Anal Pain: 8 Main Causes & Treatment Options

Medical review: Dr. Clarisse Bezerra
Family Doctor
June 2022

Anal pain can occur for many different reasons like hemorrhoids, fissures or fistulas. Therefore, it is important to monitor when you feel pain and whether you have other symptoms, like bloody stools or itching. ​

This pain can also be caused by a sexually-transmitted infection, like chlamydia, gonorrhea or herpes. Other possibilities include a bacterial infection, intestinal inflammation, abscesses or cancer. 

It is important to see your family doctor or a gastroenterologist for assessment and to identify the cause of pain. Treatment with antibiotics or even surgery may be necessary, depending on the cause of pain. 

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Some of the most common causes of anal pain are: 

1. Hemorrhoids

Hemorrhoids can be identified by a swelling in the anal region that causes discomfort and pain when sitting or walking, anal itching, bright red blood in the stool or when wiping, and the presence of a small, swollen lump in the anus that causes the sensation of something that is stuck. Understand the difference between internal and external hemorrhoids. 

Hemorrhoids care often the result of chronic constipation, anal sex or pregnancy. Learn more about what can cause hemorrhoids

What to do: To treat hemorrhoids, sitz baths or hemorrhoid ointment may be recommended by your doctor. Read more about medications and home remedies you can try. If the hemorrhoids do not disappear and symptoms are worsening, you should see a gastroenterologist for assessment, as the most appropriate treatment can then be advised. Severe hemorrhoids may be removed with a surgical procedure. 

2. Anal fissure

An anal fissure is a small wound that appears on the anus. It can cause pain during bowel movements as well as bloody stools. Anal fissures are usually identified due to the appearance of symptoms like burning with bowel movements or urination, or anal itching. 

What to do: In most cases, anal fissures resolve on their own without the need for any intervention. However, the doctor may prescribe treatment to help relieve symptoms, like anesthetic ointments (e.g. lidocaine) or sitz baths in warm water. 

3. Intestinal endometriosis 

Intestinal endometriosis is an illness in which the endometrium, the uterine lining, spreads to the intestinal walls. This can cause anal pain during menstruation. In addition to anal pain, some women also experience abdominal pain, nausea, vomiting, bloody stools, difficulty passing stool or persistent diarrhea. See what other symptoms of endometriosis can occur. 

What to do: You should see a gynecologist as soon as possible to confirm a diagnosis and initiate treatment, which may involve a surgical procedure.

4. Infection

The most common infections to cause anal pain are sexually-transmitted microorganisms, like HPV, herpes, chlamydia and HIV. Infections, like fungal infections, can also develop amid inadequate hygiene practices. Therefore, it is important to see the doctor if you suspect an infection so that the microorganism causing it can be identified and eliminated. 

What to do: Use medication (e.g. antibiotics, antifungals, etc.) as prescribed by your doctor. Avoid using excessive toilet paper and opt to cleanse your anus and genitals with warm water and soap following a bowel movement or urination. 

5. Perianal abscess

An abscess can develop due to a skin infection or from another anal-rectal illness, like inflammatory bowel disease, rectal cancer or surgery. It is associated with swelling, redness and moderate pain. Some may present with pus and cause a high-grade fever. 

What to do: You should seek medical attention to obtain antibiotics and drain the pus from the abscess. If the abscess is very large or deep, the doctor may advise admission to the hospital for IV analgesics and antibiotics. They doctor may order further testing to evaluate the abscess, like a CT scan, and perform a surgical procedure to remove it, as total removal can prevent a new infection or a fistula. 

6. Inflammatory bowel disease 

Inflammatory bowel disease, caused mainly by ulcerative colitis or Crohn’s disease, is characterized by rectal redness and inflammation, as well as diarrhea with blood, abdominal pain, bowel obstruction and pain with bowel movements. All of these symptoms can contribute to anal pain. 

What to do: You should see your doctor if you experience bloody diarrhea, as this way tests can be order to identify the cause and rule out other illnesses. From there, the doctor can prescribe appropriate treatment, which usually involves the use of medication like sulfadiazeine, mesalazine, or prednisone. In more serious cases, the doctor may advise surgical intervention. 

7. Radiation therapy

Radiation therapy for cancer in the pelvic region is usually indicated for rectal cancer. It an cause anal inflammation as a side-effect, which can lead to pain with bowel movements before and after treatment. Know what other cancer symptoms you should monitor for. 

What to do: The oncologist should assess the necessity for a treatment alternative, dosing change or discontinuation. He or she will evaluate the side effects and whether the treatment is causing more harm than good. 

8. Anal cancer

Anal cancer can present with symptoms like bleeding, pain or a palpable lump. It can start off as a wound or wart, and transform into a nodule. There are some studies that associate this type of cancer with HPV infections, therefore it is important to be up-to-date with pap tests and other regular cancer screening. 

What to do: If you present with any symptoms of anal cancer, you should see a doctor immediately for testing. Once confirmed, the doctor will indicate the most appropriate treatment plan for you. 

When to see the doctor

It is important to consult a gastroenterologist or proceed to the emergency room if pain does not subside within 48 hours or if it does not resolve with anal ointments, analgesics (like acetaminophen) or anti-inflammatories (like ibuprofen).

The doctor should identify the cause of anal pain that is recurrent or worsens over time, as it may be a serious problem, like an anal fistula or cancer. These conditions often require surgical intervention. 

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Edited by Tua Saude editing team in June 2022. Medical review completed by Dr. Clarisse Bezerra - Family Doctor in May 2022.

References

  • UNIVERSIDADE FEDERAL DO RIO GRANDE DO SUL. TeleCondutas. 2018. Available on: <https://www.ufrgs.br/telessauders/documentos/telecondutas/tc_hemorroidas.pdf>. Access in 01 Mar 2022
  • PHILLIPS, R.K.S; CLARK, S. Cirurgia Colorretal. 5 ed. Rio de Janeiro: Elsevier, 2017. 231-236.
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  • REVISTA PORTUGUESA DE COLOPROCTOLOGIA. Fissura anal- Parte I: fundamentos teóricos. 2009. Available on: <https://www.spcoloprocto.org/uploads/rpcol__jan_abril_2009__pags_18_a_26__recomendacoes__fissura_anal__parte_i.pdf>. Access in 01 Mar 2022
  • WOLTHUIS, Albert M et al . Bowel endometriosis: Colorectal surgeon’s perspective in a multidisciplinary surgical team. World J Gastroenterol. 42. 15616–15623, 2014
  • DE PAULA, Pedro Roberto. Doença Hemorroidária. 2016. Available on: <https://cbcsp.org.br/wp-content/uploads/2016/aulas/doencahemorroidaria.pdf>.
  • UFRGS. Telecondutas: Hemorróidas. 2018. Available on: <https://www.ufrgs.br/telessauders/documentos/telecondutas/tc_hemorroidas.pdf>. Access in 01 Mar 2022
Medical review:
Dr. Clarisse Bezerra
Family Doctor
Dr. Bezerra possesses a medical degree and specializes in family medicine. She is licensed to practice under CRM-CE licence #16976.