Anal pain

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at December 9, 2015
StartSymptomsAnal pain

Anal pain in or around the anus or rectum is common, and often not serious. The causes are numerous, and can usually be diagnosed and treated easily. A few causes, however, are serious and should be checked by a doctor.


Definition & Facts

Anal pain is any pain in or around the anus or rectum. The pain can be intense, or just enough to be annoying. Sometimes it lasts for weeks or months but other times, it is a much shorter duration. Anal pain can often feel especially severe because of the many nerve endings in the area.

Additionally, it can be exacerbated by constipation or diarrhea. As a result of anal pain, or one of its many causes, there can be anal bleeding, though this is usually not serious unless there is significant blood loss.


There are many different ailments and diseases that can cause anal pain. Seemingly the most common, hemorrhoids are swollen veins that stick out of the anal opening, causing anal pain. Anal fissures, however, are also common, but even more painful. Anal fissures are actual tears in the lining of the anus usually caused by hard stools.

An abscess is pus filled tissue that is swollen, and can become infected. The resulting infection can cause fever, as well as long lasting pain. Similarly, a fungal infection can create long lasting pain, though it is usually not as severe as the pain of an abscess.

Less common causes of anal pain can be more serious, such as tumors seen with anal cancer or colon cancer. Similarly, a anal fistula can be the source of severe pain. This is an abnormal tunnel between the rectum and the skin that can become blocked by stool or an abscess.

Other diseases may also have an effect on the anus. Crohn’s Disease, Ulcerative colitis, and Irritable bowel syndrome are all caused by inflammation of the bowel. They can all result in diarrhea or constipation, which may irritate the anus.

In contrast, anal sex and rectal sexually transmitted diseases (STDs) such as gonorrhea, chlamydia and herpes effect the anus and rectum, but still can cause pain. Finally, muscle spasms or trauma to the tailbone or skin around the anal opening can all be issues that may lead to anal pain.

When to see a doctor

Anal pain can sometimes clear up quickly on its own, with or without over the counter treatments. However, when anal pain does not get better within a day or two, it is important to consult a doctor. It is possible that a hemorrhoid has developed a blood clot, and if this is treated quickly, it is most likely to result in successful in pain relief.

Pain that lasts longer than two weeks, or gets worse over time, might be serious. A doctor can make a diagnosis or follow up with tests to do so. Similarly, if the anal pain is accompanied by other symptoms, such as fever, one should be sure to get professional advice. Fever can indicate infection and needs prompt attention.

Minor bleeding is not usually a cause for concern, but if it does not stop after a day, or if there is a significant amount of blood, or blood will not stop, the patient should seek emergency medical attention. Loss of too much blood can result in dizziness, lightheadedness, and is the sign of a serious issue.

Treatment & Therapy

As with any disease or ailment, early detection is the key. A doctor can diagnose and treat most conditions that cause anal pain in the office or with medications. The right treatments for the issue are important. Different types of problems will require different solutions.

For example, a doctor can treat a hemorrhoid with medications such as creams, but sometimes they will require surgery. There are several types of hemorrhoid surgery, including hemorrhoidectomy, in which the hemorrhoid is cut out, PPH, a less invasive procedure, and laser treatments. All will require healing time, but will eventually end the anal pain of the hemorrhoid.

Similarly, anal fissures may be initially treated with creams or other medications, but may also require surgery to cure, especially if they are large. If the problem, however, is a skin irritation, it is almost always easily cleared up with medicinal creams prescribed by a doctor. Similarly, STDs can be treated with specific medications.

Any mass present in the anus is cause for concern. If the mass is an abscess or a hemorrhoid with a blood clot, it can simply be drained. More serious masses can be cancerous. If found early, they can be surgically removed, and treated with chemotherapy, and lasers, as deemed appropriate.

Other causes of anal pain need to be treated as well. For example, with any of the inflamed bowel diseases, the source of the inflammation needs to be dealt with. While many of these diseases cannot be cured, they can be kept under control with medications. Keeping them under control will limit the episodes of diarrhea and constipation that are sometimes the cause of anal pain.

In cases where inflammatory disease is not the cause of the constipation or diarrhea, these can often be maintained by a proper diet with fiber and plenty of fluids.

Prevention & Prophylaxis

It is most advantageous to prevent anal pain whenever possible. Some causes are preventable with good hygiene and healthy nutrition and common sense.

First, and most importantly, you should always keep the anal area clean and dry. Using a dry toilet paper after a bowel movement does not always get the area totally clean. Additionally, some toilet papers are rough and irritating, while others are so soft as to crumble and leave pieces behind. The best method of cleaning the anal area is to use a bidet, but most people do not have such access.

In lieu of a bidet, a shower, sitz bath, or wet toilet paper might be used. No soaps, especially perfumed, nor colored toilet paper should be used as these can cause irritations as well. Be sure to pat the area dry. In order to keep the skin around the anus dry, you should not wear tight clothing, but should wear light, cotton underwear.

Next, one has to consider their diet. A diet high in fiber is ideal. Work up to eating about 25-30 grams of fiber per day by eating whole grains, fruits and vegetables. Additionally, the body needs sufficient liquid, so drinking at least eight glasses of water is a good practice. Following these nutritive standards should allow a person to have healthy bowel movements, which are less likely to create conditions that cause anal pain.

Furthermore, a person should clean the anal area after exercise so that it remains free of sweat and dry. Another suggestion that is useful is to avoid sitting for long periods of time, putting pressure on the anus. Get up and walk around whenever possible. And, perhaps most importantly, you should avoid scratching the anus or skin around the anus.

While it may give temporary relief, it damages the tender skin and will cause more problems in the long run. Following some simple rules, will help you avoid anal pain.

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