Anal Pain: Why It Hurts and When to Seek Care

Anal pain or rectal pain may feel sharp, burning, tearing, throbbing, aching, or pressure-like. Common causes include an anal fissure, a thrombosed external hemorrhoid, an anal abscess, skin irritation, rectal inflammation, constipation-related injury, or pelvic-floor muscle spasm.

The timing and pattern of pain offer useful clues. Sharp pain during or after a bowel movement often occurs with a fissure. A sudden tender lump may be a thrombosed hemorrhoid. Constant or worsening pain with swelling, fever, chills, or drainage may indicate an abscess and needs prompt medical evaluation.

Seek urgent medical care for rapidly worsening pain, fever or chills, significant swelling, pus or foul-smelling drainage, heavy bleeding, faintness, or inability to pass stool or gas with abdominal swelling or vomiting.

Written and medically reviewed by Aisha Akhtar, MD, FCPS, FACS, a board-certified colon and rectal surgeon and general surgeon.
Last medically reviewed: August 4, 2026

This page provides general education and cannot diagnose the cause of pain. Persistent, severe, recurrent, or worsening symptoms should be examined.

Patients in Phoenix, Scottsdale, Glendale, and nearby Arizona communities may request an anal-pain evaluation or call 602-932-5660.

What Can Anal Pain Feel Like?

People describe anal or rectal pain in different ways:

• Sharp, cutting, or tearing pain during a bowel movement
• Burning pain that continues after passing stool
• A dull ache or pressure inside the rectum
• Throbbing pain with swelling
• A sudden painful lump near the anus
• Brief attacks of severe stabbing pain
• Pain that becomes worse while sitting
• Soreness, itching, raw skin, or surface irritation
• Pain with bleeding, mucus, pus, drainage, diarrhea, or bowel urgency

Symptoms overlap, so pain alone cannot reliably distinguish hemorrhoids, fissures, abscesses, inflammatory conditions, pelvic-floor disorders, or tumors.

Anal Pain Patterns and Possible Causes

This table is a guide, not a diagnosis.

Why Does My Anus Hurt?

The anus contains sensitive skin, muscles, glands, blood vessels, and nerves. Pain can begin when tissue tears, swells, becomes inflamed or infected, or when the pelvic-floor muscles tighten. Constipation, hard stool, diarrhea, prolonged toilet sitting, local trauma, skin products, and some infections can trigger or worsen symptoms.

The most useful diagnostic clues include:

• Whether the pain started suddenly or gradually
• Whether it occurs during, after, or independently of bowel movements
• Whether the pain is at the opening or feels deeper inside the rectum
• Whether there is a lump, swelling, bleeding, itching, mucus, pus, or drainage
• Whether sitting, constipation, diarrhea, intercourse, menstruation, or pregnancy affects it
• Whether fever, chills, weakness, weight loss, or a bowel-habit change is present

Many people assume every painful anal symptom is a hemorrhoid. Fissures, abscesses, skin conditions, infections, and pelvic-floor disorders are commonly mistaken for hemorrhoids and require different treatments.

Common Causes of Anal or Rectal Pain

Anal Fissure

An anal fissure is a small tear in the anal-canal lining. It commonly causes sharp, cutting, or tearing pain as stool passes, followed by burning or spasm that may continue for minutes or hours. Bright-red blood may appear on toilet paper or the outside of the stool.

Fissures may develop after hard stool, constipation, diarrhea, childbirth, or local trauma. Treatment often begins with stool regulation, warm sitz baths, and prescription topical medication when appropriate. A chronic fissure may require botulinum toxin injection or surgery after individualized discussion.

Thrombosed External Hemorrhoid

A thrombosed external hemorrhoid occurs when a blood clot develops beneath the sensitive skin outside the anus. It may appear suddenly as a firm, tender, bluish or purple lump and can cause intense pain with sitting, walking, wiping, or bowel movements.

Some improve with conservative care. Selected patients with severe symptoms may benefit from an office procedure, particularly when examined early. Fever, pus, spreading redness, or rapidly increasing swelling raises concern for an abscess rather than an uncomplicated hemorrhoid.

Hemorrhoids

External hemorrhoids can cause swelling, tenderness, itching, and pain. Uncomplicated internal hemorrhoids more often cause painless bleeding or prolapse because they are covered by less pain-sensitive tissue. Severe pain should not automatically be attributed to internal hemorrhoids; it may indicate thrombosis, prolapse with strangulation, a fissure, an abscess, or another condition.

