Anal pain or rectal pain may feel sharp, burning, tearing, throbbing, aching, or pressure-like. The discomfort may occur during a bowel movement, continue afterward, worsen while sitting, or appear as a sudden painful lump near the anus. Common causes include an anal fissure, thrombosed external hemorrhoid, anal abscess, skin irritation, rectal inflammation, or pelvic floor muscle spasm.
Quick answer: Sharp pain during or after a bowel movement often suggests an anal fissure. A sudden tender lump may be a thrombosed hemorrhoid. Constant or worsening pain with swelling, fever, chills, or drainage may indicate an anal abscess and requires prompt medical evaluation.
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 does not replace an examination or individualized medical advice. Severe or rapidly worsening symptoms should be evaluated promptly.
Patients in Phoenix, Scottsdale, Glendale, and nearby Arizona communities may request an appointment or call 602-932-5660.
The anus is the opening and short canal through which stool leaves the body. The rectum is the lower portion of the large intestine immediately above the anal canal. Patients often use anal pain, rectal pain, pain near the anus, and pain inside the rectum interchangeably, but the location and pattern of pain can help identify the cause.
Pain at the anal opening is more commonly associated with a fissure, external hemorrhoid, abscess, skin irritation, or trauma. A deeper rectal ache or pressure may be related to constipation, proctitis, pelvic floor spasm, levator ani syndrome, rectal prolapse, or another condition within the rectum or pelvis.
Patients may describe:
The pain pattern provides useful clinical clues, but symptoms alone cannot always distinguish hemorrhoids, fissures, abscesses, inflammatory conditions, pelvic floor disorders, or tumors.
| Pain pattern or associated symptom | Possible causes | Recommended action |
|---|---|---|
| Sharp or tearing pain during a bowel movement | Anal fissure, trauma, inflamed skin | Schedule an evaluation if persistent, severe, or associated with bleeding |
| Burning pain after passing stool | Anal fissure, diarrhea-related irritation, dermatitis | Gentle hygiene and bowel regulation may help; seek care if symptoms continue |
| Sudden painful lump near the anus | Thrombosed external hemorrhoid, abscess | Prompt examination is appropriate, especially with severe pain or swelling |
| Constant throbbing pain with fever or drainage | Anal abscess or infection | Seek urgent medical evaluation |
| Dull rectal ache or pressure, worse while sitting | Levator ani syndrome, pelvic floor spasm, constipation, internal swelling | Schedule a colorectal or pelvic floor evaluation if persistent |
| Brief, severe stabbing pain that resolves | Proctalgia fugax | Discuss recurrent episodes with a clinician after other causes are excluded |
| Pain with blood, mucus, urgency, or diarrhea | Fissure, hemorrhoids, proctitis, inflammatory bowel disease, infection | Medical evaluation is recommended |
| Persistent pain with a growing lump or bowel habit change | Benign anorectal disease or, less commonly, a tumor | Do not delay examination |
This table is a guide, not a diagnosis. Several anorectal conditions produce overlapping symptoms.
A painful anus can result from a small tear, swollen external tissue, infection, inflammation, muscle spasm, constipation-related trauma, or irritation of the surrounding skin. Patients may search for the same symptom as “why does my butthole hurt,” “pain near my anus,” or “discomfort around the anus.”
The most useful details are:
An examination is often necessary because patients commonly mistake fissures, abscesses, skin conditions, or pelvic floor disorders for hemorrhoids.
Rectal or anal pain during a bowel movement is commonly caused by an anal fissure, particularly when the pain feels sharp, cutting, or like passing glass. Bright red blood may appear on the toilet paper or outside the stool. The American Society of Colon and Rectal Surgeons notes that fissure pain usually begins with stool passage and may continue for minutes to hours.
Other causes of pain when pooping include:
Repeated straining and prolonged toilet sitting can worsen several of these conditions.
