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Digestive health centre

Anal pain

What causes anal pain?

Anal pain is also known as rectal pain, or proctalgia, and describes pain affecting the bottom.

Common causes of anal pain include:

  • Haemorrhoids: Haemorrhoids, a sometimes painful swelling of a vein or veins at the anus, are a common problem, with about 50% of people experiencing them at some time in their life, according to the NHS. They are usually caused by straining during bowel movements. Heavy lifting and childbirth are also common causes.
  • Anal fissure: An anal fissure is a small tear in the skin at the opening of the rectum. It is caused when a large, hard stool is passed and excessively stretches the anus. This problem can also occur in people whose anal sphincter tone (the muscle that controls the anal opening) is too tight and cannot relax to pass the stool.
  • Proctalgia fugax: Proctalgia fugax involves fleeting rectal pain. This disorder occurs more commonly in women and in people younger than 45 years. Although the exact cause of the pain is not known, many doctors believe spasm of the anal sphincter muscle is the origin of this pain.
  • Levator ani syndrome: Levator ani syndrome occurs in women slightly more often than it occurs in men. The term levator ani refers to the group of muscles that surround and support the anus. Spasms of these muscles are believed to cause rectal pain.

Less likely reasons for rectal pain

  • Cancer
  • Infection, including anorectal abscesses or proctitis
  • Inflammatory bowel disease, such as ulcerative colitis or Crohn's disease
  • Foreign bodies in the rectum or rectal prolapse 

Rectal pain symptoms

The pain of proctalgia fugax is sudden and intense, usually lasting less than a minute. But in some rare cases, the spasm can go on for an hour. It is described as a sharp, stabbing, or cramp-like pain occurring at the anal opening. The pain can awaken you from a sound sleep. The attacks seem to occur in clusters, appearing daily for a while then disappearing for weeks or months.

The pain of levator ani syndrome is felt higher up inside the rectal passage and feels like a tight pressure. The sensation is made worse by sitting and improves with walking or standing. The pain usually lasts 20 minutes or longer and tends to reoccur at regular intervals.

Most haemorrhoids only cause a mild discomfort, but the pain can become severe if the haemorrhoid thromboses. This occurs when the blood in the haemorrhoid clots. The symptoms are an excruciating throbbing or stabbing pain that begins suddenly and can last for days.

An anal fissure causes a tearing or knife-like pain when it first occurs and turns into a dull ache that can last for hours. The tearing of the skin may also cause a small amount of bleeding. Each bowel movement irritates the injured skin producing a sharp pain. The pain can be so intense that most people try to delay having a bowel movement, which only causes a harder stool and more pain when it is passed.

WebMD Medical Reference

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