HIV/AIDS Related Conditions Causes of Rectal Pain in Men How an Itch or Pain Can Signal Something More Serious By Mark Cichocki, RN twitter linkedin Mark Cichocki, RN, is an HIV/AIDS nurse educator at the University of Michigan Health System for more than 20 years. Learn about our editorial process Mark Cichocki, RN Medically reviewed by Medically reviewed by Chris Vincent, MD on November 05, 2019 linkedin Chris Vincent, MD, is board-certified in family medicine. He is a clinical professor at the University of Washington School of Medicine and practices at Harborview Medical Center in Seattle. Learn about our Medical Review Board Chris Vincent, MD on November 05, 2019 Print Table of Contents View All Anatomy Anal Fissure Rectal Abscess Hemorrhoids Colitis Anal and Rectal Lesions Rectal pain a common health condition people try their best to ignore and hope will go away. They will often endure an itch, a pain, or a sore for months and even years at a time out of pure embarrassment and avoid treatment that could otherwise make things better. It's the kind of hesitancy that puts you in harm's way. Because for every pain or itch that ends up being be nothing more than hemorrhoid, there are other times when the outcomes are far worse. Possible Causes of Rectal Pain Morsa Images / Getty Images Anatomy of the Rectum and Anus While the rectum and anus are terms we often use interchangeably, they actually refer to distinct parts of the lower gastrointestinal tract with unique physiological functions. The rectum is an 8-inch long chamber that connects the colon to the anus. When a stool enters the rectum, nerves embedded deep in rectal tissues send a message to the brain that triggers a muscular response that pushes the stool through the anus and out of the body. The anus, by contrast, is the opening of the rectum centered around two sphincters that control the exit of feces during defecation. Broadly speaking, any pain occurring in the rectum or anus is often caused by either trauma or inflammation. What Can Affect the Perianal Area Anal Fissure An anal fissure is simply defined as a long tear of the tissue in or around the anus or rectum. Such tears can sometimes be difficult to treat as bowel movements can cause a healing fissure to open again and again. Causes can include a hard stool due to constipation, straining during a bowel movement, anal sex, or inserting a foreign object into the rectum. Bleeding is common. Treatment typically involves: Stool softeners (e.g., psyllium fiber)Drinking lots of waterSoaking in warm bath water to relieve pain and speed healing (a sitz bath)Over-the-counter pain relievers (e.g., acetaminophen or ibuprofen) and topical medications (e.g., topical lidocaine)Prescription topical medications (e.g., nitroglycerin or diltiazem)Surgery or botulinum toxin injection in severe cases Overview and Treatment of Anal Fissures Rectal Abscess A rectal abscess is a pocket of pus caused by a localized infection within the rectal tissue. Abscesses are similar to a pimple insofar as the glands of the anus and rectum often get clogged. When this happens, inflammation and an accumulation of pus can occur. As the abscess enlarges, it may spontaneously burst (a ruptured abscess). Symptoms can include pain and fever due to infection, painful bowel movement, swollen glands, and night sweats. An abscess can be treated in the following manner: Antibiotics to treat the bacterial infectionNeedle aspiration of remove pus and other fluidSurgical drainage of pus and fluid in more serious cases How to Treat an Anal or Rectal Abscess Hemorrhoids A hemorrhoid is an enlarged, blood-engorged vein or collection of veins in and around the rectum. Hemorrhoids can be internal or external. Internal hemorrhoids are usually not visible, as they are about 2 inches inside the anus. Internal hemorrhoids may itch or bleed, but usually don’t cause pain. External hemorrhoids are visible on the skin of the anus and may vary in size from a few millimeters to a centimeter or larger. External hemorrhoids can also itch or bleed, and may be very painful if a blood clot forms inside (this is called a “thrombosed hemorrhoid”). Thrombosed external hemorrhoids are typically the most painful during the first two or three days, after which the pain