Differential Diagnosis for Rectal Pain
Single Most Likely Diagnosis
- Levator ani syndrome: This condition is characterized by recurrent, severe pain in the rectal area, often accompanied by a feeling of pressure or spasm. It is a common cause of rectal pain without an obvious anatomic abnormality like hemorrhoids or anal fissure.
Other Likely Diagnoses
- Proctalgia fugax: A condition that causes sudden, severe pain in the rectum, often at night. It is usually fleeting but can be very painful.
- Anal spasm: Spasm of the anal sphincter muscles can cause rectal pain, and it may be triggered by various factors, including stress or certain foods.
- Rectal ulcer or proctitis: Inflammation or ulceration of the rectal mucosa can cause pain, and this might be due to various causes including inflammatory bowel disease, infection, or radiation.
Do Not Miss Diagnoses
- Rectal cancer: Although less common, rectal cancer can present with rectal pain, especially if the tumor is large or has invaded surrounding structures.
- Inflammatory bowel disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause rectal pain, along with other symptoms such as diarrhea, bleeding, and weight loss.
- Infections (e.g., abscess, cellulitis): Infections in the rectal area can cause severe pain and require prompt treatment to prevent serious complications.
- Ischiorectal or perirectal abscess: An abscess in the tissue around the rectum can cause significant pain and may require drainage.
Rare Diagnoses
- Coccydynia: Pain in the coccyx (tailbone) area can sometimes be referred to the rectum, especially if the coccyx is fractured or inflamed.
- Pudendal neuralgia: This is a rare condition characterized by pain in the distribution of the pudendal nerve, which can include the rectal area.
- Endometriosis: In rare cases, endometriosis can cause rectal pain, especially if endometrial tissue grows in the rectovaginal septum or on the rectum itself.