The rectum is a part of the digestive system that begins at the lower part of the large intestine and ends at the anus. Rectal pain can occur as a result of injury, inflammation, or infections that affect the rectum or anus.

People may experience rectal pain at particular times, such as when sitting, walking, or during bowel movements. Depending on the underlying cause of the pain, people may experience additional symptoms, such as constipation, rectal bleeding, or pressure in the pelvic area.

There are many possible causes of rectal pain, so it is important for people to contact a healthcare professional for a diagnosis and appropriate treatment.

This article lists some potential causes of rectal pain according to when the pain is likely to occur. We also list remedies for rectal pain and possible accompanying symptoms. Finally, we provide information on diagnosis and when to contact a doctor.

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Below are some potential causes of rectal pain. In some cases, they may occur alongside the appearance of symptoms.

When sitting

Hemorrhoids, also called piles, are swollen and inflamed veins around the anus or in the lower rectum. They can be external or internal.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), external hemorrhoids can cause rectal pain or ache when sitting.

Other possible symptoms include:

  • anal itching
  • hard, sensitive lumps around the anus
  • anal ache or pain

The NIDDK states that the symptoms of external hemorrhoids typically resolve within a few days.

When an internal hemorrhoid bulges out into the rectum, it becomes a prolapsed hemorrhoid. This is a common cause of rectal discomfort, pain, and pressure.

Internal hemorrhoids that have not prolapsed are usually not painful, but people may experience bleeding from the rectum.

When walking

A thrombosed external hemorrhoid is a blood clot that occurs in an external hemorrhoid.

According to the American Society of Colon and Rectal Surgeons (ASCRS), large, thrombosed external hemorrhoids can cause pain when walking, when people sit, or during a bowel movement.

People may have an anal mass that appears suddenly and causes pain. According to the ASCRS, the pain may worsen during the first 48 hours but then ease off over the following few days. If the skin covering the blood clot opens, people may also experience bleeding.

When urinating

Prostatitis is inflammation of the prostate gland. The prostate gland is located below the bladder and in front of the rectum. Its primary function is to make seminal fluid.

Prostatitis occurs when the prostate becomes infected with bacteria from the urine or rectum. The condition may cause pain when urinating, along with rectal pain or pressure.

Other possible symptoms of prostatitis include:

When lying down

Levator syndrome (LS) is a condition that causes episodic pain in the rectum or bony structures at the base of the spine. Experts do not know the exact cause of LS. However, it is likely due to the spasm of the levator muscles in the pelvic floor. People may experience spasms for no clear reason or after having a bowel movement.

LS can cause pain or a dull ache in the rectum, anus, or tailbone. According to the ASCRS, sitting or lying down can worsen LS symptoms.

At night

Proctalgia fugax (PF) is sudden and intense pain in the rectum that can last for several minutes at a time. The condition typically occurs at night and may wake a person from sleeping. However, it can also happen during the day.

PF likely occurs as a result of spasms in the rectum or pelvic floor muscles.

When coughing

Rectal prolapse is the medical term for when the rectum falls out of place and drops through the anus. A person who has a rectal prolapse may feel a bulge from their anus when straining, such as when coughing, sneezing, or heavy lifting.

Rectal prolapse can cause pressure and pain in the rectum or anus. Other symptoms may include:

During ovulation

Some people may experience uncomfortable or painful symptoms during the ovulation phase of their menstrual cycle. In certain cases, severe pain can be a sign of an underlying health condition, such as endometriosis.

Endometriosis is a condition in which tissue similar to the uterus lining grows in abnormal places, such as the bowels. If endometriosis is present in the rectal area, it can cause pressure on the rectal wall, resulting in the following symptoms:

During a period

During menstruation, the body releases chemicals called prostaglandins. High levels of prostaglandins can cause the bowel wall to contract, causing pain, cramping, and diarrhea.

People with irritable bowel syndrome (IBS) may experience changes in their symptoms throughout the menstrual cycle, and these may correspond to natural hormone fluctuations. According to the Canadian Society of Intestinal Research, studies have found that people with IBS may experience an increase in rectal sensitivity during their period.

During pregnancy

A 2018 study assessed anal pain in 94 females in weeks 19–25 of pregnancy. Participants filled out a questionnaire reporting on anal symptoms throughout the following stages of pregnancy:

According to the results, 68% of participants experienced anal symptoms, with anal pain being the most common. Other anal symptoms included:

  • constipation
  • an inability to control bowel movements
  • hemorrhoidal complications
  • anal fissures

Risk factors for anal symptoms included constipation and medical history of anal problems.

After a hysterectomy

A hysterectomy is a medical term for the removal of the uterus. In some cases, a hysterectomy can weaken the connective tissue between the rectum and the vagina. This can cause a rectocele, a type of prolapse in which the rectum pushes into the vagina.

People may experience symptoms of a rectocele in the rectum, vagina, or both. Symptoms may include:

  • pressure in the pelvis
  • pain in the abdomen or lower back
  • a sensation of something falling down within the pelvis
  • feeling a mass within the vagina
  • vaginal bleeding that is not due to the menstrual cycle
  • constipation
  • difficulty having bowel movements
  • bowels not feeling empty after a bowel movement
  • in some cases, the inability to control a bowel movement

Standing up may worsen symptoms, whereas lying down may ease them.

Before or after a bowel movement

An anal fissure is a small tear in the lining of the anal canal, which is the end of the large intestine between the rectum and anus.