Anal Abscess or Fistula

An anal abscess is an infected cavity near the anus or rectum. Pain is often constant and may worsen with sitting or bowel movements. Swelling, warmth, redness, fever, chills, pressure, or pus drainage may occur. A deep abscess can cause rectal pressure without an obvious external lump.

An abscess generally requires drainage. An anal fistula is an abnormal tunnel that can remain after an abscess and may cause recurrent swelling, pain, a persistent skin opening, or intermittent drainage.

Proctitis or Rectal Inflammation

Proctitis may cause rectal pain, urgency, the repeated sensation of needing to pass stool, bleeding, mucus, pus, diarrhea, or painful bowel movements. Causes include inflammatory bowel disease, certain infections, radiation therapy, and diversion after ostomy surgery. Pain with discharge, sores, bleeding, or a recent sexual-exposure concern may require testing for infectious proctitis.

Pelvic-Floor Spasm and Levator Ani Syndrome

Pelvic-floor muscle spasm can cause a deep dull ache, pressure, fullness, or the sensation of sitting on a ball. Levator ani syndrome often becomes more noticeable during prolonged sitting and may last for hours. Treatment may include pelvic-floor physical therapy, biofeedback, bowel-habit optimization, and selected medication after structural causes are excluded.

Proctalgia Fugax

Proctalgia fugax causes brief, sudden attacks of severe rectal pain that resolve completely. Persistent pain, a new lump, bleeding, fever, or drainage is not typical and should be evaluated for another cause.

Skin Irritation or Dermatitis

Diarrhea, moisture, stool leakage, excessive wiping, fragranced wipes, soap, topical products, yeast, eczema, psoriasis, and other skin conditions can cause burning, itching, soreness, or superficial pain. Treatment depends on identifying the irritant or skin condition.

Constipation or Fecal Impaction

Hard stool can stretch or injure the anal canal, cause a fissure, irritate hemorrhoids, and create rectal pressure. Severe constipation or impacted stool may cause pain, fullness, difficulty passing stool, or leakage around retained stool.

Other Possible Causes

Other causes include inflammatory bowel disease, rectal prolapse, pudendal nerve irritation, coccyx or pelvic pain referred toward the rectum, local trauma, and—less commonly—an anal or rectal tumor. Persistent pain with a firm or growing lump, recurrent bleeding, ulceration, unexplained weight loss, thinner stools, or a bowel-habit change requires examination.

Why Does My Rectum Hurt When I Poop?

An anal fissure is a common cause of sharp pain during a bowel movement, particularly when the pain feels like cutting, tearing, or passing glass. The pain may continue afterward, and a small amount of bright-red blood may be visible.

Other possibilities include:

• Hard stool or constipation
• Diarrhea-related irritation
• A thrombosed external hemorrhoid
• Inflamed or prolapsing hemorrhoidal tissue
• Proctitis or inflammatory bowel disease
• An anal abscess
• Pelvic-floor muscles that do not relax appropriately
• Trauma to the anal canal

Repeated straining and prolonged toilet sitting can worsen several of these conditions.

Why Does My Anus Burn After Pooping?

Burning after a bowel movement may come from a fissure, frequent diarrhea, irritated hemorrhoids, excessive wiping, fragranced wipes, soap, moisture, stool leakage, or dermatitis. Persistent burning should not automatically be treated with hemorrhoid cream because the correct treatment depends on the cause.

Why Do I Have Rectal Pain Without Bleeding?

Pain can occur without visible blood. Possible causes include pelvic-floor spasm, levator ani syndrome, proctalgia fugax, an early or deep abscess, constipation, skin irritation, nerve pain, rectal inflammation, a nonbleeding thrombosed hemorrhoid, or internal pressure from prolapse.

The absence of bleeding does not rule out a significant condition. Deep, persistent, worsening, or recurrent pain deserves evaluation, especially with swelling, drainage, fever, urgency, or changing bowel habits.

Why Is Anal or Rectal Pain Worse When Sitting?

Sitting can increase pressure on a thrombosed hemorrhoid, abscess, irritated skin, pelvic-floor muscles, coccyx, or pudendal nerve. A visible painful lump suggests an external anorectal condition. Deep aching without a visible lump may require assessment of the rectum, pelvic-floor muscles, coccyx, and pelvic nerves.

What Causes Sudden Rectal Pain at Night?

Brief attacks of stabbing rectal pain that begin suddenly and fully resolve may represent proctalgia fugax. A first episode should not be self-diagnosed. Persistent pain or pain accompanied by a lump, bleeding, fever, swelling, or drainage requires examination for a fissure, thrombosed hemorrhoid, abscess, inflammation, or another structural cause.