Pain that begins or intensifies after passing stool often occurs because bowel movement stretches or irritates injured tissue. Anal fissure pain may remain severe for minutes or several hours after defecation. Hemorrhoids may also become irritated, swollen, or prolapsed after a bowel movement.
Burning after stool can also result from diarrhea, excessive wiping, fragranced wipes, soap, moisture, stool leakage, or dermatitis. Persistent post-defecation pain should not automatically be treated as hemorrhoids without a diagnosis.
Anal or rectal pain can occur without visible blood. Possible causes include:
The absence of bleeding does not exclude a significant condition. Deep, persistent, worsening, or recurrent rectal discomfort warrants evaluation, particularly when accompanied by swelling, drainage, fever, bowel urgency, or a change in bowel habits.
A dull rectal ache or pressure can feel as though something is present inside the rectum. Some patients describe pressure around the anus, fullness, incomplete emptying, or the sensation of sitting on a ball.
Possible causes include:
Levator ani syndrome typically causes a dull ache or pressure that may last for hours and become more noticeable while sitting. A deep abscess may also cause rectal pain or pressure even when no external lump is visible.
Pain that becomes worse while sitting may occur with:
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.
Brief attacks of severe, stabbing rectal pain that begin suddenly and resolve may represent proctalgia fugax, a functional anorectal pain syndrome involving episodic muscle spasm. Episodes are usually short, while pain from levator ani syndrome generally feels deeper, duller, and lasts longer.
A first episode should not automatically be labeled proctalgia fugax. Fissure, thrombosed hemorrhoid, abscess, inflammation, and other structural causes should be excluded, particularly when pain persists, a lump is present, or symptoms include fever, bleeding, or drainage.
Pain after anal intercourse or penetration may result from friction, inadequate lubrication, a small fissure, tissue trauma, hemorrhoidal irritation, pelvic floor spasm, or infection. Rectal pain accompanied by discharge, sores, ulcers, bleeding, bowel urgency, or a recent exposure concern may require testing for infectious proctitis or a sexually transmitted infection.
Stop the activity causing pain and seek evaluation for persistent pain, significant bleeding, fever, discharge, or worsening symptoms. Severe pain should not be masked with numbing products before further penetration because reduced sensation may allow additional injury.
Pelvic and rectal discomfort may become more noticeable during menstruation because pelvic muscles contract and pelvic pain can be referred toward the rectum. Recurrent rectal pain, painful bowel movements, or rectal bleeding that consistently occurs with menstruation may require evaluation for pelvic floor dysfunction, gastrointestinal disease, or, less commonly, rectal endometriosis.
During pregnancy, constipation, hemorrhoids, pelvic pressure, and changes in bowel habits may contribute to anal pain. New severe pain, a tender lump, fever, drainage, or significant bleeding during pregnancy should be discussed promptly with an obstetric clinician or colorectal specialist.
Anal pain is a symptom rather than a diagnosis. The following conditions are among the more important causes.
An anal fissure is a small tear in the lining of the anal canal. It classically causes sharp, cutting, or tearing pain during a bowel movement, followed by burning or spasm that may last for hours. Bright red blood may appear on toilet paper or the outside of the stool.
Fissures commonly develop after hard stool, constipation, diarrhea, childbirth, or local trauma. Initial treatment often focuses on regulating stool consistency, improving fiber and fluid intake, using warm sitz baths, and applying prescription topical medication when indicated. Chronic or nonhealing fissures may require botulinum toxin injection or surgery after individualized discussion of benefits and risks.
A thrombosed external hemorrhoid develops when a blood clot forms under the sensitive skin outside the anus. It may appear suddenly as a firm, tender, purple or bluish lump and can cause intense pain with sitting, walking, wiping, or bowel movements.
Some thrombosed hemorrhoids improve with conservative care. Selected patients with severe symptoms may benefit from an office procedure, particularly when evaluated early. A painful lump with fever, pus, spreading redness, or rapidly increasing swelling may instead represent an abscess and requires prompt examination.
