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Anal Pain (Proctalgia)

Introduction
Anal pain (pain in the bottom) can be distressing, but is often just the result of a minor, treatable condition.
The medical name for pain in and around the anus or rectum (back passage) is proctalgia.

Causes
Rectal pain is pain or discomfort in the lower portion of the gastrointestinal tract. The term is often used interchangeably with pain in the anus or anal pain. It is a fairly common problem and can result from conditions such as hemorrhoids or anal fissures
Anal fissures
An anal fissure is a small tear in the skin of the anus that can be caused by passing a large or hard poo.
Symptoms of an anal fissure can include:
  1. a severe, sharp pain when doing a poo
  2. a burning or gnawing pain that lasts several hours after doing a poo
  3. rectal bleeding – you may notice a small amount of blood on the toilet paper after you wipe
  4. Anal fissures can be very painful, but many heal on their own in a few weeks. Increasing the amount of fibre in your diet, drinking plenty of fluids and taking laxatives and over-the-counter painkillers can help.

If the pain persists, you may need special ointment that relaxes the ring of muscle around your anus. Occasionally, surgery may be needed to help the fissure heal.
Read more about treatments for anal fissures.
Haemorrhoids (piles)
Haemorrhoids (piles) are swellings containing enlarged blood vessels that are found inside or around the bottom. They're often thought to be caused by straining on the toilet as a result of prolonged constipation.
In many cases, haemorrhoids don't cause symptoms. When symptoms do occur, they may include:
  1. Bleeding after doing a poo
  2. An itchy bottom
  3. Feeling like there's a lump in or around your anus
  4. Soreness and redness around your anus

Anal pain, if the blood supply to the haemorrhoid becomes blocked or interrupted – for example, by a blood clot
The symptoms often pass after a few days. Increasing the amount of fibre in your diet, drinking plenty of fluids and taking laxatives and over-the-counter painkillers can help.
If the blood supply to the haemorrhoid has been blocked by a clot, a simple procedure can be carried out to remove the clot under local anaesthetic (where the area is numbed).
Anal fistulas and abscesses
An anal fistula is a small tunnel that develops between the end of the bowel and the skin near the anus. It's usually caused by an infection near the anus resulting in a collection of pus (an abscess).
Symptoms of an anal fistula or abscess can include:
  1. A constant, throbbing pain that may be worse when you sit down
  2. Skin irritation around the anus
  3. Passing pus or blood when you poo
  4. Swelling and redness around your anus
  5. A high temperature (fever)

Your doctor may prescribe antibiotics if an abscess is picked up early on. If it persists, it may need to be drained in hospital, possibly under general anaesthetic (while you're asleep).
If a fistula develops, surgery will usually be needed because they rarely heal by themselves.
Read more about treatments for anal fistulas.
Other causes
Less common causes of anal pain include:
  1. Anal cancer
  2. Anal itching (pruritus ani)
  3. Anal sex
  4. Coccydynia or coccygodynia (tailbone pain)
  5. Chronic constipation
  6. Crohn's disease (a type of inflammatory bowel disease)
  7. Diarrhea (causing anal irritation)
  8. Fecal impaction (a mass of hardened stool in the rectum due to chronic constipation)
  9. Levator ani syndrome (spasm in the muscles that surround the anus)
  10. Perianal abscess (pus in the deep tissue around the anus)
  11. Perianal hematoma (a collection of blood in the perianal tissue caused by a ruptured vein, sometimes called an external hemorrhoid)
  12. Proctalgia fugax (fleeting pain due to rectal muscle spasm)
  13. Proctitis (inflammation of the lining of the rectum)
  14. Solitary rectal ulcer syndrome (ulcer of the rectum)
  15. Thrombosed hemorrhoid (blood clot in a hemorrhoid)
  16. Trauma
  17. Ulcerative colitis (a type of inflammatory bowel disease)
  18. Ulcerative proctitis (a type of inflammatory bowel disease)

Treatment
Many common causes of anal pain will improve with simple self-care treatments, so you don't always need to see your GP.
But it's a good idea to see your GP if:
your pain is severe
your pain doesn't improve after a few days
you also experience rectal bleeding
Don't feel embarrassed to see your GP – anal pain is a common problem that they're used to seeing. Your GP can try to work out what the problem is and give you treatment advice.
They'll probably ask to see your bottom and may carry out a rectal examination (where they gently insert a gloved finger into your bottom) to check for any abnormalities.
If the cause is not immediately obvious, they may refer you to a specialist for advice and further tests.

Self care 
Depending on the cause of your anal pain, there are some measures you can try at home to get relief.
They include:
  1. Eating more fruits, vegetables and whole grains, exercising daily, and taking stool softeners, if needed, to facilitate bowel movements, reduce straining and ease pain
  2. Sitting in a tub of hot water up to your hips — known as a sitz bath — several times a day to ease the pain of hemorrhoids, anal fissures or rectal muscle spasms
  3. Applying over-the-counter hemorrhoid cream for hemorrhoids or hydrocortisone cream for anal fissures
  4. Taking an over-the-counter pain reliever such as acetaminophen (Tylenol, others), aspirin or ibuprofen (Advil, Motrin IB, others)

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