Differential Diagnosis for Rectal Pain

The following is a list of potential diagnoses for rectal pain, categorized for clarity and emphasis on critical conditions.

• Single Most Likely Diagnosis

  • Hemorrhoids: This is often the most common cause of rectal pain, especially if the pain is associated with bowel movements, bleeding, or a palpable mass. Hemorrhoids can be internal or external and are usually caused by increased pressure on the veins in the rectal area.

• Other Likely Diagnoses

  • Anal Fissure: A tear in the lining of the anus, which can cause sharp pain during and after bowel movements. It's often associated with constipation, diarrhea, or passing hard stools.
  • Proctalgia Fugax: A condition characterized by sudden, severe pain in the rectum that lasts for a few seconds to minutes. It's more common in women and can occur at any time, even at rest.
  • Levator Ani Syndrome: Chronic pain in the rectal area, often described as aching or pressure, which can be exacerbated by sitting. It's related to the levator ani muscle spasms.
  • Rectal Ulcer or Proctitis: Inflammation of the rectum lining, which can cause pain, bleeding, and difficulty with bowel movements. It can be due to various causes, including infections, inflammatory bowel disease, or radiation.

• Do Not Miss Diagnoses

  • Rectal Cancer: Although less common, rectal cancer can present with rectal pain, especially if the tumor is large enough to cause obstruction or invade surrounding structures.
  • Ischiorectal or Perirectal Abscess: A collection of pus in the tissue around the rectum, which can cause severe pain, fever, and swelling. It requires prompt drainage to prevent complications.
  • Thrombosed External Hemorrhoid: While usually not life-threatening, a thrombosed external hemorrhoid can cause significant pain and may require surgical intervention for relief.

• Rare Diagnoses

  • Coccydynia: Pain in the coccyx (tailbone) area, which can radiate to the rectum. It's often due to a fall or trauma to the area.
  • Pudendal Neuralgia: Pain due to irritation or damage to the pudendal nerve, which supplies the rectal area among others. It can cause chronic pain that is exacerbated by sitting.
  • Solitary Rectal Ulcer Syndrome: A condition characterized by ulcers in the rectum, often associated with chronic constipation, straining during bowel movements, or rectal prolapse.