Anal pain (proctalgia) 

  • Overview

Introduction 

How your GP investigates anal pain

If your GP needs to examine you to find out what’s causing your pain, they may carry out a rectal examination. This involves putting a lubricated gloved finger inside your bottom.

If your pain is severe, a rectal examination may not be possible - in which case your GP may be able to diagnose the problem by simply inspecting your bottom.

Anal pain (pain in the bottom) can be distressing but is often just the result of a minor treatable condition. See your GP for a diagnosis of the problem and for treatment advice.

Many people with anal pain will develop constipation, which can make the discomfort worse when going to the toilet.

Your GP should be able to diagnose the cause of your pain after an inspection of your bottom or after a gentle rectal examination.

In many cases, the cause will either be:

  • an anal fissure (tear)
  • a pile that contains a blood clot
  • an abscess (see Common causes)

If the cause is not immediately obvious, your GP may refer you to a specialist for advice and for other investigations, such as an endoscopic examination (where a thin flexible instrument with a camera is inserted into your bottom).

Your GP may prescribe medication to relieve the pain, and advise you on how to treat any constipation. This may be all the treatment you need.

Common causes

The most likely causes of anal pain are:

Anal fissure 

An anal fissure is a small tear in the skin of the anus, which can cause a sharp, knife-like pain when you open your bowels. It can be caused by passing a hard stool.

If you have an anal fissure, there may be a small amount of blood on the toilet paper after you wipe (read more about rectal bleeding). 

Many anal fissures heal on their own after time. If it persists, you may need special ointment, which relaxes the ring of muscle around your anus. Occasionally, you may need an examination under anaesthetic by a specialist in hospital.

Anal abscess

An anal abscess (pus-filled lump) will usually cause a throbbing pain that gets worse over a few days. If it is small, the abscess may drain naturally and disappear without any treatment.

Your GP may prescribe antibiotics in the early stages. If the abscess persists, you will probably need to have it drained in hospital to release the pus, usually under a general anaesthetic.

Piles (haemorrhoids) and perianal haematoma

Anal pain can sometimes be caused by piles or a perianal haematoma (burst blood vessel under the skin at the edge of the anus). 

Piles can become painful when they become 'strangulated' and bulge outside the anus, developing a blood clot. They are usually treated with painkillers, ointments and sometimes ice packs, but occasionally surgery is needed.

A perianal haematoma is usually relieved by a simple procedure to remove the clot using a local anaesthetic, sometimes done by your GP.

Less common causes

Sometimes, anal pain may result from an abnormality that has no identifiable cause, such as unexplained muscle spasms in your bottom.

Other less common causes of anal pain include:

  • An inflammatory bowel disease such as Crohn's disease, where there may be anal fissures and abscesses as well as inflammation in the rectum. 
  • A bone-related problem such as coccydynia (pain from your tailbone) or referred pain from your lower back, pelvis or hips caused by arthritis or bone tumours. 
  • A urinary tract problem such as prostatitis (inflammation or infection of the prostate gland).
  • Cancer of the anus or lower rectum.
  • Proctalgia fugax: this is a fleeting pain of unknown cause that's usually diagnosed when other causes of pain have been ruled out. Paracetamol and a warm bath may provide some relief.

You can click on the above links for more information on these conditions.

Page last reviewed: 18/07/2012

Next review due: 18/07/2014

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