Rectal Pain: What is it, Causes, Treatment, Prevention

Rectal pain is often harmless, but it can get very traumatising for people going through it. A sharp, throbbing pain in the anus, rectum or the gastrointestinal tract, rectal pain is often accompanied by itching, bleeding and even discharge and constipation. There can be many causes of rectal pain including conditions such as inflammatory bowl disease, hemorrhoids, as well as inflammation of the lining of the rectum.

What is rectal pain?

Rectal or anal pain is discomfort and pain around the anus, particularly during bowel movements. It can manifest as aching, tenderness, pulsing, burning, or acute pain. Rectal or anal pain is very common. The Cleveland Clinic Journal of Medicine states that almost 11.6 per cent of the US population suffers from this condition. Several factors can lead to this pain.

“It could be result of enlarged veins inside the anus, also called piles or hemorrhoids prevalent among different age groups. Alternatively, it might result from minor tears in the skin surrounding your anus, especially common in individuals encountering difficulties with passing stool. Infections, intense bowel movement issues, such as constipation or diarrhea, tumours or involuntary muscle contractions can also contribute to rectal discomfort,” explains General surgeon Dr Prabhakar B.

What are the causes of rectal pain?

1. Fissure in anus or anal fissure

This refers to cuts in the anus, right at the opening. These are a result of straining while trying to pass a hard stool. An extremely painful condition, trying to pass stool with an anal fissure can lead to the spasm of anal sphincter or the muscle that leads to the opening of the anus. The pain is severe while passing stool, and can throb for hours later as well. It can also lead to bright red blood spots on the toilet paper. A paper published Annals of Gastroenterology states that if an anal fissure persists for more than 4-6 weeks, then it can be termed as chronic. This needs to be treated as it can impact daily life in a negative way.

2. Hemorrhoids

Hemorrhoids are enlarged blood vessels in the anus that can cause discomfort and pain. These are swollen veins in the anus and can also develop inside the rectum. It can be cured by applying a suppository containing hydrocortisone. You can also use a numbing medicine and do a sitz bath multiple times in a day.

3. Rectal abscess

This refers to infection in the anus. Also called as an anal abscess, this happens with an anal cavity becomes infected with pus. This is accompanied by fever, constipation as well as pain. The abscess needs to be drained for this to get treated, surgery is another option.

4. Rectal mass

Rectal mass refers to tumors and rectal prolapse. A rectal mass can happen if the cells in the rectum mutate. There might also be several growths, known as polyps on the inner lining of the rectum. It can also turn cancerous, states this study, published in Abdominal Imaging. The risk of rectal cancer grows as a person ages, the average age being 68 years.

5. Inflammatory bowel diseases

Many inflammatory bowel diseases such as Crohn’s or Ulcerative colitis can also lead to rectal pain. These diseases result from tissue inflammation in your digestive tract. Ulcerative colitis is inflammation on the lining of your large intestine as well as your rectum. Crohn’s disease leads to inflammation in the deep layers of the digestive tract, including upper gastrointestinal tract, small and large interstine. This can lead to rectal bleeding as well as abdominal pain as well. According to Centers of Disease Control and Prevention, around three million Americans suffers from these diseases.

6. Rectal ulcers

This refers to ulcers in the rectum that can cause rectal pain. These sores can bleed as well, and can also lead to constipation, discharge, and an inability to control bowel movements. A study published in Medicine states that a rectal ulcer may not only end at sores, and can lead to complications in the other parts of the rectum as well as the digestive tract.

7. Anal Fistula

Anal fistula is pus discharge around the anus. The anus has glands around it that help lubricate it by secreting oils. The infection of these glands results in an infected cavity. Tunnels that connect this infected gland to the anus are called anal fistulas. If the infection goes untreated, then a fistula can develop. This can lead to swelling in the area, difficult, bloody bowel movements, as well as fever.

What is Proctalgia Fugax?

Proctalgia fugax is a condition where a person experiences sudden and intense pain in the rectum or anus that lasts for a short time, often ranging from a few seconds to minutes. “The pain can be sharp or cramp-like and may happen without warning or because of certain triggers like stress or bowel movements. It’s thought to happen because of muscle spasms in the rectum or anal canal,” explains Dr Prabhakar. Although it doesn’t cause long-term harm, it can be very uncomfortable. Treatment options include lifestyle changes, relaxation techniques, or medications to help manage the pain during severe episodes.

What is Levator Ani Syndrome?

Levator ani syndrome is a condition where a person experiences recurring pain or discomfort in the lower pelvic area, particularly around the rectum. The pain feels like a dull ache or pressure and may happen without any visible problems in that area. “It is thought to be caused by muscle spasms in the pelvic floor. Triggers for the pain may include stress, sitting for long periods, or certain foods. Treatment involves making lifestyle changes, doing physical therapy, using relaxation techniques, and sometimes taking medications to help manage the symptoms and improve quality of life,” says Dr Prabhakar.

What is Proctitis?

Proctitis is when the lining of the rectum becomes inflamed, causing symptoms like rectal pain, urgency to have a bowel movement, bleeding, discharge, or diarrhea. “It can happen due to infections, inflammatory bowel diseases, radiation therapy, or certain medications. Treatment of this depends on the cause and may include medications, dietary changes, or other therapies to manage symptoms and help the rectal lining to heal,” says Dr Prabhakar.