Anal Pain After Intercourse or Penetration

Pain may result from friction, inadequate lubrication, a small fissure, tissue trauma, hemorrhoidal irritation, pelvic-floor spasm, or infection. Stop the activity causing pain. Seek evaluation for persistent pain, significant bleeding, fever, discharge, sores, ulcers, bowel urgency, or a recent exposure concern.

Avoid using numbing products to continue penetration through severe pain because reduced sensation may allow further injury.

Anal Pain During a Period or Pregnancy

Rectal discomfort may become more noticeable during menstruation because pelvic pain and muscle contractions can be felt near the rectum. Recurrent pain with menstruation, painful bowel movements, or cyclical rectal bleeding may require evaluation for pelvic-floor dysfunction, gastrointestinal disease, or, less commonly, rectal endometriosis.

During pregnancy, constipation, hemorrhoids, pelvic pressure, and bowel-habit changes can contribute to anal pain. New severe pain, a tender lump, fever, drainage, or significant bleeding should be discussed promptly with an obstetric clinician or colorectal specialist.

When Should You See a Doctor for Anal Pain?

Arrange an evaluation when anal or rectal pain:

• Lasts more than a few days or keeps returning
• Is severe or progressively worsening
• Does not improve with appropriate self-care
• Occurs with rectal bleeding
• Is associated with a lump, swelling, skin opening, or drainage
• Makes sitting, walking, sleeping, or passing stool difficult
• Occurs with constipation, diarrhea, urgency, or another bowel-habit change
• Develops after a previous abscess or fistula
• Occurs during pregnancy or in someone with diabetes, inflammatory bowel disease, or immune suppression
• Is accompanied by unexplained weight loss or a persistent change in stool caliber

A focused anorectal examination can distinguish fissures, hemorrhoids, abscesses, fistulas, infections, inflammatory disease, pelvic-floor spasm, prolapse, and less common tumors.

When Is Anal Pain an Emergency?

Seek urgent medical attention for:

• Pain that rapidly worsens or spreads
• Fever or chills with anal or rectal pain
• Significant swelling, redness, or warmth near the anus
• Pus or foul-smelling drainage
• Severe constant or throbbing pain
• Heavy bleeding or bleeding that does not stop
• Bleeding with dizziness, faintness, weakness, or shortness of breath
• Inability to pass stool or gas with marked abdominal swelling or vomiting
• Severe symptoms after recent colorectal surgery or in someone with diabetes or immune suppression

These findings may indicate an abscess, spreading infection, significant bleeding, obstruction, or another urgent condition.

What Can Help Mild Anal Pain at Home?

For mild symptoms without fever, significant swelling, heavy bleeding, pus, or rapidly worsening pain, temporary comfort measures may include:

• Keep stool soft and formed with dietary fiber and adequate fluids when medically appropriate
• Avoid straining and prolonged toilet sitting
• Use a warm sitz bath for comfort
• Clean gently with water and pat the area dry
• Avoid fragranced wipes, harsh soap, aggressive scrubbing, and repeated topical products
• Address constipation or diarrhea with guidance from a healthcare professional
• Use nonprescription pain medication only when safe for your medical history and other medicines

Do not puncture or attempt to drain a painful lump. Avoid repeatedly applying steroid, anesthetic, antibiotic, or hemorrhoid creams without a diagnosis; these products may irritate the skin, mask progression, or delay the correct treatment.

Home care does not replace evaluation for persistent, severe, recurrent, or complicated symptoms.

How Is Anal or Rectal Pain Diagnosed?

Evaluation begins with the pain’s location, timing, duration, severity, and relationship to bowel movements. The clinician may ask about constipation, diarrhea, bleeding, drainage, childbirth, pelvic symptoms, previous abscesses or surgery, inflammatory bowel disease, sexual exposure history, medications, and immune status.

Depending on the presentation, evaluation may include:

• Inspection of the skin and anal opening
• A gentle digital rectal examination when appropriate
• Anoscopy or proctoscopy to examine the anal canal and lower rectum
• Pelvic-floor muscle assessment
• Testing for infection when indicated
• Biopsy of a persistent or suspicious lesion
• Ultrasound, CT, or pelvic MRI when a deep abscess or complex fistula is suspected
• Colonoscopy or other bowel evaluation when bleeding, inflammation, bowel-habit change, age, or risk factors warrant it

The examination is adapted to the patient’s comfort and clinical condition. When pain is severe, the initial examination may be limited while an acute infection or another urgent problem is addressed.