Anal fissures can cause sharp pain, which may begin with a bowel movement and can continue for a few minutes to hours. Other symptoms may include bright red blood in the stool or on toilet paper after having a bowel movement or a skin tag, or a small lump that appears near the anal fissure.

After a colonoscopy

A colonoscopy is a medical procedure that involves inserting a flexible tube called an endoscope into the anus and through the rectum to the colon. The scope has a camera attached, which allows a doctor to see inside the colon.

People may experience some mild pain or pressure during a colonoscopy. However, a doctor can provide a sedative to help reduce any discomfort.

Gentle movement and walking may help to alleviate any anal, rectal, or gas pains after the procedure.

During or after receptive anal intercourse or instrumentation

The skin around the rectum is very sensitive. Friction from sexual activity involving the anus or inserting objects into the rectum can cause injury, irritation, swelling, or bleeding.

Anal sex is mostly safe. If a person experiences pain during or after anal sex, they may need to increase lubrication.

Individuals who engage in unprotected anal intercourse are at a greater risk of anorectal infections. The most common symptom is a frequent or continuous urge to have a bowel movement. Other symptoms may also include anorectal pain or discomfort.

Learn about how to practice anal sex safely here.

Other medical conditions that can cause rectal pain include:

Inflammatory bowel disease

Inflammatory bowel disease (IBD) is a term for two conditions: Crohn’s disease and Ulcerative colitis (UC). These conditions cause chronic inflammation of the gastrointestinal tract.

Crohn’s most often affects the portion of the small intestine before the large intestine and colon. UC is a long-term condition where the colon and rectum become inflamed.

However, if UC only affects the rectum, it is called proctitis. People with this condition may experience pain in the rectal area.

Other symptoms include:

Research has shown that proctitis has also resulted from medical procedures. Chronic radiation proctitis is a side effect that affects 5–20% of people receiving radiation treatment for cancer. A case report from 2000 also demonstrates that one person developed ulcerative proctitis 10 months after a fecal microbiota transplant.

Stercoral ulcers

Stercoral ulcers occur when a person has chronic constipation leading to stagnation of fecal matter.

Multiple areas of ulceration can present in the colon. The most common locations of ulceration are in the sigmoid colon and the rectum.

Anorectal cancer

Anorectal cancer refers to any cancer that affects the anus or rectum.

With anal cancer, a person may not experience symptoms straightaway. They may notice anal bleeding, which people often mistake for hemorrhoids.

Other symptoms of anal cancer include:

  • rectal itching
  • a lump where the anus opens
  • a feeling of fullness or pain at the anus
  • changes in bowel movements, including narrower stools
  • anal discharge
  • swollen lymph nodes at the anus or groin
  • difficulty controlling bowel movements

Many of these symptoms may have causes that are not related to anorectal cancers. However, if a person notices these symptoms, it is important they contact a doctor.

The treatment options for rectal pain may vary depending on the underlying cause.

To relieve general pain around the rectum and anus, people can try the following:

  • taking a sitz bath or sitting in warm water for a few minutes
  • gently washing the area with lukewarm water, particularly after a bowel movement or sweating
  • avoiding using any irritating detergents or soap
  • wearing breathable, cotton underwear
  • wearing loose, comfortable clothing
  • avoiding sitting for long periods
  • sitting on a cushion or rubber ring to relieve pressure
  • taking over-the-counter pain medication to alleviate pain
  • using a stool softener, making stools easier to pass
  • eating a diet high in fiber and drinking plenty of water to prevent constipation and straining during a bowel movement
  • taking any medications according to the prescribing doctor’s instructions

Some conditions may require surgical treatment if a person experiences severe or persistent symptoms that do not respond to more conservative treatment. Examples include:

  • severe fissures
  • severe fistulas
  • severe hemorrhoids

A person who experiences rectal pain may also experience accompanying symptoms. Depending on the cause of the rectal pain, these may include:

  • a feeling of pressure in the anal, rectal, or pelvic area
  • a sensation of the bowels not emptying fully after a bowel movement
  • difficulty having bowel movements
  • gas and gas pains
  • leakage or an inability to control bowel movements
  • rectal or anal bleeding

A doctor may carry out a rectal examination to diagnose the cause of rectal pain.

During a rectal examination, a person will lie down on their left side, with their knees curled towards their chest. A doctor will then insert a lubricated, gloved finger into the rectum to feel for any problems. People may need to squeeze around the finger to test muscle function.

Depending on the person’s symptoms, a doctor may also carry out additional tests. These may include:

  • Endorectal ultrasound: This allows a doctor to see images of the rectal wall and surrounding areas. It can be useful in showing rectoceles or rectal prolapse.
  • Anorectal manometry: This test assesses the function and strength of muscles around the rectum.
  • Videodefecogram: This is a specialized X-ray to show muscle function during bowel movements.

People who experience any of the following symptoms will need to contact a doctor:

  • rectal pain that does not ease or eases and then returns
  • severe pain or other symptoms
  • ongoing rectal bleeding
  • a visible or palpable mass that does not improve
  • recent trauma to the anus

People may experience rectal pain for a variety of reasons, including pregnancy, hemorrhoids, and muscle spasms. Depending on the cause, symptoms may ease or worsen with a change of position, such as sitting, lying down, or walking.

People may be able to ease rectal pain with home remedies, such as taking a warm bath, sitting on a cushion, or taking pain relief medication.

A person will need to contact a doctor if they experience persistent or worsening rectal pain, rectal bleeding, or any other concerning symptoms.