Common Causes of Rectal Pain and How They’re Treated

Rectal pain is a common experience. While some cases are due to a chronic and/or serious medical condition, most are not. Nevertheless, the pain can be intense and impact your quality of life.

This article reviews the many causes of rectal pain and the various treatments used to manage them, including self-care strategies, medications, and more. You'll also learn when you need to seek medical attention.

Symptoms

Depending on the cause, rectal pain may be described as burning, stinging, aching, throbbing, or stabbing.

Rectal pain is also often accompanied by other symptoms, such as:

• Bleeding
• Irritation, itchiness, or swelling of the skin around the anus
• Feeling like you cannot fully empty your bowels of stool (tenesmus)
• Diarrhea or constipation
• Passage of mucus

When to Seek Medical Attention

It's important to seek medical attention right away if you are experiencing:

• Severe or worsening rectal pain
• Rectal pain along with fever, chills, or anal discharge
• Significant rectal bleeding, especially if you feel dizzy or lightheaded

Schedule a healthcare provider's appointment or call your healthcare provider if you are experiencing:

• Rectal pain that is constant and not improving with at-home remedies
• Rectal pain along with a change in bowel habits or mild bleeding
• Unintended weight loss or unusual fatigue

Causes

Your rectum begins at the end of your large intestines (colon) and ends at your anus. When stool reaches your rectum from your colon, you will feel an urge to have a bowel movement. Stool moves through your rectum and out of your body through your anus.

Since the rectum is located close to the anus, and they work together, "rectal pain" may be due to a problem within your rectum or your anus.

While not a complete list, here are some conditions that cause rectal/anal pain. Some are more concerning than others, but luckily, many can be managed at home.

Hemorrhoids

Hemorrhoids are swollen or enlarged veins in the rectum. They are estimated to affect over half of all American adults. They are more common in pregnancy, older people, those who sit for prolonged periods of time, and those who strain during bowel movements.

Hemorrhoids are a common cause of bright red blood after a bowel movement. Besides bleeding, patients commonly report itching around their anal area or discomfort during a bowel movement or when sitting.

If a blood clot forms inside a hemorrhoid—what's called a thrombosed hemorrhoid—sudden, severe rectal/anal pain may develop.

Anal Fissure

An anal fissure is a small tear in the skin at the opening of the anus where stool comes out. It usually occurs from excessive straining and stretching of the anal canal when passing a large or hard stool.

Once an anal fissure develops, the internal anal sphincter (the muscle that controls the anal opening) often goes into spasm, making it even more difficult to pass stools.

The pain of an anal fissure occurs with every bowel movement and is often very severe, sharp, and/or "ripping" in nature. A dull, throbbing pain may then take over and 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 hardened, dry stool gets lodged in the rectum causing pain, among other symptoms, like stool leakage and bloating.

Fecal impaction results from chronic constipation, oftentimes in older individuals who are unable to sense the urge to have a bowel movement. Limited fluid intake, a low-fiber diet, and an inactive lifestyle also tend to contribute.

Levator Ani Syndrome

Levator ani syndrome is characterized by episodes of aching or pressure-like pain high up in the rectum. The episodes last 30 minutes or longer.

This syndrome is more common in women, especially those between 30 and 60 years of age.

While the precise cause remains unknown, some research suggests the attacks may be triggered by stress, sex, bowel movements, sitting for long periods of time, and childbirth.

Proctalgia Fugax

Proctalgia fugax causes recurrent, sudden attacks of cramping, spasming, gnawing, or stabbing pain in the rectum unrelated to bowel movements. The attacks last around 15 minutes on average and may be triggered by stressful life events or anxiety.

Proctalgia fugax may occur at any age in men or women, but 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 an anal fistula have a history of a collection of pus called a perianal abscess that was previously drained.

Symptoms of an anal fistula may include pain, anal swelling, skin irritation around the anus, fever and chills, and 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 extremely painful and caused by some sort of trauma or injury that makes the veins in your anal area suddenly break open. For example, this may occur because of straining during a bowel movement, lifting heavy weights, or forceful coughing.

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a general term for two disorders: Crohn's disease and ulcerative colitis. Both cause chronic inflammation (pain and swelling) of the digestive system.

Crohn's disease affects your digestive tract, anywhere from your mouth to your anus. Symptoms may include diarrhea, crampy abdominal pain, rectal soreness and fullness, tiredness, fever, and weight loss.

Ulcerative colitis nearly always involves the rectum and lower colon, although the entire colon may be affected. Symptoms may include bleeding, diarrhea, cramping abdominal pain, and rectal soreness.

Proctitis

Proctitis refers to inflammation of the lining of the rectum. Besides soreness and a sensation of rectal fullness, other symptoms of proctitis include bloody bowel movements, diarrhea, abdominal cramping, and passing mucus.

