Common Causes of Rectal Pain and How They’re Treated

Rectal pain is common. Some cases are due to a chronic and/or serious medical condition, but most are not. Still, the pain can impact your quality of life.

This article reviews the many causes of rectal pain, their treatment, and self-care strategies. You'll also learn when you should talk to a doctor about rectal pain.

Rectal Pain and Other Symptoms

Rectal pain may present differently depending on the cause. It may burn, sting, ache, throb, or stab.

Rectal pain often appears with other symptoms, such as:

• Bleeding
• Irritation, itchiness, or swelling of the skin around the anus
• Tenesmus, the feeling that you can't fully empty your bowels
• Diarrhea or constipation
• Passage of mucus

When to Seek Medical Attention

Seek medical attention right away if you have:

• Rectal pain that is severe or gets worse
• Rectal pain with fever, chills, or anal discharge
• Significant rectal bleeding, especially if you feel dizzy or lightheaded

Schedule an appointment or call your doctor if you have:

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

Causes of Rectal Pain

Your rectum begins at the end of your large intestine, also called your colon. It ends at your anus.

When stool reaches your rectum, you will feel an urge to have a bowel movement. Stool moves through your rectum and out of your body through your anus.

"Rectal pain" may be due to a problem within your rectum or your anus. This is because the two are located near each other and work together.

Some conditions that cause rectal pain are more concerning than others. Fortunately, many can be managed at home.

This list is not complete, but here are some conditions that may cause rectal or anal pain.

Hemorrhoids

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

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 are a common cause of bright red blood after a bowel movement. Patients also report itching around the anal area. People with hemorrhoids may also have discomfort during bowel movements or when sitting.

A hemorrhoid becomes thrombosed when a blood clot forms inside it. 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 may spasm. The anal sphincter is the muscle that controls the anal opening. When it spasms, it may become even harder to pass stools.

The pain of an anal fissure occurs with every bowel movement. It often feels severe, sharp, and/or "ripping." After a bowel movement, the pain may be dull or throbbing. This pain may last for several minutes to hours.

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 and 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 have episodes of aching or pressure-like pain high up in the rectum. These 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:

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

Proctalgia Fugax

Proctalgia fugax causes recurrent, sudden attacks of pain in the rectum. The pain may feel:

• Cramping
• Spasming
• Gnawing

The pain is not related to bowel movements. On average, the 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 that was drained. This is a a collection of pus that forms in the anal canal.

Symptoms of an anal fistula may include:

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

Perianal Hematoma

A perianal hematoma is a collection of blood that develops around the anus. It is sometimes mistaken for an external hemorrhoid.

Perianal hematomas are very painful. They are 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:

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

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a general term for two disorders:

• Crohn's disease
• 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

Inflammatory bowel disease is a common cause of proctitis. Sexually transmitted diseases passed through anal sex may also cause proctitis. These include:

• Gonorrhea
• Chlamydia
• Syphilis
• Herpes
• HIV

Trauma can also cause proctitis. This might happen, for example, if an object is inserted into the anus. Other causes may include:

• Cancer radiation therapy
• Foodborne illnesses, including salmonella and shigella

Antibiotics, too, may cause proctitis by killing helpful bacteria in the rectum. This could allow harmful bacteria to grow.

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
• 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. This is not common.

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

How Rectal Pain Is Diagnosed

If you have rectal pain, you may see a primary care physician, gastroenterologist, or colorectal surgeon.

Your doctor 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, or 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 doctor 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.

Self-Care Strategies

In many cases you can treat your rectal pain at home.

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.

These conditions may also improve with changes in diet. A diet rich in fiber 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.

Medications

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

Pain Relievers

Different types of medications may help rectal pain, such as:

• 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, you may receive antivirals. Herpes and HIV are examples of viruses that cause proctitis.

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

You may receive a complementary therapies if you have chronic anal pain caused by:

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

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 and massage and botox injections may also help.

Procedures/Surgery

The treatment of fecal impaction may require an enema. This could be done at home or in a healthcare provider's office. In severe cases, hard stool may need to be manually removed.

Other medical therapies or office-based procedures may be used for various conditions. Rubber-band ligation can be used for some hemorrhoids, for example. In this procedure, a rubber band cuts off the blood supply to a hemorrhoid. This causes it to shrink.

Severe cases of proctitis caused by IBD or hemorrhoids may require surgery.

Surgery is often needed for these conditions:

• Anal fistula
• Anal/rectal cancer
• Solitary rectal ulcer syndrome with rectal prolapse

Summary

There are many potential causes of rectal pain including hemorrhoids, anal fissure, 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's needed.

Still, if you are unsure why you are experiencing rectal pain, it is severe or not improving, or you have other worrisome symptoms like bleeding or fever, see your doctor.

A Word From Verywell

You may not want to talk about rectal pain, even with a doctor. It may help to remember that the issue is common. Your doctor's sole concern is making sure you're well.

Once a diagnosis is reached, your doctor can help you find the right treatment plan. Hopefully, the plan will address the cause of your rectal pain once and for all.

In the rare case that your pain is due to cancer or a chronic condition like IBD, early treatment is key. The sooner you are evaluated, the better.