Anal Pain

What is anal pain?

Anal pain is pain located in or around your anus (butthole) or rectum. Your anus is the last 3 to 4 centimeters of your large intestine. Your rectum is the 6-inch segment that comes just before your anus. Together with the surrounding skin, they make up your perianal region. This region can be very sensitive.

Anal pain is a common condition with many possible causes. Most aren’t serious, but some may require treatment. It’s important to acknowledge anal pain and notice if it gets worse or doesn’t get better. Don’t be embarrassed to consult a healthcare provider about anal pain or seek treatment if you need it.

What are the possible causes of anal pain?

Some of the most common causes of anal pain include:

• Hemorrhoids, swollen blood vessels inside your anus or rectum.
• Infections, including sexually transmitted infections (STIs) and fungal infections.
• Perianal abscess caused by an infected anal gland.
• Anal fissures, small tears in your anal lining.
• Trauma, from straining to pass hard poops or from anal penetration.
• Pudendal neuralgia, a condition that affects your pudendal nerve. It's responsible for sensation in your anal and genital areas.

Some of the less common causes of anal pain include:

• Anal fistula, a tunnel that develops when an anal abscess erodes through your skin.
• Inflammatory bowel disease (IBD) in your rectum, like ulcerative colitis or Crohn’s disease.
• Rectal ulcers, due to IBD or solitary rectal ulcer syndrome.
• Levator ani syndrome or proctalgia fugax, conditions that cause anal muscle spasms.
• Cancer in your anus or in your rectum.
• Anal pruritus, a skin condition that can cause intense itching.

What does anal pain feel like?

A healthcare provider diagnosing your anal pain might ask you to describe the pain or ask if you have other symptoms along with it. This can offer clues to the possible causes of your anal pain. For example:

Sharp anal pain

Anal pain that feels sharp or cutting might suggest an open wound, like an ulcer or fissure. Some people describe the muscle spasms in levator ani syndrome as a stabbing pain. A thrombosed hemorrhoid can also cause intense, localized pain. This is a hemorrhoid that has developed a blood clot inside it.

Anal pain with pressure

You may feel pressure along with pain inside your anus if you have something swollen inside. This could be a hemorrhoid, an abscess or, rarely, a tumor. If you have constipation, you can feel pain from stress and strain along with pressure from hardened, impacted poop stuck inside your rectum or anal canal.

Anal pain with itching

Anal itching indicates a skin condition inside your anus. Some of these can also cause anal pain. Hemorrhoids can cause both, and so can an anal yeast infection (a form of candidiasis). Anal warts are another possible cause. Anal warts are a symptom of human papillomavirus (HPV), a common STI.

Anal pain after pooping

If you notice anal pain, particularly after pooping, it may be because pooping irritates your condition. An anal fissure is a common cause of pain after pooping because pooping stretches the fissure (tear). Pooping can also irritate hemorrhoids and cause them to bleed or to prolapse — poke out of your anus.

Anal pain during your period

Anal pain during your period is common. Menstrual cramps can affect your perianal muscles as well as your uterus muscles. A chemical called prostaglandin causes these muscles to contract, sometimes sharply. More rarely, endometriosis can affect your rectum, causing menstrual pain and bleeding there.

Anal pain during pregnancy

Constipation and hemorrhoids are both common pregnancy discomforts. As pregnancy progresses, the weight of the growing fetus may put pressure on perianal nerves. You may feel this pressure and pain more when sitting. And as pregnancy progresses, you may be sitting more than usual.

What should I do if I have anal pain?

In many cases, you can treat anal pain at home. It often goes away within a few days. In other cases, it doesn’t get better or gets worse. It’s never a bad idea to check in with a healthcare provider about anal pain, especially if it’s severe, long-lasting or comes with other concerning symptoms, like rectal bleeding.

What medicines or therapies can I use to treat anal pain at home?

For immediate anal pain relief, you can try:

• Over-the-counter (OTC) pain relievers, like acetaminophen or NSAIDs.
• Applying a medicated cream, like hydrocortisone or lidocaine.
• Soaking your anus in a sitz bath for 20 minutes, several times a day.
• Taking an over-the-counter laxative to improve constipation.

How do healthcare providers treat anal pain?

A healthcare provider will ask questions about your symptoms and examine your anus, if necessary, to diagnose the cause of your anal pain. The treatment will depend on the cause. In many cases, they’ll advise the same home treatments listed above. But some more complicated conditions might require:

• Antibiotics, antivirals or antifungals to treat an infection.
• Prescription pain medications (analgesics).
• Targeted medications to treat IBD-related rectal inflammation.
• Surgery to repair a fistula, remove a thrombosed hemorrhoid or release muscle tension.

When should I consult a healthcare provider about my anal pain?

You can always consult a healthcare provider about anal pain if you aren’t sure what’s causing it or how to treat it. If you’ve already tried to treat it at home and it hasn’t worked, contact a healthcare provider before it gets worse. See a provider right away if you experience any of the following alarming symptoms:

• Pain that’s severe enough to interfere with your daily activities or wake you at night.
• Pain that isn’t relieved by over-the-counter medications or that gets worse.
• Pain accompanied by heavy or continuous bleeding.
• Pain that prevents you from pooping, or constipation that’s not relieved by laxatives.

A note from Cleveland Clinic

Anal pain can be uncomfortable in more ways than one. Besides your physical discomfort, you may feel reluctant to address your symptom with a healthcare provider. But don’t let embarrassment prevent you from getting the care you need. Remember, anal pain isn’t unusual, and help is out there.