Anal pain, which is pain in or around your bottom (anus) or back passage (rectum), is also known as proctalgia. It is a common complaint that can affect anyone, at any age.
Anal pain is often caused by a minor condition and often goes away on its own. You can usually relieve the pain yourself but if not, your GP will be able to offer treatment.
Anal pain causes include:
Occasionally, other anal pain causes include:
Rectal prolapse can also cause anal pain. This occurs when muscles that support your back passage weaken, allowing some of your rectum to bulge out of your anus. Symptoms include difficulty holding your stools in and feeling a lump in your anal area.
If all other causes have been ruled out, you may receive one of two diagnoses:
It is not fully understood what causes levator ani syndrome or proctalgia fugax. Spasms of the muscles around the anus may be involved but it is not known what triggers these spasms. These conditions are more common in people with anxiety or irritable bowel syndrome (IBS).
Talk to your doctor if you're concerned about symptoms.
You can book an appointment with a Spire private GP today.
Many causes of anal pain can be resolved with simple self-care treatments you can do at home. However, you should see your GP if you have anal pain that:
Your GP will ask about your symptoms, any pain after a bowel movement and your general health. To help with diagnosis, your GP may examine your anus and carry out a rectal examination.
They will ask you to lie down on your side, with your knees pulled up to your chest. Your GP will look for lumps, bumps, fissures and skin rashes around your anus. Then, using a gloved finger, they will feel inside your rectum to check for bleeding, lumps and tender areas. They may need to further examine your rectum using a proctoscope — a short, straight, hollow metal tube with a light at the end.
Your GP may refer you for further investigations or to a consultant, such as a gastroenterologist or colorectal surgeon. Your doctor may recommend further tests including:
You may not need all of these tests. If the results of your initial anal and rectal examination are normal, you have occasional pain and no bleeding, you may be diagnosed with proctalgia fugax and will not need further tests. Your doctor may advise that you return to see them if your symptoms change.
To help relieve anal pain, try:
Depending on the cause, your GP may recommend:
If you have proctalgia fugax, you may not need any treatment. Currently, there are no proven treatments but your doctor may recommend:
If you have levator ani, treatments include:
If another underlying condition is responsible for your anal pain, your GP or consultant will recommend treatment depending on your diagnosis.
What causes anal pain when sitting?
Anal pain when sitting is usually caused by:
A less common cause of anal pain when sitting is coccydynia, which is a painful tailbone (coccyx), usually caused by inflammation of the joint connecting the coccyx and sacrum.
What causes anal pain when menstruating?
In most cases, anal pain when menstruating is not serious. Normal symptoms of menstruation – including bloating, cramps and swelling of the womb – can put pressure on muscles in your bottom and cause them to spasm, leading to anal pain. In some women, the womb tilts towards their back instead of their front, which causes cramps in the back, buttocks and anal area.
However, severe anal pain when menstruating could be a sign of rectovaginal endometriosis. Endometriosis occurs when the cells that line your womb grows in places where they shouldn't be. Rectovaginal endometriosis is one of the most painful types of endometriosis, where the cells invade the vagina and rectum.
If you are concerned about anal pain when you menstruate, see your GP.
Why do I get sudden anal sphincter pain?
Sudden anal sphincter pain is usually caused by spasms of your anal and rectal muscles. The most common cause is proctalgia fugax, which affects up to one in every five people. Symptoms include sudden, severe bouts of anal pain that last for several seconds or minutes at a time. It is not yet known what triggers these attacks but medicines that relax the anal and rectal muscles can help.
Why do I feel anal pain when coughing?
When you cough, a band of muscles around your anus contracts. This contraction can make pain caused by an anal abscess, anal fissure, anal fistula or piles worse. Also, if you have weak muscles around your rectum, coughing can cause your rectum to bulge out of your anus (rectal prolapse), which can cause pain.
How do I get rid of anal pain?
The treatment to resolve anal pain depends on the cause. However, in many cases, anal pain will get better with simple self-care treatments, such as eating a fibre-rich diet, taking regular exercise and drinking lots of water. You can also take over-the-counter medication, such as ibuprofen or paracetamol.
If your anal pain doesn’t improve with these self-care treatments, your GP may recommend other treatments depending on the cause of your anal pain. This can include antibiotics or surgical draining for an anal abscess, laxatives or medication for an anal fissure, or surgery for haemorrhoids or an anal fistula.
If you have proctalgia fugax, you may not need any treatment. If you have levator ani, there are a range of treatment options, such as biofeedback therapy, botulinum toxin injections and nerve stimulation.