Anal pain is pain or discomfort in the last part of lower gastrointestinal tract, the anus, where bowel movements leave the body.
It can range from itchy irritation to sharp pain that may be worse during bowel movements. Although most causes of anal pain are harmless, the level of pain can be severe because the anus has a lot of nerve endings.
Causes range from irritation from skin trauma and external hemorrhoids to internal pain caused by inflammatory bowel disease and cancer.
Depending on the cause, treatment can be as simple as starting a stool softener or more invasive procedures such as colonoscopy or even surgery may be needed.
It is important to describe the type of pain (dull, sharp, burning, etc) and for how long it has been going on. It is also important to note whether you have noticed any bleeding from your anus during or after bowel movements. Finally, family history is important as well. Let the doctor know if any of your immediate family members (mother, father, siblings) has had any cancers of the digestive tract or inflammatory bowel disease. —Dr. Jonathan Xia
1. External hemorrhoids
- Dull pain and itchiness near the anus
- A lump can usually be felt in the area around the anus
- You may see bleeding, mainly after bowel movements
External hemorrhoids are swollen veins that can form near the anus. They are usually caused by constipation and straining during bowel movements. Sometimes a blood clot can form in them and this can cause dull pain, itchiness, or tingling sensations in the anus. You may feel a painful lump near the anus. They may bleed as well, mainly after bowel movements.
Treatment includes increasing fiber in your diet and using stool softeners to prevent constipation. You can apply over-the-counter steroid creams, such as hydrocortisone, to the hemorrhoid to reduce pain and swelling.
2. Anal fissure
- Sharp tearing, ripping, or burning pain that occurs in the anus
- Pain is worse during a bowel movement.
- You may see light bleeding when wiping after bowel movements.
Treatment includes increasing fiber or taking stool softeners to keep your stools soft. Medications that help relax the anal sphincter muscle can also be used to help the tear heal. You can also soak your buttocks in 2 to 3 inches of warm water in a process called taking a “sitz bath.” This can help relieve pain by relaxing the anus.
3. Pruritus ani (anal itch)
- Tingling and itchiness in the anus or area around it
- May cause a burning pain or soreness
Pruritus ani is itching or burning pain in the anus or area around it. It can affect up to 5% of the population, according to a study in the journal Surgical Clinics of North America.
It is often caused by irritation from fecal matter that gets stuck to the skin around the anus. It’s more likely to happen if you have soft stool. Trauma from wiping after bowel movements can cause it as well.
It can be treated with anti-itch ointments such as over-the-counter hydrocortisone. You can also use talcum powder on the skin around the anus to keep it clean and dry.
4. Sexually transmitted infections
- Sharp burning pain in the anus or around it
- Pain may be worse with bowel movements
- Mucous discharge can come from the anus
- Bleeding can occur as well
- Fevers and chills
Sexually transmitted infections (STIs), such as chlamydia, gonorrhea, anal warts, and HIV, can cause sharp burning pain in the anus and surrounding areas. This can sometimes cause mucous discharge and bleeding in the area as well. This is more likely to occur in people who are having anal receptive intercourse.
Treatment includes identifying the type of STI and treating it with the appropriate antibiotic. You should stop having anal intercourse until you are treated. It’s also required to notify your sexual partners if you have an STI.
5. Anal or rectal cancer
- Sharp pain in the anus
- Changes in bowel (constipation or diarrhea)
- Sensation of mass or lump in the anus or surrounding areas
- Bleeding from the anus (either spontaneously or during a bowel movement)
- Weight loss and decreased appetite
Cancers of the anus or rectum develop when the normal cells lining the anus change into abnormal cells and grow unchecked.
Depending on the type of cancer and how advanced it is, treatment can range from surgery to chemotherapy and radiation therapy.
Most patients believe that anal pain or anal pain with bleeding is always a sign of cancer in the lower digestive tract. However, this is not true. There are many benign conditions that can have similar symptoms and are significantly more common. —Dr. Xia
6. Inflammatory bowel disease (IBD)
- Sharp pain in the anus or surrounding areas
- Bleeding during bowel movements
- Abnormal drainage from the anus or surrounding areas
Inflammatory bowel disease (IBD) is a gastrointestinal disease that affects about 1% of the population in the U.S., according to the Centers for Disease Control and Prevention. It includes both ulcerative colitis and Crohn’s disease. It is a disease where your body has an overactive immune system that attacks your own gut.
Symptoms can include pain in the anus and surrounding areas, bleeding during bowel movements, diarrhea, and abnormal pus-like drainage from the anus or surrounding areas.
IBD is usually treated with medications that control the overactive immune response. In serious cases, surgery may be necessary to remove the inflamed areas of the colon.
Other possible causes
A number of other conditions can also cause symptoms of anal pain:
When to call the doctor
- Any type of bleeding you notice during or after bowel movements will require a thorough evaluation as it's important to rule out cancer.
- Weight loss
- Changes in bowel movements, either worsening constipation or new diarrhea
- Sensation of a mass, lump, or abnormal growth in the anus or surrounding areas
- Fevers and chills
Should I go to the ER?
You should go to the emergency department if you have any of these signs of a more serious problem:
- Heavy bleeding from the anus that is ongoing
- Bleeding that occurs with the symptoms of lightheadedness and dizziness
- Anal pain that is not controlled by over-the-counter medications
- Anal pain along with fever
- Stool softeners
- Over-the-counter steroid cream such as hydrocortisone
- Dietary fiber supplement
- Over-the-counter pain medications such as acetaminophen (Tylenol)
- Sitz baths (shallow warm water soaks)
Other treatment options
- Immunosuppression medications
I understand that it may be difficult to disclose such private issues but the majority of times they can be fixed easily. Therefore, don’t hesitate, and contact your healthcare providers if you are having ongoing issues. —Dr. Xia