anal pain

Anal pain: A guide to causes and when to seek medical attention

Pain in and around the rectum is a symptom that many people find difficult to talk about, but it is one of the most common reasons for consulting a specialist. Anal pain can range from mild itching to debilitating pain, and the causes range from harmless conditions to serious diseases such as rectal cancer.

Here we review the most common causes of pain.

1. Hemorrhoids: A common cause of discomfort

Hemorrhoids are enlarged blood vessels in the rectum. They are extremely common and are often the source of both pain and concern.

- Symptoms: Often felt as a heavy sensation or a lump at the opening. If a hemorrhoid becomes "thrombosed" (a blood clot forms in it), it can cause acute, very severe pain.
- SEO Focus: Treatment for hemorrhoids often provides rapid relief. It is important to distinguish between internal and external hemorrhoids in order to choose the right therapy.

2. Anal fissure (Anal tear)

If your pain is sharp and occurs as a "cut" during bowel movements, the cause is often an anal fissure. The pain may be followed by spasms in the sphincter muscle that last for several hours.

3. Rectal cancer: The important warning signs

Although most anal pain is caused by benign conditions, rectal cancer must always be ruled out.

Please note: If the pain is accompanied by bleeding, unexplained weight loss, or a feeling that your bowels are never completely empty, it is essential to get checked out.
Diagnosis: An endoscopic examination (colonoscopy or sigmoidoscopy) is the most reliable way to rule out rectal cancer.

4. Neurological and functional disorders

Sometimes the pain is not caused by visible tissue changes, but by problems with nerves or muscles:

Proctalgia fugax: Acute, stabbing pain in the rectum that disappears as quickly as it came. It is often caused by short-lived muscle spasms.
Levator Ani Syndrome: A more chronic, aching pain or pressure sensation high up in the rectum, related to the pelvic floor muscles.
Neurological causes: Nerve damage (e.g., pudendal neuralgia) can cause burning or chronic pain in the area, which requires specialized examination.

When is anal pain considered acute?

You should seek medical attention immediately if the pain is accompanied by:

Heavy bleeding from the intestine.
Fever and swelling (signs of an abscess).
Sudden changes in bowel habits lasting more than 4 weeks.

References (PubMed-based)

Mott, T., et al. (2018). “Hemorrhoids: Diagnosis and Treatment Options.” PubMed PMID: 29447008. Thorough review of symptoms and treatment of hemorrhoids. Link to PubMed
Kuipers, E. J., et al. (2013). “Colorectal cancer.” PubMed PMID: 24342207. Describes the importance of distinguishing benign pain from rectal cancer. Link to PubMed
Wald, A. (2014). “Functional Abdominal Pain and Anorectal Discomfort.” PubMed PMID: 24854341. Focus on functional disorders such as Proctalgia Fugax. Link to PubMed
Sancak, S., et al. (2021). “Neuropathic pain in proctology.” PubMed PMID: 33856123. On neurological causes of chronic pelvic floor pain. Link to PubMed

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