External hemorrhoids can cause swelling, tenderness, itching, and pain. Internal hemorrhoids are covered by tissue that is less sensitive to pain and therefore more often cause painless bleeding or prolapse. Internal hemorrhoids may become painful when they are prolapsed, swollen, or strangulated.
Treatment depends on the type and severity of hemorrhoids. Options may include bowel regulation, office procedures such as rubber band ligation for selected internal hemorrhoids, or surgery for advanced disease.
An anal abscess is an infected cavity near the anus or rectum. Symptoms may include constant or worsening pain, swelling, redness, fever, chills, pressure, or pus drainage. Some deeper abscesses cause rectal pain or pressure without an obvious external lump.
An abscess generally requires drainage. The American Society of Colon and Rectal Surgeons states that antibiotics alone are a poor substitute for drainage in most uncomplicated abscesses. Patients with diabetes, impaired immunity, extensive cellulitis, or systemic illness may also require antibiotics or hospital-based care.
An anal fistula is an abnormal tunnel connecting the anal canal to skin near the anus, often following an abscess. Symptoms may include recurrent swelling, intermittent pain, skin irritation, a persistent opening, and drainage of pus, blood, or stool-like material.
Treatment depends on the fistula tract and its relationship to the sphincter muscles. Accurate mapping is important because treatment should control infection while protecting continence.
Proctitis is inflammation of the rectal lining. It may cause rectal pain, urgency, tenesmus—the repeated sensation of needing to pass stool—bleeding, mucus, pus, diarrhea, or pain with bowel movements. Causes include inflammatory bowel disease, certain sexually transmitted infections, other infections, radiation therapy, and diversion after ostomy surgery.
Blood, mucus, or pus from the rectum, particularly with significant pain, warrants medical evaluation.
Pelvic floor muscles may remain excessively tight or contract painfully. Levator ani syndrome often causes a deep dull ache or pressure in the rectum or pelvis, may feel like sitting on a ball, and is frequently worse after prolonged sitting.
Treatment may include pelvic floor physical therapy, biofeedback, bowel habit optimization, relaxation techniques, treatment of contributing constipation, and selected medications. Hemorrhoid procedures do not treat pelvic floor muscle spasm.
Proctalgia fugax causes sudden, brief episodes of sharp rectal pain, usually without a visible lesion. It is considered only after other causes of anorectal pain have been excluded. Recurrent or changing symptoms should be discussed with a clinician.
Moisture, stool leakage, diarrhea, over-cleaning, fragranced wipes, soaps, topical products, yeast, eczema, psoriasis, and other skin conditions may cause burning, itching, soreness, or superficial pain. Treatment depends on identifying the irritant or underlying dermatologic condition.
Gonorrhea, chlamydia, herpes, syphilis, and other infections can involve the anus or rectum and cause pain, sores, discharge, bleeding, mucus, or bowel urgency. Testing should be guided by symptoms, exposure history, examination, and current clinical recommendations.
Crohn’s disease may cause anal fissures, ulcers, abscesses, fistulas, skin changes, and perianal inflammation. Ulcerative colitis may cause proctitis with rectal pain, urgency, diarrhea, mucus, and bleeding. Recurrent fistulas, unusual fissures, chronic diarrhea, abdominal pain, or unexplained weight loss may require broader gastrointestinal evaluation.
Rectal prolapse occurs when rectal tissue descends or protrudes through the anus. Symptoms may include a bulge, pressure, mucus, bleeding, incomplete evacuation, and fecal leakage. Prolapse may be mistaken for hemorrhoids, but treatment differs.
Hard stool can stretch or injure the anal canal, contribute to a fissure, irritate hemorrhoids, and create pressure inside the rectum. Severe constipation or impacted stool may cause pain, fullness, leakage around retained stool, and difficulty passing a bowel movement.
The pudendal nerve supplies sensation to the anal and genital region. Nerve irritation may produce burning, tingling, pressure, or pain that worsens with sitting. Coccyx, lower back, pelvic, gynecologic, or urologic disorders can also refer pain toward the anus or rectum.
