Rectal Pain

Causes of rectal pain

Anal fissure

An anal fissure is a small tear in the lining of the anal canal, usually from passing a hard stool, or from diarrhea. It causes:

• sharp, cutting or tearing pain during a bowel movement
• burning or throbbing that lasts minutes to hours afterward
• bright red blood on the toilet paper or the surface of the stool

The pain causes the anal sphincter to spasm, which reduces blood flow and slows healing. Most fissures heal in 4 to 6 weeks with softer stools and sitz baths. Chronic fissures may need prescription ointments, Botox injections or minor surgery.

Hemorrhoids

Hemorrhoids are swollen veins in the anus and lower rectum. Internal hemorrhoids are usually painless but bleed. External hemorrhoids can itch and ache. A thrombosed external hemorrhoid, where a clot forms, causes sudden, severe pain and a firm, bluish lump at the edge of the anus. Pain peaks in 48 to 72 hours and then eases over 1 to 2 weeks. If seen within about 3 days, a doctor can remove the clot under local anesthetic for faster relief.

Perianal abscess and fistula

A perianal abscess is a pus collection from an infected anal gland. It causes constant, throbbing pain that is worse when sitting, a red, hot, tender lump, and sometimes fever. It needs surgical drainage. Antibiotics alone are not enough. About a third to a half of abscesses later form an anal fistula, a tunnel that drains pus intermittently.

Proctalgia fugax and levator ani syndrome

• Proctalgia fugax: sudden, severe cramping or stabbing pain in the rectum lasting seconds to 30 minutes, often at night, then gone completely. It is caused by muscle spasm and is harmless.
• Levator ani syndrome: a chronic dull ache or pressure high in the rectum lasting hours, often worse sitting. The pelvic floor muscle is tense and tender.

Both are diagnosed after other causes are excluded. Warm baths, muscle relaxation, pelvic floor physical therapy and biofeedback help.

Inflammation and infection

• Proctitis: inflammation of the rectal lining from ulcerative colitis, Crohn's disease, radiation or sexually transmitted infections (gonorrhea, chlamydia, herpes, syphilis). Symptoms include pain, urgency, mucus and bleeding.
• Crohn's disease: can cause fissures, fistulas and abscesses around the anus.

Other causes

• Constipation and fecal impaction: a dull, full, pressing pain in the rectum.
• Prostatitis: pain in the perineum and rectum in men, with urinary symptoms.
• Endometriosis: cyclical rectal pain with periods or bowel movements.
• Coccydynia (tailbone pain): pain at the bottom of the spine, worse sitting and standing up from sitting.
• Pilonidal cyst: a painful, infected lump in the cleft between the buttocks, above the anus.
• Rectal or anal cancer: often painless early on. Pain, bleeding, a change in bowel habit, a feeling of incomplete emptying and weight loss need prompt investigation.
• Trauma or a foreign body.

Rectal pain by type

How doctors find the cause

Your doctor will ask when the pain happens, how long it lasts, about bleeding, bowel habits, sexual history and other symptoms. They inspect the anus, and do a gentle finger exam if pain allows. If a fissure makes the exam too painful, it may be done under anesthesia. Tests may include anoscopy (a short tube to see the anal canal), STI swabs, blood tests, sigmoidoscopy or colonoscopy, and MRI or ultrasound for abscesses and fistulas.

Relief and home treatment

• 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.
• Soft stools: eat 25 to 35 g of fiber a day, drink plenty of fluids, and use a fiber supplement such as psyllium. A stool softener helps in the short term.
• Do not strain or sit on the toilet for long periods. Go when you feel the urge.
• Pain relief: acetaminophen (paracetamol) or ibuprofen at the label dose. Over-the-counter numbing creams (lidocaine) can help briefly.
• Gentle cleaning: use moist, unscented wipes or rinse with water rather than rubbing with dry paper.
• Sit on a cushion if sitting is painful.

Avoid using hemorrhoid creams containing steroids for more than a week, as they thin the skin.

Frequently asked questions

What causes sudden sharp pain in the rectum?

Sudden, severe cramping pain that lasts seconds to minutes and then disappears is usually proctalgia fugax, a harmless muscle spasm. Sharp pain during bowel movements is typically an anal fissure. A sudden painful lump at the anus is often a thrombosed hemorrhoid.

Why does my rectum hurt when I sit?

Pain on sitting is common with perianal abscesses, thrombosed hemorrhoids, levator ani syndrome, tailbone problems and pilonidal cysts. A constant throbbing pain with swelling or fever suggests an abscess, which needs prompt drainage by a doctor.

Why does my rectum hurt after a bowel movement?

Pain lasting minutes to hours after a bowel movement, with bright red blood on the toilet paper, is classic for an anal fissure. Softening stools with fiber and fluids, and warm sitz baths, help most fissures heal within 6 weeks.

When should I worry about rectal pain?

See a doctor urgently for fever with rectal pain, a hot, swollen lump, heavy bleeding, or pain that keeps getting worse. Make a routine appointment for pain lasting more than 1 to 2 weeks, recurring bleeding, a change in bowel habits or weight loss.

Can rectal pain be cancer?

Rarely. Rectal and anal cancers are often painless early on. They are more likely to cause bleeding, a change in bowel habits, a feeling of incomplete emptying or weight loss. Pain from cancer usually develops later. Any persistent symptoms should be checked, especially over age 45.