By MaryAnn de Pietro

Reviewed by Saurabh (Seth) Sethi, MD MPH

The rectum is the lower part of the large intestine, and it ends at the anus. Injury, inflammation, and infections that affect the anus and rectum can cause rectal pain. Several clues can help a healthcare professional determine the cause of rectal pain.

For instance, determining when the pain occurs — such as when sitting or during a bowel movement — and uncovering any additional symptoms can help narrow down the cause.

Other common symptoms include itching, stinging, bleeding, and stomach cramps.

Rectal pain has a wide variety of causes, from minor to serious. Because pain around the rectum has so many possible sources, it is important to get a proper diagnosis.

Causes of rectal pain include the following:

Hemorrhoids

Hemorrhoids are veins in the anus that have swollen up.

They may develop on the inside or outside of the rectum.

Hemorrhoids are a common cause of rectaldiscomfort, especially if they are on the inside.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, about 50%of adults over the age of 50 develop hemorrhoids.

The veins in the anus may swell more often when a person has trouble having a bowel movement and pushes forcefully. Pushing during childbirth also increases a person’s risk of developing hemorrhoids.

Along with rectal pain, hemorrhoids may cause additional symptoms, including:

• swelling around the rectal opening
• itching
• burning

Anal fissures

An anal fissure is a small cut or tear in the skin that lines the rectal opening.

They usually develop due to stretching or straining the tissue at the opening of the rectum. Similar to hemorrhoids, anal fissures occur as a result of bearing down during childbirth or passing a hard stool.

Other symptoms of an anal fissure include:

• burning
• increased rectal pain during bowel movements
• blood in the stool

Muscle spasms

Like all muscles, those around the rectum may spasm, and this can cause pain.

Rectal spasms may only last a few seconds or several minutes. Brief rectal spasms are called proctalgia fugax.

Certain things may trigger a spasm, such as having a bowel movement, sexual activity, or constipation. Spasms may also occur for no known reason.

Some research suggests that proctalgia is common and may occur in up to about 18% of the population. Proctalgia most often develops in adults ages 30–60, and it is more common in women.

Levator ani syndrome is a variation of proctalgia fugax. It involves spasms and rectal pain that may last for as long as 20 minutes. Other symptoms of rectal spasms include:

• sudden rectal pain
• pain that worsens when sitting

Fecal impaction

Fecal impaction is a hard stool that is stuck in the rectum. Chronic constipation is the most frequent cause of fecal impaction.

Other symptoms of fecal impaction may include:

• bloating
• stomach pain
• nausea

Bowel conditions

Certain bowel conditions can cause inflammation in the intestines, including the rectum.

According to the Centers for Disease Control and Prevention (CDC), both ulcerative colitis and Crohn’s disease can cause pain in the lower intestinal tract.

Other symptoms of these bowel conditions include:

• stomach cramps
• diarrhea
• decreased appetite
• blood in the stool

Sexually transmitted infections

Although not as common as other causes, sexually transmitted infections (STIs) can spread to the rectum from the genitals and cause pain. Various types of STIs can spread, including human papillomavirus, herpes, and chlamydia.

Other symptoms of STIs affecting the rectum may include:

• itching
• rectal discharge
• burning
• bleeding

Rectal prolapse

A rectal prolapse occurs when part or all of the rectum slides out through the anal opening.

The condition is not common, and the cause is not clear. However, up to 67% of people who experience a rectal prolapse have long term constipation. It is also much more common in women over the age of 50.

Other symptoms of rectal prolapse include:

• a bulge outside the anus
• leaking stool
• pain during bowel movements

Anal sex

The skin around the rectum is very sensitive. Friction from sexual activity involving the anus cancause small tears, irritation, swelling, or bleeding. This is partly because the anus does not produce its own lubrication.

Anal sex is mostly safe. If a person experiences pain during or after anal sex, they can try using foreplay and plenty of lubricant to prevent pain in future.

Learn about how practice anal sex safely here.

Rectal abscess

A rectal abscess is a pus filled infection in the glands or cavities that surround the rectum or the anus. Bacteria may get into the cavities, causing an infection.

Other symptoms of a rectal abscess may include:

• painful urination
• fever
• swelling around the rectum

Inflammation of the rectal lining

Inflammation of the lining of the rectum develops most often from bowel disease. In addition to rectal discomfort, other symptoms of inflammation around the rectal lining may include:

• rectal bleeding
• diarrhea
• a feeling of pressure in the rectum

Cancer

Rectal or anal cancer can also cause rectal discomfort. However, most cases of rectal pain are not due to cancer.

Still, it is important to recognize other signs of rectal cancer, including:

• a change in bowel habits
• rectal pain that gets worse or does not go away
• blood in the stool
• unintentional weight loss

Pain relief

The treatment options for rectal pain usually depend on the cause.

For example, treatment for fecal impaction may include a medical procedure to remove the impacted stool. Treatment for STIs often involves medications.

To relieve general rectal pain, people can try:

• taking a sitz bath, or sitting in warm water for 15–20 minutes
• applying a topical numbing ointment
• taking over-the-counter anti-inflammatory medication
• eating a diet high in fiber and drinking plenty of water to prevent constipation and straining during a bowel movement
• using a stool softener, which makes it easier and less painful to have a bowel movement
• sitting on a cushion, which may decrease the pressure on the rectum
• taking antibiotics for bacterial infections

When to see a doctor

A person should talk to their doctor if rectal pain lasts longer than a few days.

Rectal pain often goes away quickly without needing to see a healthcare provider. However, there are instances when it is important to see a doctor.

Consider visiting a healthcare provider if:

• the pain lasts for longer than a few days
• the pain becomes severe or spreads to other areas of the body
• a fever is present
• there is ongoing rectalbleeding
• a lump is present at the anal opening
• there has been trauma to the anus

Summary

Rectal pain might occur briefly and usually does not indicate a serious condition, especially when it only happens occasionally.

However, there are times when it is a symptom of something more serious, such as inflammatory bowel disease or an STI.

Although many cases of rectal pain are treatable with home remedies, it may be necessary to see a doctor in some instances, such as if rectal pain worsens or does not go away.

Anyone who develops rectal pain and is concerned should see their healthcare provider.