: a randomized prospective study.Ann Gastroenterol. 2017;30(4):438-441. doi:10.20524/aog.2017.0154Ooijevaar RE, Felt-Bersma RJF, Han-Geurts IJ, van Reijn D, Vollebregt PF, Molenaar CBH.Botox treatment in patients with chronic functional anorectal pain: experiences of a tertiary referral proctology clinic.Tech Coloproctol. 2019;23(3):239-244. doi:10.1007/s10151-019-01945-8Davis BR, Lee-Kong SA, Migaly J; Feingold DL, Steele SR.The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of hemorrhoids.Dis Colon Rectum. 2018;61(3):284–292. doi:10.1097/DCR.0000000000001030
National Institute of Diabetes and Digestive and Kidney Diseases.Definition & facts of hemorrhoids.
Lohsiriwat V.Treatment of hemorrhoids: a coloproctologist’s view.World J Gastroenterol. 2015;21(31):9245-52. doi:10.3748/wjg.v21.i31.9245
Gardner IH, Siddharthan RV, Tsikitis VL.Benign anorectal disease: hemorrhoids, fissures, and fistulas.Ann Gastroenterol. 2020;33(1):9–18. doi:10.20524/aog.2019.0438
Rey E, Barcelo M, Jiménez Cebrián MJ, Alvarez-Sanchez A, Diaz-Rubio M, Rocha AL.A nation-wide study of prevalence and risk factors for fecal impaction in nursing homes.PLoS One. 2014;9(8):e105281. doi:10.1371/journal.pone.0105281
Bharucha AE, Lee TH.Anorectal and pelvic pain.Mayo Clin Proc. 2016;91(10):1471–1486. doi:10.1016/j.mayocp.2016.08.011
Son CG.Case report for a refractory levator ani syndrome treated with traditional Korean medication.JKM. 2017;38(2):73-77. doi:10.13048/jkm.17019
American Society of Colon and Rectal Surgeons.Abscess and fistula expanded information.
National Institute of Diabetes and Digestive and Kidney Diseases.Colonic & anorectal fistulas.
Hardy A, Cohen C.The acute management of haemorrhoids.Ann R Coll Surg Engl. 2014;96(7):508-511. doi:10.1308/003588414X13946184900967
Feuerstein JD, Cheifetz AS.Crohn disease: epidemiology, diagnosis, and management.Mayo Clin Proc. 2017;92(7):1088-1103. doi:10.1016/j.mayocp.2017.04.010
Lichtenstein GR, Hanauer SB, Sandborn WJ.Emerging treatment options in mild to moderate ulcerative colitis.Gastroenterol Hepatol (N Y). 2015;11(3 Suppl 1):1-16
MedlinePlus.Proctitis.
Centers for Disease Control and Prevention.Proctitis, proctocolitis, and enteritis.
Navarro-Sánchez A, Luri-Prieto P, Compañ-Rosique A, et al.Sexuality, quality of life, anxiety, depression, and anger in patients with anal fissure. A case-control study.J Clin Med. 2021;10(19):4401. doi:10.3390/jcm10194401
Endometriosis Foundation of America.Endometriosis symptoms: painful sex (dyspareunia).
Forootan M, Darvishi M.Solitary rectal ulcer syndrome: a systematic review and meta-analysis study protocol.Medicine (Baltimore). 2018;97:e10565. doi:10.1097/MD.0000000000010565
American Cancer Society.Signs and symptoms of anal cancer.
NHS.Anal pain.
UCSF Health.Medical tests - rectal bleeding.
UpToDate.Patient education: hemorrhoids (Beyond the Basics).
Docherty MJ, Jones RCW, Wallace MS.Managing pain in inflammatory bowel disease.Gastroenterol Hepatol (N Y). 2011;7(9):592-601.
Dykstra MA, Buie WD.Anal fissures.CMAJ. 2019;191(26):E737. doi:10.1503/cmaj.190074
National Institute of Diabetes and Digestive and Kidney Diseases.Treatment for constipation.
Centers for Disease Control and Prevention.Inflammatory bowel disease (IBD) basics.
Gaj F, Biviano I, Candeloro L, Andreuccetti J.Anal self-massage in the treatment of acute anal fissure: a randomized prospective study.Ann Gastroenterol. 2017;30(4):438-441. doi:10.20524/aog.2017.0154
Ooijevaar RE, Felt-Bersma RJF, Han-Geurts IJ, van Reijn D, Vollebregt PF, Molenaar CBH.Botox treatment in patients with chronic functional anorectal pain: experiences of a tertiary referral proctology clinic.Tech Coloproctol. 2019;23(3):239-244. doi:10.1007/s10151-019-01945-8
Davis BR, Lee-Kong SA, Migaly J; Feingold DL, Steele SR.The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of hemorrhoids.Dis Colon Rectum. 2018;61(3):284–292. doi:10.1097/DCR.0000000000001030
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