Causes of Rectal Pain

Rectal Pain Overview

The rectum is a distinct part of the gastrointestinal system. However, people typically describe rectal pain as any pain or discomfort in the anus, rectum, or lower portion of the gastrointestinal (GI) tract.

This pain is common, and the causes are rarely life threatening. Oftentimes, it results from a bout of muscle spasms or constipation.

Sometimes, rectal pain is accompanied by other symptoms. These may include:

• Bleeding
• Discharge
• Itching
• Stinging

Causes of Rectal Pain

Minor Injury or Other Trauma

In many cases, trauma or injury to the rectum or anus results from anal play during sex or masturbation. It can also result from a particularly hard fall or injury during other physical activity.

People who have significant constipation with hard stools may experience tears in the anal mucosa, also known as anal fissures. These can be quite painful.

In addition to rectal pain, minor injury can cause:

• Bleeding
• Difficulty with bowel movements
• Swelling

Sexually Transmitted Infection (STI)

STIs may spread from the genitals to the rectum, or the infection can be transmitted during anal sex.

STIs that may cause rectal pain include:

• Chlamydia
• Gonorrhea
• Herpes
• Syphilis
• Human papillomavirus (HPV)

In addition to rectal pain, anal STIs can cause:

• Itching
• Minor bleeding
• Discharge
• Soreness

Hemorrhoids

Hemorrhoids are a very common cause of rectal pain. The symptoms you experience depend on where the hemorrhoid is.

Internal hemorrhoids can develop on the inside of the rectum, but they can protrude through the rectum if they’re sufficiently large. Internal hemorrhoids usually are inside of the anus, and most people aren’t aware of them. They can sometimes manifest with painless rectal bleeding, especially after having bowel movements.

External hemorrhoid arise from blood vessels that are external and from a point where there are nerve connections, which is why people may feel them itching, swelling, and causing pain.

In addition to rectal pain, hemorrhoids can cause:

• A lump or cyst-like bump near the anus 
• Difficult bowel movements
• Itching or irritation
• Swelling around the anus

Anal Fissures

Anal fissures are small tears in the thin tissue that lines the opening of the rectum. They’re very common, especially in infants and people who’ve given birth.

Fissures develop when hard or large stools stretch the delicate lining of the rectum and tear the skin. They heal slowly because any bowel movement can further irritate and inflame the tissue.

In addition to rectal pain, anal fissures can cause:

• A small lump or skin tag that develops near the fissures
• Bright red blood on stool or toilet paper
• Itching around the anus

Muscle Spasm (Proctalgia Fugax)

Proctalgia fugax is rectal pain caused by muscle spasms in the rectal muscles. It’s similar to another type of anal pain caused by muscle spasms, levator syndrome.

This condition affects twice as many women as men and usually occurs in people between 30 and 60 years old. One study estimates that 8 to 18 percent of Americans experience this.

In addition to rectal pain, proctalgia fugax can cause:

• Sudden, severe spasms
• Spasms that last for a few seconds or minutes, or even longer

Anal Fistula

The anus is surrounded by small glands that secrete oils to keep anal skin lubricated and healthy. If one of these glands becomes blocked, an infected cavity (abscess) may form.

Some abscesses around the anus develop into fistulas, or small tunnels that connect the infected gland to an opening in the anus skin. A fistula is more likely to develop if an abscess is untreated.

In addition to rectal pain, anal fistulas can cause:

• Fever
• Difficult bowel movements
• Passing blood or pus during bowel movements
• Swelling around the anus and anal opening 

Perianal Hematoma

A perianal heatoma occurs when a collection of blood drains into the tissues around the anal opening. When the blood pools, it causes a lump to form at the anal opening.

In addition to rectal pain, perianal hematoma can cause:

• A lump at the anus 
• Difficulty sitting or walking
• Bleeding or spotting on tissue paper
• Difficult bowel movements

Solitary Rectal Ulcer Syndrome

Solitary rectal ulcer syndrome is a condition that leads to the development of ulcers in the rectum. Ulcers are open sores that can bleed and drain.

It’s not clear what causes this rare syndrome, but some researchers believe it may be related to chronic constipation.

