Pain of the Anus: Causes and Relief

What anal pain feels like

How the pain feels and when it happens are the best clues to the cause:

Common causes of pain in the anus

Anal fissure

A fissure is a small tear in the lining of the anal canal, usually caused by passing a hard stool, and less often by diarrhea or childbirth. It causes sharp pain with bowel movements followed by burning or spasm that can last hours, and a little bright red blood on the toilet paper. Most heal within 6 weeks with softer stools. Fissures lasting longer are chronic and may need prescription ointments or surgery.

Hemorrhoids

Internal hemorrhoids usually bleed painlessly. External hemorrhoids lie under the skin at the anal edge. If a clot forms inside one, it becomes a thrombosed hemorrhoid: a sudden, very painful, firm, purple-blue lump. Pain peaks in the first 48 to 72 hours and then eases over 1 to 2 weeks.

Perianal abscess and fistula

An abscess is a pocket of pus from an infected anal gland. It causes increasing, throbbing pain and a red, tender swelling, sometimes with fever. It will not settle with antibiotics alone and needs to be drained. About a third to a half of abscesses leave behind an anal fistula, a small tunnel that leaks pus or blood.

Muscle spasm

• Proctalgia fugax: sudden, severe, cramp-like pain lasting seconds to minutes, often waking you at night. It is harmless and common.
• Levator ani syndrome: a dull, aching pressure high in the rectum lasting 30 minutes or more, worse when sitting, caused by tight pelvic floor muscles.

Skin conditions and itching

Irritation from wiping, moisture, scented products, eczema, psoriasis, fungal infection or pinworms can make the skin around the anus sore and itchy.

Less common causes

• Pilonidal disease: pain and swelling at the top of the buttock crease, above the anus, rather than at the anus itself. See pilonidal cyst.
• Inflammatory bowel disease: Crohn's disease can cause fissures, abscesses and fistulas that recur. Ulcerative colitis causes proctitis.
• Sexually transmitted infections: herpes causes painful ulcers. Gonorrhea, chlamydia and syphilis can cause proctitis.
• Rectal prolapse: tissue protrudes from the anus during straining.
• Coccyx pain: pain at the tailbone is often mistaken for anal pain.
• Anal cancer: rare, causing persistent pain, bleeding, a lump or a non-healing sore.

Anus pain when sitting

Pain worse when sitting is typical of an abscess, a thrombosed hemorrhoid, levator ani syndrome, a pilonidal cyst and coccyx pain. A ring cushion or sitting on a pillow helps while the cause is treated.

How doctors find the cause

A doctor will ask when the pain started, how it relates to bowel movements, whether there is bleeding, swelling, discharge or fever, and about bowel habits. They will look at the anal area and may gently examine with a gloved finger. If a fissure is very painful, the internal examination may be delayed until it is less sore. Further tests can include:

• Anoscopy: a short scope to view the anal canal
• Flexible sigmoidoscopy or colonoscopy: for bleeding in people over 45, or with change in bowel habit or suspected inflammatory bowel disease
• MRI or ultrasound: to map an abscess or fistula
• Swabs: for STIs or herpes

Treatment and relief

Home care for anal pain

• Soften your stools: aim for 25 to 35 grams of fiber a day, drink plenty of water, and use a fiber supplement such as psyllium. A stool softener can help in the short term.
• Sitz baths: sit in warm water for 10 to 15 minutes, two or three times a day and after bowel movements. This relaxes the anal sphincter and eases pain.
• Avoid straining and do not sit on the toilet for long periods.
• Gentle cleaning: use water or unscented wipes and pat dry.
• Pain relief: acetaminophen (paracetamol) or ibuprofen at the label dose. A topical numbing cream (lidocaine) may help short term.

Medical treatments

• Chronic fissures: prescription ointments that relax the sphincter (nitroglycerin or diltiazem), Botox injections, or a small operation (lateral internal sphincterotomy) when other treatment fails.
• Thrombosed hemorrhoids: within about 72 hours of onset, the clot can be removed under local anesthetic for rapid relief. After that, home care is usually best.
• Abscess: incision and drainage, sometimes with antibiotics. Fistulas need surgery.
• Levator ani syndrome: pelvic floor physical therapy, biofeedback and warm baths.
• Proctitis and IBD: treatment of the underlying infection or inflammation.

Frequently asked questions

What causes sharp pain in the anus?

Sharp pain during or after a bowel movement is most often an anal fissure. Sudden sharp cramps that wake you at night and pass within minutes are usually proctalgia fugax. A sudden painful lump with sharp pain suggests a thrombosed hemorrhoid.

Why does my anus hurt after a bowel movement?

Pain lasting minutes to hours after passing stool is classic for an anal fissure, where the tear causes the sphincter muscle to spasm. Hemorrhoids and irritated skin can also hurt after wiping. Softer stools and warm sitz baths usually help.

How long does anal pain last?

It depends on the cause. A thrombosed hemorrhoid eases over 1 to 2 weeks. An acute fissure usually heals within 6 weeks. Proctalgia fugax lasts only seconds to minutes. Pain from an abscess keeps getting worse until it is drained.

When should I worry about pain in my anus?

See a doctor if pain lasts more than a week, you have bleeding, a lump, fever or pus, or your bowel habit has changed. Get urgent help for severe pain with fever, spreading redness, or heavy bleeding.

Can anal pain be a sign of cancer?

Rarely. Anal and rectal cancers more often cause bleeding, a lump or a change in bowel habit than pain. Persistent pain, a non-healing sore or bleeding in someone over 45 should be checked with an examination and often a colonoscopy.