Differential Diagnosis for Rectal Pain Increasing in Severity

Single Most Likely Diagnosis

• Anal fissure: This condition is characterized by a tear in the lining of the anus, which can cause severe pain during and after bowel movements. The pain can increase in severity over time if left untreated, making it a likely candidate for the single most likely diagnosis.

Other Likely Diagnoses

• Hemorrhoids: Enlarged veins in the rectum or anus can cause pain, especially if they become thrombosed. The pain can increase as the condition progresses or if the hemorrhoids become more inflamed.
• Proctalgia fugax: This condition involves sudden, severe pain in the rectum that can last from a few seconds to several minutes. While the pain is typically intermittent, frequent episodes could be perceived as increasing in severity over time.
• Levator ani syndrome: Characterized by chronic pain or discomfort in the rectum, this condition can cause the sensation of rectal pain that increases in severity, especially with prolonged sitting or during bowel movements.

Do Not Miss Diagnoses

• Rectal cancer: Although less common, rectal cancer can cause rectal pain that increases in severity over time. Early detection is crucial, making it a "do not miss" diagnosis.
• Inflammatory bowel disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause rectal pain, among other symptoms. The severity of the pain can increase as the disease progresses or during flare-ups.
• Ischiorectal abscess: An abscess in the ischiorectal fossa can cause severe, increasing pain in the rectal area. Prompt diagnosis and treatment are necessary to prevent complications.

Rare Diagnoses

• Coccydynia: Pain in the coccyx (tailbone) can sometimes be referred to the rectal area, causing the sensation of rectal pain. This condition is relatively rare and usually follows a traumatic injury to the coccyx.
• Pudendal neuralgia: This condition involves pain caused by damage to the pudendal nerve, which can manifest as rectal pain. It is less common and can be challenging to diagnose.
• Solitary rectal ulcer syndrome: This rare condition involves the presence of one or more ulcers in the rectum, which can cause rectal pain that increases in severity, especially during bowel movements.