In addition to rectal pain, solitary rectal ulcer syndrome can cause:

• Constipation
• Bleeding or other discharge
• Feeling fullness or pressure in the pelvis
• Straining when passing stool
• Feeling as if you’re unable to empty all stool from your rectum
• Inability to control bowel movements

Thrombosed Hemorrhoid

Hemorrhoids are very common. Occasionally, a blood clot can develop in an external hemorrhoid. This is known as thrombosis.

The external clot may feel like a hardened lump that’s tender to the touch. Although these clots aren’t dangerous, they can be extremely painful.

In addition to rectal pain, a thromboses hemorrhoid can cause:

• Itching and irritation around the anus
• Swelling or lumps around the anus
• Bleeding when passing stool

Tenesmus

Tenesmus is rectal pain caused by cramping. It’s often associated with inflammatory bowel diseases (IBDs), such as Crohn’s disease and ulcerative colitis.

However, it can occur in people who don’t have a diagnosed IBD. In these cases, specific movement or motility disorders of the GI tract may be to blame. Common motility disorders are constipation and diarrhea.

In addition to rectal pain, tenesmus can cause:

• Cramping in and near the rectum
• Feeling the need to have a bowel movement, even after you’ve had one
• Straining harder but producing a smaller amount of stool

Inflammatory Bowel Disease (IBD)

IBD is a group of intestinal disorders that can cause inflammation, pain, and bleeding in the digestive tract, including the rectum.

The two most common inflammatory bowel diseases (IBD’s) are Crohn’s disease and ulcerative colitis (UC). Those two conditions affect nearly 3 million American adults.

Symptoms of IBD depend largely on the type of IBD you have. The symptoms can also change over time, as the condition worsens or improves.

In addition to rectal pain, IBDs like Crohn’s disease and UC can cause:

• Abdominal pain and cramping
• Blood in stool
• Constipation
• Diarrhea
• Fever
• Reduced appetite
• Unintended weight loss

Proctitis

Proctitis causes inflammation in the lining of the rectum. Although it’s common in people with IBD, it can affect anyone. STIs can also cause proctitis, and it can even be the result of radiation therapy for cancer.

In addition to rectal pain, proctitis can cause:

• Diarrhea
• Feeling of fullness or pressure in the rectum
• Bleeding or other discharge 
• Feeling as if you need to pass stool, even when you just had a bowel movement

Perianal or Perirectal Abscess

The rectum and anus are surrounded by glands or cavities. If bacteria, fecal matter, or foreign matter get into the cavities, they can become infected and fill with pus.

If the infection grows worse, the gland may develop a tunnel through the nearby tissue and create a fistula.

In addition to rectal pain, perianal o perirectal abscess can cause:

• Fever 
• Redness of the skin around the anus
• Difficulty starting a urine stream
• Bleeding
• Swelling around the anus and in the rectum
• Painful urination

Fecal Impaction

Fecal impaction is a common GI problem that can lead to rectal pain. Chronic constipation can lead to impacted feces, which is a mass of hardened stool in the rectum.

Although fecal impaction is more common in older adults, it can occur at any age.

In addition to rectal pain, fecal impaction can cause:

• Abdominal pain
• Distention or bloating in the abdomen and rectum
• Nausea
• Vomiting

Rectal Prolapse

Rectal prolapse occurs when your body loses the attachments that hold the rectum in place in your GI tract. When this happens, the rectum may protrude out from the anus.

Rectal prolapse is rare. It’s most common in adults, and women over age 50 are six times more likely to develop this condition than men. However, the average age of a woman with rectal prolapse is 60, while the age is 40 for men.

In addition to rectal pain, rectal prolapse can cause:

• A mass of tissue extending from the anus 
• Bleeding
• Constipation
• Fecal incontinence
• Stool or mucus passing freely from the anal opening

Levator Syndrome

Levator syndrome ( levator ani syndrome) is a condition that causes aching or pain in and around the anus. The pain is a result of muscle spasms in the pelvic floor muscles.

Although women are more likely to be affected, it’s still possible for men to develop the syndrome.

In addition to rectal pain, levator syndrome can cause:

• Bloating
• Pain on the left side of the abdomen
• Bladder pain
• Pain while urinating
• Urinary incontinence 
• Painful intercourse 
• Vaginal pain 

How Serious is Rectal Pain?

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