Anal Pain: Causes, Home Relief and When to Worry

Anal pain: causes by the type of pain

Common causes of anal pain

Anal fissure

A small tear in the lining of the anal canal, usually from passing a hard or large stool, or from prolonged diarrhea. Pain is sharp during the bowel movement and can last an hour or more afterward because the anal sphincter muscle goes into spasm. Most heal within 6 weeks with softer stools. Fissures lasting longer are called chronic. See anal fissure.

Thrombosed hemorrhoid

A blood clot forms in an external hemorrhoid, causing a sudden, very tender lump. Pain is worst in the first 48 to 72 hours and then fades over 1 to 2 weeks as the clot is absorbed. Internal hemorrhoids usually bleed rather than hurt. See hemorrhoids.

Perianal abscess

An infected anal gland fills with pus. Pain is constant, throbbing and gets worse, making sitting difficult. An abscess needs drainage. Antibiotics alone do not cure it. About a third or more go on to form an anal fistula, a tunnel that leaks discharge. See perianal abscess.

Muscle spasm

• Proctalgia fugax: sudden, severe, cramping pain inside the anus lasting seconds to a few minutes, then disappearing. It often wakes people at night and is linked to stress. It is harmless.
• Levator ani syndrome: chronic aching or pressure high in the rectum lasting 30 minutes or longer, often worse when sitting.

Less common causes

• Pilonidal disease: an infected cyst in the buttock crease, above the anus.
• Proctitis: inflammation of the rectum from STIs, inflammatory bowel disease or radiation, causing pain, urgency and discharge.
• Infections: herpes causes painful ulcers. Syphilis, gonorrhea and fungal infections also occur.
• Crohn's disease: complex abscesses, fistulas and fissures.
• Injury: from childbirth, anal sex or objects.
• Tailbone pain: after a fall or childbirth, felt near the anus when sitting. See coccyx fracture.
• Anal cancer: uncommon. It can cause pain, bleeding, a lump or itching that does not go away. Risk is higher with HPV infection, HIV and smoking.

How doctors find the cause

A clinician will ask when the pain started, whether it is linked to bowel movements, how long each episode lasts, about bleeding, swelling, fever, constipation, diarrhea and sexual history. Most causes can be seen on a simple look at the area with you lying on your side. A gentle finger examination or a short scope (anoscopy) may be done if it is not too painful. With an obvious fissure, internal examination is often delayed until the pain settles. MRI or an examination under anesthesia is used for complex abscesses and fistulas.

Treatment and home relief

Things that help most anal pain

• Soften your stools: eat 25 to 35 grams of fiber a day from fruit, vegetables, beans and whole grains, or take a fiber supplement such as psyllium. Drink plenty of water. A stool softener can help in the short term.
• Sitz baths: sit in a few inches of warm water for 10 to 15 minutes, 2 to 3 times a day and after bowel movements. This relaxes the sphincter and eases pain.
• Do not strain or sit on the toilet for long periods. Go as soon as you feel the urge.
• Pain relief: acetaminophen (paracetamol) or ibuprofen at the label dose. Avoid codeine and other opioids, which cause constipation.
• Clean gently: use water or unscented wipes and pat dry.
• Sit on a cushion rather than a hard seat.
• Numbing creams: short-term use of over-the-counter lidocaine cream can ease pain. Long-term use of hemorrhoid creams containing steroids can thin the skin.

Medical treatments

• Fissures: prescription ointments that relax the sphincter (nitroglycerin or calcium channel blockers such as diltiazem). Botulinum toxin injection or a small operation (lateral internal sphincterotomy) for chronic fissures.
• Thrombosed hemorrhoid: removing the clot under local anesthetic within about 72 hours gives faster relief. After that, home care is usually best.
• Abscess: incision and drainage, usually the same day.
• Muscle spasm: warm baths, pelvic floor physical therapy, and biofeedback for levator ani syndrome.
• Infections: antibiotics or antivirals.

Prevention

• Keep stools soft and regular with fiber and fluids.
• Treat diarrhea promptly.
• Avoid straining and long toilet sessions, including scrolling on a phone.
• Use lubrication and go slowly with anal sex. Use condoms to prevent STIs.
• Stay active, which helps bowel regularity.

Frequently asked questions

What causes sudden sharp pain in the anus?

A sudden sharp pain that lasts seconds to minutes and then disappears is often proctalgia fugax, a harmless muscle spasm. A sharp pain during a bowel movement suggests an anal fissure. A sudden painful lump at the anus is likely a thrombosed hemorrhoid.

Why does my anus hurt after a bowel movement?

Pain during and after bowel movements is the classic sign of an anal fissure, a small tear in the anal lining. The sphincter muscle goes into spasm afterward, so pain can last an hour or more. Soft stools, fiber, water and warm baths help most fissures heal within 6 weeks.

Why does my anus hurt when I sit?

Pain when sitting suggests an abscess, a thrombosed hemorrhoid, levator ani syndrome, pilonidal disease or a tailbone injury. Constant throbbing pain with a swelling that gets worse over days is likely an abscess and needs to be seen within a day or so.

When should I worry about anal pain?

Get urgent care for constant, worsening pain with swelling or fever, heavy bleeding, or pain that prevents you from passing stool or urine. See a doctor if pain lasts more than 2 weeks, or comes with a lump, ongoing bleeding, a change in bowel habit or weight loss.

Can hemorrhoids cause anal pain?

Internal hemorrhoids usually bleed without pain. External hemorrhoids can itch and ache, and become very painful if a blood clot forms inside them. A thrombosed hemorrhoid is a sudden, tender, purple lump that is most painful in the first 2 to 3 days.