Rectal pain is almost always caused by something common and treatable. The most frequent culprits are hemorrhoids, anal fissures, and muscle spasms in the pelvic floor. Less often, the pain signals an infection, an abscess, or inflammation that needs medical attention. Understanding the pattern of your pain, when it happens, and what else accompanies it can help you narrow down what’s going on.
Hemorrhoids: The Most Common Cause
Hemorrhoids are swollen veins in or around your anus and rectum, and they’re the single most likely explanation for rectal discomfort. The pain from hemorrhoids tends to feel like a dull ache, pressure, or throbbing that lingers throughout the day rather than spiking at one particular moment. External hemorrhoids, the ones you can sometimes feel as a soft lump near the opening, are often tender to the touch and can make sitting uncomfortable.
Internal hemorrhoids usually don’t hurt at all unless they prolapse (slide out through the opening). What they do cause is bright red blood on toilet paper or in the bowl. If you’re seeing blood but not feeling much pain, internal hemorrhoids are a strong possibility. The main triggers are straining during bowel movements, passing hard stools, chronic constipation or diarrhea, pregnancy, and regularly lifting heavy objects. All of these increase pressure on the veins in that area.
Anal Fissures: Sharp Pain During Bowel Movements
If the pain is sharp, searing, or feels like a tear specifically during or right after a bowel movement, an anal fissure is the likely cause. A fissure is a small tear in the thin lining of the anal canal. The intense pain during the bowel movement is often followed by a deep ache that can last anywhere from a few minutes to several hours afterward. About 7 to 8 percent of people will experience a fissure at some point in their lives, and they’re especially common in younger, otherwise healthy adults.
Fissures and hemorrhoids share most of the same triggers: straining, hard stools, chronic diarrhea, and childbirth. The key difference is the quality and timing of the pain. Hemorrhoid pain is more of a constant, low-grade discomfort. Fissure pain is intense, directly tied to passing stool, and then gradually fades.
Muscle Spasms in the Pelvic Floor
Some rectal pain has nothing to do with a visible injury or swelling. Levator ani syndrome and a related condition called proctalgia fugax are caused by spasms in the muscles surrounding the rectum. The hallmark of this type of pain is that it’s typically unrelated to bowel movements. It can come on spontaneously, flare up while sitting, or even wake you from sleep.
Episodes usually last less than 20 minutes, though in severe cases the pain can persist for hours and recur frequently. The sensation is often described as a deep, pressing ache high in the rectum. If your rectal pain seems random and disconnected from anything happening in the bathroom, pelvic floor muscle spasms are worth considering. Stress, prolonged sitting, and tension in the pelvic area can all contribute.
Abscesses and Fistulas
A perianal abscess is a pocket of pus that forms in the deep tissue around the anus. It causes throbbing, constant pain that tends to get progressively worse over days. The area often becomes swollen, red, warm to the touch, and you may develop a fever. Abscesses don’t resolve on their own and need to be drained.
If an abscess doesn’t heal properly, it can leave behind an abnormal tunnel between the inside of the rectum and the skin near the anus, called a fistula. Fistulas cause persistent drainage, irritation, and recurring pain in the same area. Both conditions require medical treatment rather than home care.
Proctitis: Inflammation of the Rectal Lining
Proctitis refers to inflammation in the last 10 to 12 centimeters of the rectum. It causes anorectal pain, a persistent feeling that you need to have a bowel movement even when you don’t (called tenesmus), and sometimes mucus or pus-like discharge. The two main categories of proctitis look very similar from the outside but have different causes.
Infectious proctitis is caused by sexually transmitted infections, particularly gonorrhea, chlamydia, herpes, and syphilis. It’s most common in people who have receptive anal sex. Inflammatory bowel disease, specifically ulcerative colitis, can also cause proctitis. Because the symptoms overlap so heavily, the CDC notes that infectious proctitis is sometimes mistaken for inflammatory bowel disease, which delays proper treatment. If you have rectal pain with discharge, urgency, or diarrhea, especially after sexual contact, getting tested for STIs is an important step.
When Rectal Pain Could Be Something Serious
Anal cancer is uncommon, but it’s worth knowing the signs because it’s frequently misdiagnosed as hemorrhoids. Both can cause pain during bowel movements, bleeding, and itching. What distinguishes cancer is a lump in or around the anus that persists and grows, along with systemic symptoms like unexplained weight loss, fatigue, or pelvic pain. Changes in bowel habits that don’t improve, difficulty controlling bowel movements, and bleeding that doesn’t respond to typical hemorrhoid treatments are reasons to get evaluated further.
Certain symptoms call for immediate attention: rectal bleeding that’s heavy or won’t stop, especially if accompanied by lightheadedness or dizziness; and rectal pain that rapidly worsens, spreads, or comes with fever, chills, or discharge. These can indicate a serious infection or significant blood loss.
What Happens at the Doctor’s Office
If your rectal pain doesn’t improve with home care or you have concerning symptoms, a doctor will typically start with a visual exam and a brief internal look using an anoscope. This is a small, 7-centimeter instrument that requires no preparation beforehand and lets the doctor see hemorrhoids, fissures, or signs of infection around the anal canal. It takes just a few minutes.
If more information is needed, a flexible sigmoidoscopy allows a view further up into the rectum and lower colon. This is more comfortable than older rigid instruments and allows the doctor to take tissue samples or photograph areas of concern. It does require an enema beforehand to clear the rectum. Neither procedure is something to dread, and both provide answers relatively quickly.
Home Relief That Actually Works
For hemorrhoids and fissures, the most effective home treatment is a sitz bath: sitting in a few inches of warm water at about 104°F (40°C) for 15 to 20 minutes. Doing this three to four times a day can significantly reduce pain, itching, and swelling. You can use a shallow basin that fits over your toilet seat or simply fill a bathtub with a few inches of water.
The other major intervention is softening your stools so they pass without straining. The recommended fiber intake is 14 grams per 1,000 calories you eat, which works out to about 28 grams per day on a standard 2,000-calorie diet. Most people fall well short of that. Increasing fiber through fruits, vegetables, beans, and whole grains, or adding a fiber supplement, makes bowel movements easier and takes pressure off irritated tissue. Drinking plenty of water alongside the extra fiber is essential, because fiber without adequate fluid can actually worsen constipation.
Avoiding prolonged sitting on the toilet, not straining or pushing during bowel movements, and going when you first feel the urge rather than delaying all help prevent recurrence. Over-the-counter topical creams or ointments designed for hemorrhoids can provide temporary relief from itching and mild pain, though they won’t fix the underlying issue.