Cancer is a less common cause of anal pain, but persistent pain should not be dismissed when accompanied by a firm or growing lump, recurrent bleeding, ulceration, unexplained weight loss, narrower stools, bowel habit changes, or persistent fullness. Anal cancer symptoms can resemble hemorrhoids, so a suspicious lesion may require biopsy.
Schedule an evaluation when anal or rectal pain:
Many patients assume anorectal pain is caused by hemorrhoids. A focused examination helps distinguish hemorrhoids from fissures, abscesses, fistulas, infections, inflammatory disease, pelvic floor spasm, prolapse, and less common tumors.
Seek urgent medical attention for:
These findings may indicate an abscess, spreading infection, significant bleeding, obstruction, or another urgent condition. Mayo Clinic advises immediate assessment when anal pain becomes much worse, spreads, or occurs with fever, chills, or discharge.
Home care may be reasonable for mild symptoms without fever, significant swelling, heavy bleeding, pus, or rapidly worsening pain. Measures may include:
Do not attempt to puncture or drain a painful lump. Do not repeatedly use steroid, anesthetic, antibiotic, or hemorrhoid creams without a diagnosis, because these products may irritate the skin, delay appropriate treatment, or mask progression.
Self-care does not replace evaluation for persistent, severe, recurrent, or complicated symptoms.
Evaluation begins with the history of the pain: its exact location, timing, duration, severity, relationship to bowel movements, and associated symptoms. Relevant information may include constipation, diarrhea, bleeding, drainage, childbirth, pelvic symptoms, prior abscesses or surgery, inflammatory bowel disease, sexual exposure history, medications, and immune status.
Depending on the presentation, evaluation may include:
The examination is adapted to the patient’s comfort and clinical condition. When pain is severe, the initial examination may be limited while urgent infection or another acute problem is addressed.
Treatment should address the cause rather than only suppress the pain.
For fissures, uncomplicated hemorrhoidal symptoms, constipation-related trauma, and some forms of irritation, treatment may include:
Depending on the diagnosis, treatment may include topical medication for an anal fissure, antimicrobial treatment for a confirmed infection, anti-inflammatory therapy for proctitis, or medication directed at muscle spasm or neuropathic pain. Medication selection should follow an examination because the same symptom can arise from conditions requiring very different treatments.
Possible office treatments include:
Rubber band ligation is intended for internal hemorrhoids and does not treat anal fissures, external hemorrhoids, abscesses, or pelvic floor pain.
Procedural or surgical care may be required for:
The recommended procedure depends on the diagnosis, disease anatomy, symptom severity, continence considerations, prior treatment, and patient goals.
Levator ani syndrome and other pelvic floor pain disorders may respond to pelvic floor physical therapy, biofeedback, myofascial techniques, relaxation training, bowel regulation, and selected medication. Treatment is fundamentally different from hemorrhoid or fissure therapy.
A colon and rectal surgeon has focused training in disorders of the colon, rectum, anus, and pelvic floor. This is important because several conditions can produce nearly identical symptoms:
An accurate diagnosis helps prevent repeated use of treatments that do not address the underlying problem.
Common causes include an anal fissure, external hemorrhoid, thrombosed hemorrhoid, constipation, diarrhea-related irritation, abscess, fistula, skin inflammation, proctitis, or pelvic floor muscle spasm. The timing, location, and associated symptoms help narrow the possibilities, but persistent pain often requires examination.
“Butthole pain” is a common nonmedical description of anal or rectal pain. A sharp pain during bowel movements suggests a fissure, while a sudden tender lump may be a thrombosed hemorrhoid. Constant pain with fever, swelling, or drainage may indicate an abscess.
Sharp anal pain may result from a fissure, thrombosed external hemorrhoid, abscess, trauma, ulcer, or muscle spasm. Pain that starts with a bowel movement and continues afterward is particularly suggestive of a fissure.