Other infections, inflammation that can cause rectal pain

Other than the mentioned infections and inflammatory issues, rectal pain can be caused by:

• Sexually transmitted diseases like gonorrhea, chlamydia, syphilis, or herpes
• Bacterial infections like bacterial proctitis
• Tuberculosis, fungal infections such as candidiasis.
• Viral infections like cytomegalovirus or human papillomavirus.
• Inflammatory conditions like proctalgia fugax, levator ani syndrome, or chronic proctitis can also result in rectal discomfort without any infection.

What is Rectal Prolapse?

Rectal prolapse happens when the rectum, which is the last part of the large intestine, slides down through the anus. This occurs when the muscles and tissues supporting the rectum weaken or get damaged. “It can cause feelings of bulging or fullness in the rectal area, discomfort, pain, bleeding, or difficulty controlling bowel movements. Treatment options depend on how severe the prolapse is and may include lifestyle changes, exercises, medications, or surgery to fix or support the rectum and nearby tissues,” says Dr Prabhakar. According to American Society of Colon & Rectal Surgeons, women who are over the age of 50 years are six times more susceptible to rectal prolapse than men.

Symptoms that accompany rectal pain

Symptoms that commonly accompany rectal pain include:

• Discomfort or pain in the rectal area.
• Sensation of pressure or fullness in the rectum.
•  Bleeding from the rectum, which may be seen on toilet paper or in the toilet bowl.
•  Itching or irritation around the anus.
•  Difficulty passing stool or feeling like the bowels are not completely empty after a bowel movement.
•  Changes in bowel habits, such as diarrhea or constipation.
•  Swelling, lumps, or protrusions around the anus.
•  Discharge from the rectum, which may be bloody or contain mucus.
•  Involuntary leakage of stool or mucus from the rectum (fecal incontinence).

These symptoms can vary depending on the underlying cause of the rectal pain and may be mild, moderate, or severe.

How is rectal pain diagnosed?

Recognising rectal pain at home involves paying attention to signs like discomfort, bleeding, changes in bowel habits, or swelling around the anus. If you experience persistent or severe symptoms, it is important to meet a specialist. “To diagnose rectal pain, your doctor will start by asking about the pain’s characteristics and conducting a physical examination, which may include looking at the rectal area and feeling for abnormalities. Depending on the suspected cause, further tests such as colonoscopy, sigmoidoscopy, imaging tests, stool tests, or manometry may be ordered to visualize the rectum, check for infections or structural issues, and assess muscle function,” explains Dr Prabhakar.

How is rectal pain treated?

Treatment for rectal pain depends on its cause and may include medications, such as pain relievers or antibiotics, medications to relieve constipation, lifestyle changes like dietary adjustments, warm baths for soothing relief, topical treatments to reduce swelling, physical therapy exercises, or surgical procedures in severe cases.

Home remedies for rectal pain

It is advisable to consult a doctor for the right diagnosis before trying these remedies:

1. Warm water baths

Soaking in a tub of warm water for about 15-20 minutes a few times a day can help reduce inflammation, soothe discomfort, and promote healing in the rectal area.

2. Using over-the-counter creams or wipes

Applying creams, ointments, or medicated wipes that you can buy without a prescription can help with itching, pain, and swelling. Look for ingredients like hydrocortisone, or lidocaine.

3. Cold compresses and keep the area clean

Using ice packs or cold compresses on the affected area for 10-15 minutes at a time can reduce swelling and numb the area, providing temporary pain relief. After going to the bathroom, gently wash the anal area with warm water and avoid using harsh soaps or wipes that could irritate the skin.

4. Increase your fibre intake and stay hydrated

Eating more fruits, vegetables, whole grains, and legumes can help soften stools and make bowel movements easier, which reduces strain on the rectum. Drinking plenty of water can help prevent constipation, which can worsen rectal pain.

5. Avoid straining

Try not to push too hard during bowel movements. It’s better to let things happen naturally.

How long does rectal pain last?

The duration of rectal pain varies depending on its cause and individual factors. In some cases, it may last for a few hours or days and go away on its own, especially if it’s due to minor issues like constipation or a mild infection. “However, if the pain persists or becomes severe, it could indicate a more serious condition that requires medical attention. Chronic conditions such as inflammatory bowel disease or pelvic floor dysfunction may cause ongoing or recurrent rectal pain lasting for weeks, months, or longer,” says Dr Prabhakar.

How to prevent rectal pain?

To prevent rectal pain, you can:

• Maintain a healthy diet rich in fibre to prevent constipation and promote regular bowel movements.
•  Staying hydrated by drinking enough water throughout the day.
•  Avoid straining during bowel movements and establish healthy bowel habits.
•  Practice good hygiene by keeping the anal area clean and dry.
•  Exercise regularly to promote overall bowel health and prevent constipation.
•  Avoid prolonged sitting, especially on hard surfaces, to reduce pressure on the rectal area.
•  Practice safe sex to reduce the risk of sexually transmitted infections that can cause rectal pain.
•  Use caution when lifting heavy objects to avoid straining the pelvic floor muscles.
•  Manage stress levels through relaxation techniques such as deep breathing, meditation, or yoga.
•  Avoid smoking and excessive alcohol consumption, as they can contribute to digestive problems and rectal irritation.Rectal pain can be caused by both external factors and individual predispositions. For instance, things like diet, hydration, hygiene, and lifestyle habits can greatly affect rectal pain.