Small Anal Pain

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Anal pain — pain in and around your anus or rectum (perianal region) — is a common complaint. Although most causes of anal pain are benign, the pain itself can be severe because of the many nerve endings in the perianal region.
Many conditions that cause anal pain may also cause rectal bleeding, which is usually more frightening than serious.
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The causes of anal pain usually can be easily diagnosed. Anal pain usually can be treated with over-the-counter pain relievers and hot water soaks (sitz baths).
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Kahan S, et al. Rectal pain. In: In a Page Signs and Symptoms. 2nd ed. Philadelphia, Pa.: Wolters Kluwer Health Lippincott Williams & Wilkins; 2009.
Goroll AH, et al. Approach to the patient with anorectal complaints. In: Primary Care Medicine: Office Evaluation and Management of the Adult Patient. 7th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2014. http://www.ovid.com. Accessed June 23, 2016.
Feldman M, et al. Diseases of the anorectum. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed June 23, 2016.
Picco MF (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 9, 2016.
Madoff RD. Diseases of the rectum and anus. http://www.clinicalkey.com. Accessed June 23, 2016.
Adams JG. Anorectal disorders. In: Emergency Medicine: Clinical Essentials. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2013. http://www.clinicalkey.com. Accessed June 23, 2016.
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Verywell Health's content is for informational and educational purposes only. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
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Jerry Kennard, PhD, is a psychologist and associate fellow of the British Psychological Society.
Medically reviewed by Priyanka Chugh, MD on November 21, 2019
Priyanka Chugh, MD, is board-certified gastroenterologist with a background in internal medicine. She practices with Trinity Health of New England​ in Waterbury, Connecticut.
Pain in the rectum is a common experience and is not, in general, due to a serious medical condition. However, the pain can be intense and worrying. Here are the main causes of rectal pain, plus advice to calm the pain caused by each.
An anal fissure is a small tear in the skin at the opening of the rectum. It is usually caused as a result of straining and stretching the rectum when passing a hard stool. Anal fissures can also occur if the anal sphincter (the muscle that controls the anal opening) is too tight to pass stools.
The pain is a sharp knifelike pain that returns during the times when the anal opening is irritated. It can be very painful during bowel movements especially if you get constipated or dehydrated. A dull throbbing pain may then take over and it may last for hours. You may see blood in your stool or on the toilet paper when you wipe.
Eating a high fiber diet with fruit and vegetables softens the stool, making bowel movement less painful. You should also drink more liquids. You might consider using an over-the-counter stool softener.
To relieve pain, take a sitz bath. This involves sitting in warm water two or three times a day for 20 minutes. It reduces the pain and helps heal the fissure.
You can discuss with your doctor whether to use other remedies such as numbing cream, hydrocortisone cream, Preparation H. You may also wish to switch to moist baby wipes rather than using toilet paper.
Hemorrhoids are swollen veins in the anus that are estimated to affect over half of all American adults.1 They are caused by straining during bowel movements and are common in pregnant women or following heavy lifting. They are also a common cause of fresh blood in bowel movements.
Hemorrhoids are very painful if bowel movements are hard, but it is usually a general discomfort. If the hemorrhoids burst, the pain may be very intense, beginning suddenly and lasting for several days. If you have severe anal pain and rectal bleeding, seek care immediately.
Take a warm sitz bath for 20 minutes three times a day. Eat a high fiber diet, drink lots of fluids, and take a fiber supplement to soften bowel movements so using the bathroom will be less painful.
Apply a hemorrhoid cream and take over-the-counter pain relievers to decrease the pain. Don't strain when you defecate and don't sit on the toilet for long periods of time. See your doctor if your symptoms don't go away after one week.2
More prevalent in women, levator ani syndrome is characterized by apparent spasms in the group of muscles that surround and support the anus. It is not known why it occurs, but it can be very painful and can last up to 20 minutes.3 The pain is often worse when sitting and is felt high up inside the rectum.
Warm (not hot) sitz baths can help. You can also use over-the-counter pain relievers.
Proctalgia fugax is a variation of levator syndrome with fleeting pain. The cause of proctalgia fugax pain is unknown.4 It is a sudden, brief and intense pain at the anal opening that usually only lasts for a minute or so, but can wake you up. It may occur in clusters, then go away and return weeks or months later.
As with levator syndrome, warm sitz baths and over-the-counter pain relievers are recommended.
There are medical conditions that have associated rectal pain, such as cancer, foreign bodies in the rectum, rectal prolapse, infections, inflammatory diseases such as Crohn's disease and ulcerative colitis, and thrombosed hemorrhoids.
All of these diseases are accompanied by different symptoms and a doctor will have to provide diagnosis and treatment. Cancer is rarely the cause of anal pain, but it tends to be the thing first worried about.
Seek urgent medical intervention if:
If you are concerned with any physical symptoms then you should always see your doctor.
It is better not to be complacent and get a diagnosis so that you know what you are dealing with and so you can then get the best treatments to relieve the problem.
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Lohsiriwat V. Treatment of hemorrhoids: A coloproctologist's view. World J Gastroenterol. 2015;21(31):9245-52. doi:10.3748/wjg.v21.i31.9245
Lohsiriwat V. Treatment of hemorrhoids: A coloproctologist's view. World J Gastroenterol. 2015;21(31):9245-52. doi:10.3748/wjg.v21.i31.9245
Chiarioni G. [Treatment of levator ani syndrome: update and future developments]. Recenti Prog Med. 2011;102(5):196-201. doi:10.1701/659.7668
Chiarioni G, Asteria C, Whitehead WE. Chronic proctalgia and chronic pelvic pain syndromes: new etiologic insights and treatment options. World J Gastroenterol. 2011;17(40):4447-55. doi:10.3748/wjg.v17.i40.4447
Hemorrhoids. National Institute of Diabetes and Digestive and Kidney Diseases.
Ansari P. Levator Syndrome. Merck Manual
The 7 Best Over-the-Counter Hemorrhoid Treatments of 2021
Why Rectal Itch Isn't Something Men Should Ignore
6 Drug-Free Ways to Ease Hemorrhoids
What to Expect During a Fistulotomy
When You Have Recurrent Anal Pain Without a Known Cause
What to Expect From a Prolapsed Hemorrhoid
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