Anal pain

Anal pain is pain in and around the anus or rectum, also called the perianal region. Anal pain is a common complaint. Although most causes of anal pain aren’t serious, the pain itself can be severe because of the many nerve endings in the perianal region.

Many conditions that cause anal pain also may cause rectal bleeding, which is usually more frightening than serious.

The causes of anal pain usually can be easily diagnosed. Anal pain usually can be treated with nonprescription pain relievers and hot water soaks, also called sitz baths.

Causes of anal pain include:

• Anal cancer
• Anal fissure (a small tear in the lining of the anal canal)
• Anal fistula (an abnormal channel between the anus or rectum usually to the skin near the anus)
• Anal itching (pruritus ani)
• Anal sex
• Anal or rectal stricture (narrowing that may occur from scarring, severe inflammation or cancer)
• Constipation — which can be chronic and last for weeks or longer.
• Crohn’s disease — which causes tissues in the digestive tract to become inflamed.
• Diarrhea (causing anal irritation)
• Fecal impaction (a mass of hardened stool in the rectum due to chronic constipation)
• Genital warts
• Hemorrhoids (swollen and inflamed veins in your anus or rectum)
• Levator ani syndrome (spasm in the muscles that surround the anus)
• Perianal abscess (pus in the deep tissue around the anus)
• Perianal hematoma (a collection of blood in the perianal tissue caused by a ruptured vein, sometimes called an external hemorrhoid)
• Proctalgia fugax (fleeting pain due to rectal muscle spasm)
• Proctitis (inflammation of the lining of the rectum)
• Pudendal neuralgia, a nerve condition that causes extreme pain in the anal and pelvic area.
• Solitary rectal ulcer syndrome (ulcer of the rectum)
• Tailbone pain, also known as coccydynia or coccygodynia
• Thrombosed hemorrhoid (blood clot in a hemorrhoid)
• Trauma
• Ulcerative colitis — a disease that causes ulcers and swelling called inflammation in the lining of the large intestine.
• Ulcerative proctitis (a type of inflammatory bowel disease)

Seek immediate medical attention

Have someone drive you to urgent care or the emergency room if you develop:

• A large amount of rectal bleeding or rectal bleeding that won’t stop, especially if it comes with lightheadedness, dizziness or feeling faint.
• Anal pain that gets much worse, spreads or comes with fever, chills or anal discharge.

Schedule a doctor’s visit

Make an appointment with your health care team if your pain lasts more than a few days and self-care remedies aren’t helping. Also make an appointment with your team if anal pain comes with a change in bowel habits or rectal bleeding.

A hemorrhoid that develops quickly or is especially painful may have formed a blood clot inside, called a thrombosed hemorrhoid. Removing the clot within the first 48 hours often gives the most relief, so request a timely appointment with your health care team. The blood clot of a thrombosed hemorrhoid, although painful, can’t break loose and travel. It won’t cause any of the complications associated with blood clots that form in other parts of the body, such as stroke.

See your health care team for rectal bleeding, especially if you’re older than 40, to rule out rare but serious conditions such as colon cancer.

Self-care

Depending on the cause of your anal pain, there are some measures you can try at home to get relief. They include:

• Eating more fruits, vegetables and whole grains, and exercising daily.
• Taking stool softeners, if needed, to help with bowel movements, reduce straining and ease pain.
• Sitting in a tub of hot water up to your hips, known as a sitz bath, several times a day. This helps ease the pain of hemorrhoids, anal fissures or rectal muscle spasms.
• Applying nonprescription hemorrhoid cream for hemorrhoids or hydrocortisone cream for anal fissures.
• Taking a nonprescription pain reliever such as acetaminophen (Tylenol, others), aspirin or ibuprofen (Advil, Motrin IB, others).