Causes of Rectal Pain in Men

Rectal pain a common health condition we try our best to ignore and hope will go away. We 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 put in harm's way. Because for every pain or itch that ends up being be nothing more than a hemorrhoid, there are other times when the outcomes are far worse.

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 eight-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 which 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.

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 water
• soaking 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 may be needed in severe cases

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 infection
• needle aspiration of remove pus and other fluid
• surgical drainage of pus and fluid in more serious cases

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 pain
• Ice packs to reduce swelling
• Medicated hemorrhoidal creams and ointments 

Both internal and external hemorrhoids, if large and causing significant bleeding, pain, or discomfort:

• Stool softeners (e.g., psyllium fiber) to avoid the passing of hard stools
• Surgery 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 week
• Sclerotherapy, 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 over the hemorrhoid to extract the clot

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.

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.

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.

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.