From the Guidelines
Rectal pain is most commonly caused by anorectal abscesses, anal fissures, and hemorrhoids 1. Other possible causes include proctitis, rectal ulcers, inflammatory bowel disease, constipation, diarrhea, and rectal infections. In some cases, rectal pain can be a symptom of a more serious underlying condition, such as rectal cancer or pelvic floor dysfunction.
Common Causes of Rectal Pain
- Anorectal abscesses: characterized by infection in the soft tissue around the anus, often presenting with perianal pain, swelling, and fever 1
- Anal fissures: typically causing postdefecatory pain and minor rectal bleeding 1
- Hemorrhoids: can cause bleeding, protrusion, itching, and pain, especially when thrombosed or prolapsed 1
Diagnosis and Treatment
It is essential to consult a healthcare professional for a thorough evaluation and diagnosis, which may include a physical exam, digital rectal exam, or imaging tests such as a colonoscopy or MRI 1. Treatment options may include over-the-counter pain relievers like acetaminophen or ibuprofen, stool softeners, and topical creams or ointments like lidocaine or hydrocortisone [@Example@]. In some cases, prescription medications like muscle relaxants or antidepressants may be necessary to manage chronic pain.
Prevention and Management
In general, it is recommended to avoid straining during bowel movements, practice good hygiene, and avoid scratching the rectal area to prevent further irritation [@Example@]. A high-fiber diet and adequate hydration can also help prevent constipation and reduce rectal pain. If symptoms persist or worsen, seek medical attention promptly. Laboratory and radiological studies may be useful in specific situations, such as assessing the severity of illness or identifying underlying conditions like Crohn's disease 1.
From the Research
Causes of Rectal Pain
The causes of rectal pain can be varied and complex. Some of the possible causes include:
- Anal fissures, which can be caused by trauma to the anal canal during defecation, resulting in a tear in the anoderm and subsequent pain and spasm 2
- Anorectal and perineal pain, which can be caused by conditions such as proctitis, anal venous thrombosis, or neoplasms, as well as functional anorectal pain or pathologies like interstitial cystitis or pudendal neuralgia 3
- Proctitis, which is usually caused by sexually transmitted infections that can be treated with antibiotics 4
- Hemorrhoids, which can cause pain, itching, and bleeding, and can be treated with a high-fiber diet, ligature therapy, or surgery depending on their size 5
- Perianal abscess or fistula, which can cause throbbing and continuous pain, and require incision and drainage or surgical treatment 5
Specific Conditions
Some specific conditions that can cause rectal pain include:
- Anal fissures, which can persist due to a cycle of hard stools, pain, and reflex spasm 2, 5
- Proctalgia fugax, which is a sharp paroxysmal pain lasting for maximum 30 minutes, and levator ani syndrome, which is characterized by a tender puborectal muscle on digital rectal examination and pain lasting for more than 30 minutes 3
- Coccycodynia, which is a non-functional disorder caused by painful palpation of the os coccygis, and can be treated with anti-inflammatory medications, os coccygis mobilisation, and infiltration therapy 3
- Neurogenic anorectal pain, which can be caused by conditions such as chronic prostatitis or interstitial cystitis, and can be treated with anti-inflammatory medications, pain modulating antidepressives, anticonvulsives, or local infiltration therapy 3