Anal pain (proctalgia)

The information on this page has been adapted from original content from the NHS website.

Anal Pain

Anal pain is more common than you might think, although people don’t always like to talk about it. Most of the causes are temporary and not serious, but some may need treatment to get better.

Overview

What is anal pain?

Anal pain is pain located in or around your anus (butthole) or rectum. Your anus is the last 3 to 4 centimeters of your large intestine. Your rectum is the 6-inch segment that comes just before your anus. Together with the surrounding skin, they make up your perianal region. This region can be very sensitive.

Anal pain is a common condition with many possible causes. Most aren’t serious, but some may require treatment. It’s important to acknowledge anal pain and notice if it gets worse or doesn’t get better. Don’t be embarrassed to consult a healthcare provider about anal pain or seek treatment if you need it.

Possible Causes

What are the possible causes of anal pain?

Some of the most common causes of anal pain include:

• Hemorrhoids, swollen blood vessels inside your anus or rectum.
• Infections, including sexually transmitted infections (STIs) and fungal infections.
• Perianal abscess caused by an infected anal gland.
• Anal fissures, small tears in your anal lining.
• Trauma, from straining to pass hard poops or from anal penetration.

Some of the less common causes of anal pain include:

• Anal fistula, a tunnel that develops when an anal abscess erodes through your skin.
• Inflammatory bowel disease (IBD) in your rectum, like ulcerative colitis or Crohn’s disease.
• Rectal ulcers, due to IBD or solitary rectal ulcer syndrome.
• Levator ani syndrome or proctalgia fugax, conditions that cause anal muscle spasms.
• Cancer in your anus or in your rectum.
• Anal pruritus, a skin condition that can cause intense itching.

What does anal pain feel like?

A healthcare provider diagnosing your anal pain might ask you to describe the pain or ask if you have other symptoms along with it. This can offer clues to the possible causes of your anal pain. For example:

Sharp anal pain

Anal pain that feels sharp or cutting might suggest an open wound, like an ulcer or fissure. Some people describe the muscle spasms in levator ani syndrome as a stabbing pain. A thrombosed hemorrhoid can also cause intense, localized pain. This is a hemorrhoid that has developed a blood clot inside it.

Anal pain with pressure

You may feel pressure along with pain inside your anus if you have something swollen inside. This could be a hemorrhoid, an abscess or, rarely, a tumor. If you have constipation, you can feel pain from stress and strain along with pressure from hardened, impacted poop stuck inside your rectum or anal canal.

Anal pain with itching

Anal itching indicates a skin condition inside your anus. Some of these can also cause anal pain. Hemorrhoids can cause both, and so can an anal yeast infection (a form of candidiasis). Anal warts are another possible cause. Anal warts are a symptom of human papillomavirus (HPV), a common STI.

Anal pain after pooping

If you notice anal pain, particularly after pooping, it may be because pooping irritates your condition. An anal fissure is a common cause of pain after pooping because pooping stretches the fissure (tear). Pooping can also irritate hemorrhoids and cause them to bleed or to prolapse — poke out of your anus.

Anal pain during your period

Anal pain during your period is common. Menstrual cramps can affect your perianal muscles as well as your uterus muscles. A chemical called prostaglandin causes these muscles to contract, sometimes sharply. More rarely, endometriosis can affect your rectum, causing menstrual pain and bleeding there.

Anal pain during pregnancy

Constipation and hemorrhoids are both common pregnancy discomforts. As pregnancy progresses, the weight of the growing fetus may put pressure on perianal nerves. You may feel this pressure and pain more when sitting. And as pregnancy progresses, you may be sitting more than usual.

Anal pain (proctalgia)

Anal pain (pain in the bottom) can be distressing. But is often just the result of a minor, treatable condition. Many common causes of anal pain will improve with self-care treatments. See your GP if your pain is severe, doesn’t improve after a few days or you have rectal bleeding.

Common causes of anal pain

Anal fissures

An anal fissure is a small tear in the skin of the anus.

Symptoms of an anal fissure can include:

• a severe, sharp pain when doing a poo
• a burning or gnawing pain that lasts several hours after doing a poo
• rectal bleeding – you may notice a small amount of blood on the toilet paper after you wipe

Anal fissures can be very painful, but many heal on their own in a few weeks.

Increasing the amount of fibre in your diet, drinking plenty of fluids and taking laxatives and over-the-counter painkillers can help.

If the pain continues, your GP will advise on the appropriate treatment.

Haemorrhoids (piles)

Haemorrhoids (piles) are swellings containing enlarged blood vessels that are found inside or around the bottom.

They can be caused by straining on the toilet as a result of prolonged constipation, or other things that increase the pressure in your tummy.

In many cases, haemorrhoids don’t cause symptoms. When symptoms do occur, they may include:

• bleeding after doing a poo
• an itchy bottom
• feeling like there’s a lump in or around your anus
• soreness and redness around your anus
• anal pain, if the blood supply to the haemorrhoid becomes blocked or interrupted – for example, by a blood clot

The symptoms often pass after a few days. Increasing the amount of fibre in your diet, drinking plenty of fluids and taking laxatives and over-the-counter painkillers can help.

If the blood supply to the haemorrhoid has been blocked by a clot, a simple procedure can be carried out to remove the clot under local anaesthetic (where the area is numbed).

Anal fistulas and abscesses

An anal fistula is a small tunnel that develops between the end of the bowel and the skin near the anus. It’s usually caused by an infection near the anus resulting in a collection of pus (an abscess).

Symptoms of an anal fistula or abscess can include:

• a constant, throbbing pain that may be worse when you sit down
• skin irritation around the anus
• passing pus or blood when you poo
• swelling and redness around your anus
• a high temperature (fever)

Your GP may prescribe antibiotics if an abscess is picked up early on.

If it persists, it may need to be drained in hospital, possibly under general anaesthetic (while you’re asleep).

If a fistula develops, surgery will usually be needed because they rarely heal by themselves.

Less common causes of anal pain

Less common causes of anal pain include:

• proctalgia fugax – a condition that causes episodes of sudden, severe anal pain that last for a few minutes at a time; medication that relaxes the muscles in the pelvis may help
• levator ani syndrome – an aching or pressure sensation in and around the anus that may be constant or last for hours or days at a time; treatment to relax the muscles in the pelvis may help
• an inflammatory bowel disease such as Crohn’s disease – other symptoms can include tummy cramps, bloody diarrhoea and weight loss; treatments are available to help relieve the symptoms
• an infection – such as a fungal infection or rectal sexually transmitted infection (STI)
• a bone-related problem – such as coccydynia (tailbone pain) or pain that spreads from your lower back, pelvis or hips, caused by arthritis or bone tumours
• a urinary tract problem – such as prostatitis (inflammation or infection of the prostate gland)
• cancer of the anus or lower rectum – this can have similar symptoms of haemorrhoids and anal fissures, but is much rarer

When to get medical advice

Many common causes of anal pain will improve with simple self-care treatments, so you don’t always need to see your GP.

But it’s a good idea to see your GP if:

• your pain is severe
• your pain doesn’t improve after a few days
• you also experience rectal bleeding

Don’t feel embarrassed to see your GP. Anal pain is a common problem that they’re used to seeing. Your GP can try to work out what the problem is and give you treatment advice.

They’ll probably ask to see your bottom. They may carry out a rectal examination (where they will gently put a gloved finger into your bottom) to check for any abnormalities.

If the cause is not immediately obvious, they may refer you to a specialist for advice and further tests.

More useful links

The information on this page has been adapted from original content from the NHS website.

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