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.

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 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 caused by either trauma or infection. The five most common reasons for this in men include:

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 and laxatives
• drinking lots of water
• soaking in warm bath water to relieve pain and speed healing

• over the counter pain relievers and topical medications
• surgery may be needed in severe cases

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. The abscess results when the structure bursts open.

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

Hemorrhoids

A hemorrhoid is an enlarged, blood engorged vein or collection of veins in and around the rectum. It causes rectal itching and pain, localized bleeding, and the formation of a lump in and around the anus. 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 include:

• soaking in warm water to reduce pain

• ice packs to reduce swelling
• medicated hemorrhoidal creams and ointments 
• stool softeners to avoid the passing of hard stools
• 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
• surgery to remove the hemorrhoid

Colitis (Ulcerative Colitis or Crohn's Disease)

Colitis is an inflammation of the intestinal tract. Ulcerative colitis is limited to the large intestine while Crohn's disease can involve the entire digestive system.

Both result in gastrointestinal inflammation and rectal pain. While the cause of ulcerative colitis is not entirely understood, many believe that it's an autoimmune response in the large intestine, possibly associated with food, bacteria, or even genetics.

Symptoms include rectal pain, bowel urgency (feeling that you need to defecate even when you don't), nausea, bloody diarrhea, fatigue, weight loss, and mucus and/or pus in stools. The treatment of ulcerative colitis and Crohn's disease is aimed at minimizing the inflammation and can include: 

• steroids to slow the inflammation process
• anti-inflammatory medications (on immune suppressor drugs which have a similar effect)
• antidiarrheals to stop diarrhea
• iron supplements to prevent anemia if there is persistent bleeding
• enema to stimulate bowel movement
• surgery to treat intestinal tract damage in severe cases

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 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.

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.