Common Causes of Rectal Pain and How to Find Relief

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 the large intestine that 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 get a proper diagnosis, however, as other, more urgent treatment may be required.

This article reviews the many causes of rectal pain, their symptoms, and how they are treated. You'll also learn about when to call a health professional.

Causes of Rectal Pain

Rectal pain may be due to a problem within your rectum or your anus.

This list of rectal pain causes is not complete, but gives you a sense of some possibilities.

Hemorrhoids

Hemorrhoids are swollen veins in the rectum. They are believed to affect over half American adults over 50.

Hemorrhoids are more common in certain people, including:

• Those who are pregnant
• Older people
• People who sit for long periods of time
• People who strain during bowel movements

Hemorrhoids often cause:

• Bright red blood after a bowel movement
• Itching around the anal area
• Discomfort during bowel movements or when sitting

Sometimes a blood clot forms inside a hemorrhoid. This can cause sudden, severe rectal or anal pain.

Anal Fissure

An anal fissure is a small tear in the skin at the opening of the anus. It is usually caused by straining and stretching of the anal canal when passing a large or hard stool.

When an anal fissure develops, the internal anal sphincter—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:

• Occurs with every bowel movement
• Often feels severe, sharp, and/or "ripping"
• May be dull or throbbing for minutes to hours after pooping

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 impaction occurs when hard, dry stool gets lodged in the rectum. This causes pain and other symptoms like:

• Stool leakage
• Bloating

Fecal impaction is caused by chronic constipation. It often happens in older people who may not feel the urge to have a bowel movement. Limited fluid intake, a low-fiber diet, and an inactive lifestyle can also contribute.

Levator Ani Syndrome

People with levator ani syndrome experience chronic rectal pain due to spasms of the pelvic 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:

• Bowel movements
• Childbirth
• Sex
• Sitting for long periods of time
• Stress

Proctalgia Fugax

Proctalgia fugax is 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.

The pain is not related to bowel movements. On average, attacks last around 15 minutes. They may be triggered by stress or anxiety.

Proctalgia fugax may occur at any age in males or females. It is rare before puberty.

Anal Fistula

An anal fistula is an abnormal connection that forms between the anal canal and the skin of your buttocks.

Most patients 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:

• Anal swelling
  
• Fever and chills
• Drainage of pus near the anal opening
• Fever and chills
• Pain
• Skin irritation around the anus

Perianal Hematoma

A perianal hematoma is a collection of blood that develops around the anus. It is caused by trauma or an injury that makes the veins in your anal area suddenly break open.

Examples of the kinds of injury that might cause this include:

• Forceful coughing
• Lifting heavy weights
• Straining during a bowel movement

Perianal hematomas are very painful and sometimes mistaken for external hemorrhoids.

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a general term for two disorders: Crohn's disease and ulcerative 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:

• Diarrhea
• Crampy abdominal pain
• Rectal soreness and fullness
• Tiredness
• Fever
• Weight loss

Ulcerative colitis nearly always involves the rectum and lower colon. Sometimes the entire colon may be affected. Symptoms may include:

• Bleeding
• Diarrhea
• Cramping abdominal pain
• Rectal soreness

Proctitis

Proctitis is an inflammation of the lining of the rectum. Symptoms may include:

• Rectal soreness
• A sensation of rectal fullness
• Bloody bowel movements
• Diarrhea
• Abdominal cramping
• Passing mucus

Some possible cause of proctitis include:

• Inflammatory bowel disease
• Sexually transmitted infections (STIs) passed through anal sex, including gonorrhea, chlamydia, syphilis, and HIV
• Trauma (e.g., if an object is inserted into the anus)
• Cancer radiation therapy
• Foodborne illnesses, including salmonella and shigella
• Antibiotics, which can kill helpful bacteria in the rectum and allow harmful bacteria to grow

Sexual Activity

Anal sex can cause pain in the rectum, usually from anal fissures.

Women with endometriosis—a disease in which uterine tissue grows outside of the uterus and often on the bowel—is another cause of rectal pain 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:

• Rectal bleeding and pain
• Pelvic fullness
• Tenesmus, the feeling that you can't fully empty your bowels
• Straining during bowel movements
• Passing mucus

The precise cause of this condition is unknown. Experts suspect it may stem from chronic constipation.

Other possible causes include:

• An uncoordinated rectal muscle problem
• Rectal prolapse, when the rectum protrudes through the anus

Cancer

Rectal cancer can cause rectal pain, as can anal cancer.

Bleeding is often the first sign of anal cancer. Other possible rectal or anal cancer symptoms include:

• Itching or a lump at the anal opening
• Anal discharge
• Fecal incontinence
• Swollen lymph nodes in the anal area or groin region
• A change in bowel habits
• Unusual fatigue
• Unintended weight loss

Common Symptoms With Rectal Pain

Depending on the cause, rectal pain can be pressure-like, gnawing, sharp, and more. The cause also factors into what other symptoms may be present.

In general, rectal pain often occurs along with:

• Bleeding
• Diarrhea or constipation
• Irritation, itchiness, or swelling of the skin around the anus
• Passage of mucus
• Tenesmus
  

When Should I See a Doctor for Rectal Pain?