How Is Anal Pain Treated?

Treatment should address the diagnosis rather than simply suppressing pain.

Rubber-band ligation treats selected internal hemorrhoids; it does not treat an anal fissure, external hemorrhoid, abscess, or pelvic-floor pain. Likewise, hemorrhoid creams will not correct an abscess, fistula, infection, or muscle disorder. An accurate diagnosis prevents repeated use of the wrong treatment.

Why See a Colon and Rectal Surgeon?

A colon and rectal surgeon has focused training in disorders of the colon, rectum, anus, and pelvic floor. This matters because several conditions produce similar symptoms but need very different care:

• Sharp pain with bowel movements may indicate a fissure
• A sudden painful lump may be a thrombosed hemorrhoid
• Constant worsening pain with fever may indicate an abscess
• Recurrent drainage may indicate a fistula
• Deep aching pressure may reflect pelvic-floor spasm
• Pain with urgency, mucus, or diarrhea may indicate proctitis
• Persistent pain with a lump or bowel-habit change may require biopsy or broader colorectal evaluation

Patients do not need to determine the diagnosis before requesting an appointment.

Frequently Asked Questions About Anal Pain

Why does my anus hurt?

Common causes include an anal fissure, external or thrombosed hemorrhoid, constipation, diarrhea-related irritation, an abscess, fistula, skin inflammation, proctitis, infection, or pelvic-floor muscle spasm. The pain pattern and associated symptoms help narrow the cause, but persistent pain often requires examination.

What causes sharp pain in the anus?

Sharp anal pain may result from a fissure, thrombosed external hemorrhoid, abscess, local injury, ulcer, or muscle spasm. Pain that begins during a bowel movement and continues afterward is particularly suggestive of a fissure.

How can I tell a fissure from a hemorrhoid?

A fissure usually causes sharp tearing pain during and after bowel movements, sometimes with bright-red bleeding. External hemorrhoids more often cause swelling, itching, tenderness, or a lump. Internal hemorrhoids commonly cause painless bleeding or prolapse. Because symptoms overlap, examination is the most reliable distinction.

Can hemorrhoids cause severe anal pain?

A thrombosed external hemorrhoid can cause sudden severe pain. Uncomplicated internal hemorrhoids are usually not intensely painful. Severe pain may indicate thrombosis, prolapse with strangulation, a fissure, an abscess, or another diagnosis.

Can an anal abscess look like a hemorrhoid?

Yes. Both can cause a painful lump. An abscess is more likely to cause constant worsening pain, warmth, redness, fever, chills, or pus. Because an abscess usually requires drainage, prompt assessment is important.

Can anal pain occur without bleeding?

Yes. Pelvic-floor spasm, levator ani syndrome, proctalgia fugax, an early or deep abscess, constipation, nerve pain, skin irritation, and a thrombosed hemorrhoid may cause pain without visible bleeding.

Is anal pain a sign of cancer?

Most anal pain is caused by noncancerous conditions. Persistent pain with a firm or growing lump, recurrent bleeding, ulceration, unexplained weight loss, thinner stools, or a bowel-habit change should nevertheless be examined because anal and rectal cancers can resemble benign anorectal disease.

When should I see a proctologist or colorectal surgeon?

See a colorectal specialist when pain is severe, recurrent, persistent, associated with bleeding, swelling or drainage, or not improving with appropriate self-care. A specialist can assess the anal canal, rectum, hemorrhoids, fissures, abscesses, fistulas, prolapse, and pelvic floor.

Medical Sources

• American Society of Colon and Rectal Surgeons: Anal Fissure
• American Society of Colon and Rectal Surgeons: Hemorrhoids

Related Conditions and Services

• Anal Fissure
• Hemorrhoids
• Thrombosed External Hemorrhoid
• Rectal Bleeding
• Anal Abscess and Fistula
• Pelvic Floor Dysfunction
• Rectal Endometriosis
• Rectal Prolapse
• Constipation
• Female Proctologist in Phoenix

Anal Pain Evaluation in Phoenix, Arizona

Anal and rectal pain can be difficult to discuss, but delaying evaluation may prolong symptoms or allow an infection or another treatable condition to worsen. Dr. Aisha Akhtar provides respectful, specialized evaluation of hemorrhoids, fissures, abscesses, fistulas, rectal inflammation, prolapse, pelvic-floor symptoms, and other causes of anorectal pain.

Serving Phoenix, Scottsdale, Glendale, and surrounding Arizona communities.

Request an appointment for anal or rectal pain or call 602-932-5660.