gradually subsides and disappears in a week to 10 days. Causes can be many, including bowel straining, pregnancy, anal sex, anal fissure, infection, violent coughing or vomiting, and cirrhosis of the liver. Treatment can either be invasive or non-invasive depending on the severity and location (internal or external) and may include the following. Mainly external hemorrhoidal treatment options include: Soaking in warm water (a sitz bath) to reduce painIce packs to reduce swellingMedicated hemorrhoidal creams and ointments Both internal and external hemorrhoids, if large and causing significant bleeding, pain, or discomfort may be treated with: Stool softeners (e.g., psyllium fiber) to avoid the passing of hard stoolsSurgery to remove the hemorrhoid If internal hemorrhoids are bleeding, treatment may include: Ligation, a technique in which a rubber band or suture is tied around a hemorrhoid to cut off the blood supply, causing it to dry up and fall off within a weekSclerotherapy, in which chemicals are injected around the hemorrhoid to cut off the blood supply, causing shrinkage For thrombosed external hemorrhoids, if painful and early in the course of the disease, a small incision is made over the hemorrhoid to extract the clot. Hemorrhoids Functional Anorectal Pain These are ill-defined conditions that cause prolonged, dull, aching rectal pain (in the case of levator ani syndrome), or short bursts of sharp severe rectal pain (in the case of proctalgia fugax). Neither condition is serious, but the pain may be very disabling. The cause is not known, but abnormal muscle spasm in the pelvic region is thought to be associated with the pain. Muscle relaxants, massage of the rectal muscles, and warm baths may help alleviate the pain. Anal and Rectal Lesions Lesions or growths in and around the anus can cause rectal pain. Two of the most common anal lesions are genital warts and herpes simplex. Genital warts are smooth, flesh-colored round lesions that are caused by human papillomavirus (HPV). Genital herpes is caused by the herpes simplex virus (HSV) and can result in painful, fluid-filled blisters around the anus during periods of an outbreak. Anal warts are typically painless but can interfere with bowel movements. Anal herpes, by contrast, can be extremely painful and are often accompanied by flu-like symptoms, including swollen glands and fever. Treatment of genital warts can involve topical creams or surgery to remove the warts. Genital herpes, on the other hand, responds well to oral antiviral drugs such as acyclovir or valacyclovir as well as topical acyclovir ointments. HIV and Human Papillomavirus (HPV) A Word From Verywell The important thing to remember is that rectal pain may seem silly, but it can often be a sign of something far more serious (including anal cancer which disproportionately affects gay and bisexual men with HIV). If you have anal or rectal pain, don't let embarrassment 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. Do You Know What Causes Anal Pain? Was this page helpful? Thanks for your feedback! Get information on prevention, symptoms, and treatment to better ensure a long and healthy life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American Society of Colon and Rectal Surgeons. Anal fissure. MedlinePlus. Anorectal abscess. Updated June 11, 2018. Mott T, Latimer K, Edwards C. Hemorrhoids: Diagnosis and treatment options. Am Fam Physician. 2018;97(3):172-179. 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 Additional Reading 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 Mar;61(3):284-292. doi:10.1097/DCR.0000000000001030 Parés D, Abcarian H. Management of Common Benign Anorectal Disease: What All Physicians Need to Know. Am J Med. 2018 Jul;131(7):745-751. doi:10.1016/j.amjmed.2018.01.050 Rao SS, et al. Functional Anorectal Disorders. Gastroenterology. 2016 Mar 25. pii: S0016-5085(16)00175-X. doi:10.1053/j.gastro.2016.02.009 Stewart DB Sr, Gaertner W, Glasgow S, Migaly J, Feingold D, Steele SR. Clinical Practice Guideline for the Management of Anal Fissures. Dis Colon Rectum. 2017 Jan;60(1):7-14. doi:10.1097/DCR.0000000000000735 Pfenniger, J. and Zainea, G. "Common Anorectal Conditions: Part I. Symptoms and Complaints." American Family Physician. 2011;63(12):2391-2398 .