Seek medical attention right away if you have:

• Rectal pain that is severe or gets worse
• Rectal pain with fever, chills, or anal discharge
• Rectal pain that is accompanied by difficulty having a bowel movement
• Significant rectal bleeding, especially if you feel dizzy or lightheaded

Schedule an appointment with or call your healthcare provider if you have:

• Rectal pain that is recurrent or constant and doesn't get better with at-home remedies
• Rectal pain with a change in bowel habits or mild bleeding
• Unintended weight loss
• Unusual fatigue
  

How Rectal Pain Is Diagnosed

If you have rectal pain, you may see a primary care physician, gastroenterologist (digestive specialists), 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:

• Blood tests: A complete blood count may be ordered to check for anemia or infection.
• Imaging tests: An abdominal X-ray or computed tomography (CT) scan may be ordered to look for masses, enlarged lymph nodes, or stool.
• Digital rectal exam: During this exam, the healthcare provider will insert a gloved, lubricated finger into your rectum. This is a simple way to check for blood, discharge, and abnormal masses.
• Anoscopy/proctoscopy: A thin, rigid tool with a light on the end is inserted a few centimeters into the anus. This helps a provider see the inside of your anus/rectum. A tissue sample, called a biopsy, may also be taken.
• Sigmoidoscopy/colonoscopy: During this procedure, a long, thin instrument with a tiny video camera attached to it is inserted through your rectum. It is guided up into your large intestine. Biopsies may also be taken.

Treatment of Rectal Pain

The treatment of rectal pain depends on the underlying cause. In many cases you can treat your rectal pain at home. Other times, medications or even procedures may be necessary.

At-Home Rectal Pain Treatment

Sitz baths, diet changes, and/or enemas may be enough to help some cases of rectal pain.

Sitz Baths

Taking sitz baths two or three times a day for 15 minutes can help soothe pain from:

• Hemorrhoids
• Anal fissures
• Perianal hematomas
• Levator ani syndrome
• Proctalgia fugax

A sitz bath is a bath filled with a few inches of warm water. It works by improving blood flow and relaxing the muscles around your anus.

A special sitz tub that fits over a toilet is available in most drugstores and online.

Fiber-Rich Diet

These conditions may also improve with a diet rich in fiber, which can help soften stool, making bowel movements less painful.

A high-fiber diet can help manage solitary rectal ulcer syndrome. It can also prevent recurrent fecal impaction.

Aim for 20 to 35 grams of fiber per day. Good sources include whole grains, beans, and berries.

Enemas

For rectal pain associated with constipation or difficulty having a bowel movement, you can purchase an over-the-counter enema kit.

This consists of small bag or bottle that is filled with a water and salt mixture or mineral oil. It is attached to a nozzle that you insert into the anus.

When you squeeze the container, the liquid goes up into the rectum and releases the feces.

Medications

Certain causes of rectal pain can be managed well with over-the-counter or prescription medications.

Pain Relievers

Oral and topical pain relievers can help reduce rectal pain. These include:

• Nonsteroidal anti-inflammatory medications like Advil (ibuprofen)
• Tricyclic antidepressants like Elavil (amitriptyline)
• Muscle relaxants like Flexeril (cyclobenzaprine)
• Topical numbing agents like lidocaine lotion
• Hemorrhoid creams containing ingredients like hydrocortisone or witch hazel

Stool Softeners or Laxatives

Stool softeners such as Colace (docusate) help soften hard stools and alleviate constipation. They are often used to manage:

• Hemorrhoids
• Anal fissures
• Perianal hematomas

Laxatives may also help constipation, especially in patients with:

• Fecal impaction
• Anal fissures
• Solitary rectal ulcer syndrome

Note that stool softeners and stimulant laxatives are not usually recommended for long-term use.

Antibiotics/Antivirals

If your rectal pain is related to bacteria, you may receive antibiotics. Gonorrhea and chlamydia are examples of bacterial causes of rectal pain.

If you have a virus like herpes or HIV, you may receive antivirals.

Steroids and Immunosuppressants

Inflammatory bowel disease may be treated with steroids and/or immunosuppressants. These medicines can help slow the progression of the disease.

Complementary Therapies

Complementary therapies can be used if you have chronic anal pain caused by:

• Levator ani syndrome
• Proctalgia fugax
• Solitary rectal ulcer syndrome
• Anal fissures

Such therapies may include:

• Biofeedback: In this therapy, monitoring equipment is used to measure bodily functions, such as muscle tension. A practitioner teaches you how to control these functions based on the results.
• Sacral nerve stimulation: Electrical impulses are transmitted through a device to affect nerves that control the rectum.
• Physical therapy for conditions that affect the pelvic floor muscles
• Anal self-massage for anal fissures

Procedures and Surgeries

Your healthcare provider may use an enema in their office in cases of fecal impaction (or if you are uncomfortable doing one yourself at home). In severe cases, hard stool may need to be manually removed by a practitioner.

Other medical therapies or office-based procedures may be used for various conditions.

For example, Botox injections may help relax the anal sphincter and levator ani muscles.

Rubber-band ligation can be used for some hemorrhoids. In this procedure, a rubber band cuts off the blood supply to a hemorrhoid, causing it to shrink.

Surgery is often needed for these conditions:

• Anal fistula
• Anal/rectal cancer
• Severe cases of proctitis caused by IBD or hemorrhoids
• Solitary rectal ulcer syndrome with rectal prolapse

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 treatments may be all that are needed, but be sure to follow the advice of your healthcare practitioner.