Inflammatory bowel disease is a common cause of proctitis, as are sexually transmitted diseases passed through anal sex, including gonorrhea, chlamydia, syphilis, herpes, and HIV.

Other causes of proctitis include trauma (e.g., insertion of objects into the anus), cancer radiation therapy, and foodborne illnesses, including salmonella and shigella.

Antibiotics, too, may cause proctitis by killing helpful bacteria in the rectum and allowing harmful bacteria to grow.

Solitary Rectal Ulcer Syndrome

This is an uncommon and poorly understood disorder characterized by redness or sores in the mucosal lining of the rectum.

Symptoms of this disorder include rectal bleeding and pain, pelvic fullness, tenesmus, straining during bowel movements, and the passage of mucus.

While the precise cause remains unknown, experts suspect it may stem from chronic constipation. An uncoordinated rectal muscle problem or another condition called rectal prolapse (when the rectum protrudes through the anus) are also possible causes.

Cancer

While not common, anal or rectal cancer may be the source of your pain.

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 area or groin region
• A change in bowel habits
• Unusual fatigue
• Unintended weight loss

Diagnosis

A primary care physician, gastroenterologist, or colorectal surgeon is often involved in the diagnosis and management of rectal pain.

In addition to a medical history and physical exam, your healthcare provider may perform various tests and procedures, such as:

• 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) of the abdomen may be ordered to evaluate 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 to check for blood, discharge, or abnormal masses.
• Anoscopy: A healthcare provider will insert a thin, rigid tool with a light on the end of it a few centimeters into your anus to examine the inside of your anus/rectum. A tissue sample (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 and manipulated up into your large intestine. Biopsies may also be taken.

Treatment

As you probably expect, the treatment of rectal pain depends on the underlying diagnosis.

Self-Care Strategies

In many cases, various self-care strategies can be used to manage your pain.

For example, taking sitz baths two or three times a day for 15 minutes can help soothe pain associated with hemorrhoids, anal fissures, perianal hematomas, levator ani syndrome, and proctalgia fugax. Sitz baths work by improving blood flow and relaxing the muscles that surround your anus. They are available in most drugstores and online.

A diet rich in fiber is also appropriate for these conditions. It can soften stool, making bowel movement less painful. It can help manage solitary rectal ulcer syndrome and prevent recurrent fecal impaction as well.

Aim for 20 to 35 grams of fiber per day. Some 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 be recommended for the relief of rectal pain, such as:

• Nonsteroidal anti-inflammatory medications, such as Motrin (ibuprofen)
• Tricyclic antidepressants like Elavil (amitriptyline)
• Muscle relaxants like Flexeril (cyclobenzaprine)
• Topical numbing agent (e.g., lidocaine lotion)
• Hemorrhoid creams containing various ingredients (e.g., hydrocortisone, witch hazel, etc.)

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, and perianal hematomas.

Laxatives may also be recommended for easing constipation, especially in patients with fecal impaction, anal fissures, or solitary rectal ulcer syndrome.

Antibiotics/Antivirals

For bacteria-related sources of rectal pain, such as proctitis from gonorrhea or chlamydia, antibiotics will be given. Antivirals will be given for proctitis related to an infection with herpes or HIV.

Steroids and Immunosuppressants

Inflammatory bowel disease may be treated with steroids and/or immunosuppressants in order to slow the progression of the disease.

Complementary Therapies

A combination of therapies is often used to treat chronic anal pain caused by levator ani syndrome, proctalgia fugax, and, sometimes, solitary rectal ulcer syndrome.

Such therapies may include:

• Biofeedback: Monitoring equipment is used to measure bodily functions, and a practitioner teaches you how to change them 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
• Botox injections

Procedures/Surgery

The treatment of fecal impaction may require an enema either at home or in a healthcare provider's office. For severe cases, manual removal of the hard stool may be warranted.

Other medical therapies or office-based procedures may also be considered. For example, with rubber-band ligation, the blood supply to a hemorrhoid is cut off, forcing it to shrink. Surgery may be indicated for severe cases of proctitis caused by IBD or hemorrhoids that cannot be treated any other way.

Surgery is also often needed to repair an anal fistula, treat anal/rectal cancer, and for patients with solitary rectal ulcer syndrome who suffer from rectal prolapse.

Summary

There are many potential causes of rectal pain including hemorrhoids, an anal fissure, inflammation from IBD, an infection, or trauma. Cancer is also a cause, albeit a much less common one.

Rectal pain is often easily diagnosed and managed, and 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 healthcare provider.

A Word From Verywell

You may feel hesitant to talk about rectal pain, even with a physician. It may help to remember that the issue is common and that your healthcare provider's sole concern is making sure you are well.

Once a diagnosis is reached, a suitable and effective treatment plan can be established—perhaps one that will address the cause of your rectal pain once and for all. And in the rare instance that your pain is due to cancer or a chronic condition like IBD, early treatment is key. The sooner you are evaluated, the better.