Anal Pain

Anal pain (or pain in the rectum) is quite an annoying symptom that plagues considerable part o population. Usually it is not a serious problem, but it really can worsen the affected person’s life quality.



Normally hemorrhoids (dilated veins inside rectum or externally in the skin around anus) do not hurt, but they can cause a variety of unpleasant sensations. The pain emerges particularly when a thrombosis of external hemorrhoids occur. External hemorrhoid affected by thrombosis looks like a mauve cherry lesion in the vicinity of anus.

Anal fissure

The fissure is a very annoying problem that is associated with intense pain, especially during defecation. The wound may heal, or become chronic. Chronic anal fissure is a source of secretion and regular pain. Main solution of this problem is a surgical stretching of anus performed in general anesthesia. You can get more information in relevant article.

Colon cancer

Colon cancer found in rectal area as a source of pain is relatively rare condition, but it can not be ruled out. The symptoms, however, are rather alternating constipation and diarrhea instead of classic pain. If the tumor narrows or completely obstructs the intestine, symptoms of intestinal blockage (ileus) may emerge.

Idiopathic bowel diseases

Anal area can be affected by ulcerative colitis and especially by Crohn's disease. Particularly the affection by Crohn's disease can be very insidious and difficult to diagnose and to treat. Inflammation may be associated with fistula (a tunnel) occurrence between the anus and other tissues or body surface. Fistulas can be easily infected by bacteria and such bacterial infection may cause formation of purulent abscesses.


Abscess is a cavity that is filled with pus that is formed because of an infection. Such purulent inflammation of rectum is of course associated with local pain and usually with fever and other systemic symptoms of infection. Abscess usually occurs when rectal mucosa is somehow damaged, which allows an invasion of bacterial microorganisms into deeper tissues.

Sexually transmitted infections (STDs)

Many STDs can cause rectal pain and their usual way of transmission is anal intercourse. Painful affections of rectum are often mentioned by gonorrhea infection. Anal sex alone is also associated with pain as it causes damage to rectal mucosa.

Foreign bodies

Any foreign body in rectum can be naturally associated with pain. Most of these are connected to various less common sexual practices. A patient once visited our hospital because of pain caused by a corn cob stuck in his anus. According to medical history, he urgently needed to defecate by a cornfield and one of the corn cobs somehow... well, let’s rather not mention unnecessary details.

Diagnostic approach

Patients with rectal pain problems should be examined by a surgeon (proctologist) and possibly an internist (gastroenterologist). Medical history should include information about sexual behavior, identifying the nature of pain and possible causative factors. An important question is about the presence of blood in stool. A look at anal area is important, as well as digital rectal exam. Rectum can be also examined by short rectoscopy and the whole colon by complete colonoscopy. Part of the examination should also be stool testing for presence of pathogenic bacteria.

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources