It may be something that you might be ashamed to talk about with your friends and family, but the reality is that anal pain is so common that at least once in a lifetime everybody experiences it.

Pain from the anus can extend to the area around it and to the rectum (the last portion of the large intestine).

Depending on the cause of the pain, this can be sharp and easy to localize or it can be dull and more diffuse.

Other symptoms may be associated with the pain including bleeding, mucous discharge, and swelling.

What are the Main Causes of Anal Pain?

  • Anal Fissure: A tear in the lower part of the anal canal that is extremely painful during bowel movements.
  • Anal Abscess: A pus collection in or around the anus caused by infection of the anal glands.
  • Hemorrhoids: Swollen veins in the anal canal that become painful if they cannot be pushed back or if their blood supply is compromised.
  • Anal and Pelvic Floor Spasm: A condition where the muscles in and around the anus fail to relax.
  • Inflammatory Bowel Diseases: Conditions associated with chronic inflammation of the anus and rectum (e.g. Chron’s disease and Ulcerative Colitis).
  • Skin disorders: Fungal or bacterial infections, psoriasis, warts, etc.

Additional reading resource: Hemorrhoid pain relief – Epsom salt bath

How is Anal Pain Assessed?

Anal Pain

Photo Credit: Pexels

It is very important to take a detailed history from the patient and know the onset of pain, exact location, duration, associated symptoms, and exacerbating factors.

A sharp pain that is caused by the passage of stool is usually related to an anal fissure, while a constant pain may be a sign of an inflammatory or infective process.

A visual inspection of the anal region will show any signs of a skin infection, prolapsing hemorrhoids, or the external orifice of an anal fistula. Parting gently the buttocks and asking the patient to bear down may show an anal fissure usually located on the backside of the anus.

A digital rectal examination is of paramount importance to assess the tone of the muscles and to check for any induration or masses.

Examination with an anoscope and rigid proctoscope in the outpatient clinic allows one to visualize the lining of the anus and rectum and look for internal hemorrhoids, inflammation, or tumors. In some cases, a colonoscopy is required.

What is the Treatment of Anal Pain?

Treatment options will depend on the cause of the pain. Anal fissures can be treated conservatively with laxatives, muscle relaxants, botulinum toxin injection and only occasionally require surgery.

Hemorrhoids causing pain are usually complicated and prolapsing and likely require surgical intervention, especially if recurring symptoms. Infections can be treated with antibacterial or antifungal medications.

Abscesses will need to be drained and the pus sent for microbiological examination to identify the type of bacteria involved. Anal fistula treatment is almost exclusively surgical.

The anal spasm can be managed with muscle relaxants and botulinum toxin injection. Pelvic floor dysfunction can be treated with biofeedback. Inflammatory bowel diseases will be first treated with medications in collaboration with the gastroenterologist, and by surgery if failure of medical treatment.

The use of minimally invasive techniques (laser, video-endoscopy) for the surgical treatment of anal diseases allows for minimal postoperative pain and quick return to everyday activities.

Who is a Proctologist?

A proctologist, better known as a colorectal surgeon, is a general surgeon with a subspecialization and extensive training in the diseases of the colon, rectum, and anus.

As regards diseases of the anus, it is very important to seek the help of a proctologist who will make a correct diagnosis and suggest the best treatment.

Inappropriate surgical intervention may lead to complications, such as fecal incontinence or anal stenosis that greatly impact the quality of life.

About the Author:

Prof. Dr. Antonio Privitera is an internationally renowned UK and USA-trained colorectal surgeon working in NMC Royal Hospital, Dubai Investment Park.

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