Differential Diagnosis for Anal Pain

• Single most likely diagnosis
  • Hemorrhoids: This is often the most common cause of anal pain, especially if the pain is associated with bowel movements, bleeding, or a palpable mass.
• Other Likely diagnoses
  • Anal fissure: A tear in the lining of the anus can cause severe pain during and after bowel movements, often accompanied by bleeding.
  • Proctalgia fugax: A condition characterized by sudden, severe anal pain that lasts for a few seconds to minutes, often at night.
  • Levator ani syndrome: Chronic pain in the anal region due to spasms of the levator ani muscle, which can be exacerbated by sitting.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Anal cancer: Although rare, anal cancer can present with anal pain, bleeding, or a palpable mass, and early detection is crucial for treatment.
  • Rectal abscess: A collection of pus in the rectum can cause severe anal pain, fever, and swelling, requiring prompt drainage to prevent complications.
  • Ischiorectal abscess: Similar to a rectal abscess but located in the ischiorectal fossa, it can cause severe pain and requires drainage.
• Rare diagnoses
  • Coccydynia: Pain in the coccyx (tailbone) area, often due to trauma or falls, which can radiate to the anal region.
  • Pudendal neuralgia: Pain due to irritation or damage to the pudendal nerve, which can cause anal, perineal, or genital pain.
  • Inflammatory bowel disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause anal pain, among other symptoms, due to inflammation of the bowel.