Rectal Pain Differential Diagnosis
The differential diagnosis for rectal pain is broad and can be categorized into several groups. Here's a breakdown of the possible causes:
- Single most likely diagnosis
- Anal fissure: This is a common cause of rectal pain, especially if the pain is sharp and worsens during or after bowel movements. The pain is often accompanied by bleeding.
- Other Likely diagnoses
- Hemorrhoids: Internal or external hemorrhoids can cause rectal pain, especially if they are thrombosed or prolapsed.
- Proctalgia fugax: A condition characterized by sudden, severe rectal pain that lasts for a few seconds to minutes.
- Levator ani syndrome: A condition that causes chronic or recurring rectal pain due to spasms of the levator ani muscle.
- Rectal abscess: A collection of pus in the rectum that can cause pain, swelling, and fever.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Rectal cancer: Although less common, rectal cancer can cause rectal pain, especially if the tumor is large or has invaded surrounding tissues.
- Ischemic proctitis: A condition caused by reduced blood flow to the rectum, which can lead to pain, bleeding, and potentially life-threatening complications.
- Inflammatory bowel disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause rectal pain, diarrhea, and bleeding.
- Infectious proctitis: Infections like gonorrhea, herpes, or HIV can cause rectal pain, discharge, and bleeding.
- Rare diagnoses
- Coccydynia: Pain in the coccyx (tailbone) that can radiate to the rectum.
- Pudendal neuralgia: A condition that causes chronic pain in the distribution of the pudendal nerve, which can include the rectum.
- Solitary rectal ulcer syndrome: A condition characterized by ulcers in the rectum, which can cause pain, bleeding, and difficulty with bowel movements.
- Rectal endometriosis: A condition where endometrial tissue grows in the rectum, causing pain, bleeding, and other symptoms during menstruation.