A dull ache may come from levator ani syndrome, pelvic floor spasm, constipation, proctitis, internal swelling, a deep abscess, or referred pelvic pain. Persistent or worsening aching should be evaluated.
Pressure can occur with constipation, internal hemorrhoidal swelling, rectal prolapse, pelvic floor spasm, levator ani syndrome, a deep abscess, or, less commonly, a mass. The presence of fever, drainage, bleeding, or a bowel habit change increases the need for prompt evaluation.
An anal fissure is a common cause of sharp pain during defecation. Other possibilities include hard stool, inflamed hemorrhoids, proctitis, abscess, diarrhea-related irritation, trauma, or pelvic floor dysfunction.
Burning after a bowel movement may result from a fissure, diarrhea, irritated hemorrhoids, excessive wiping, fragranced wipes, soap, moisture, stool leakage, or dermatitis. Continued burning despite gentle care should be examined.
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.
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. Symptoms overlap, so examination is the most reliable way to distinguish them.
A thrombosed external hemorrhoid can cause sudden severe pain. Uncomplicated internal hemorrhoids are usually not intensely painful because the tissue covering them is less sensitive; severe pain may indicate prolapse, strangulation, fissure, abscess, or another diagnosis.
Yes. Both may cause a painful lump. An abscess is more likely to produce constant worsening pain, warmth, redness, fever, chills, or pus. Because abscesses usually require drainage, prompt assessment is important.
Sitting can increase pressure on a thrombosed hemorrhoid, abscess, inflamed skin, pelvic floor muscles, coccyx, or pudendal nerve. Deep pain that improves when standing may be associated with levator ani syndrome.
Brief stabbing episodes may be proctalgia fugax, but persistent pain, a new lump, bleeding, fever, or drainage suggests another cause and should be examined.
Most anal pain is caused by benign conditions. However, persistent pain with a firm or growing lump, recurrent bleeding, ulceration, unexplained weight loss, thinner stools, or a bowel habit change should be evaluated because anal and rectal cancers can initially resemble benign anorectal disease.
See a colorectal specialist when pain is severe, recurrent, persistent, associated with bleeding or drainage, or not improving with appropriate self-care. A specialist can assess the anal canal, rectum, hemorrhoids, fissures, abscesses, fistulas, prolapse, pelvic floor, and other possible causes.
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 assessment of hemorrhoids, fissures, abscesses, fistulas, rectal inflammation, prolapse, pelvic floor symptoms, and other causes of anorectal pain.
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“ The whole office was wonderful. Dr Akhtar was excellent. She was thorough. She explained things extremely well. She answered all my questions. I... The whole office was wonderful. Dr Akhtar was excellent. She was thorough. She explained things extremely well. She answered all my questions. I never felt like she was rushing my exam. ”
“ Dr. Akhtar and the entire team made what could have been a very stressful experience feel comfortable, reassuring, and genuinely cared for from sta... Dr. Akhtar and the entire team made what could have been a very stressful experience feel comfortable, reassuring, and genuinely cared for from start to finish. Dr. Akhtar was professional, compassionate, and took the time to thoroughly explain everything before my procedure, which immediately put me at ease. The procedure itself went smoothly, and I truly felt I was in excellent hands the entire time. The office staff was also kind, organized, and attentive throughout the process. I’m incredibly grateful for the level of care, patience, and professionalism I received. I would absolutely recommend Dr. Akhtar to anyone looking for a skilled doctor who truly cares about their patients and their comfort. ”
“ I cannot express the how thankful I am for Dr. Akhtar. I had been to 4 other colorectal doctors, 3 gastro doctors before seeing Dr. Akhtar. I was c... I cannot express the how thankful I am for Dr. Akhtar. I had been to 4 other colorectal doctors, 3 gastro doctors before seeing Dr. Akhtar. I was crying in her office when she met me the first time. That didn't deter her. Not only that but she located the issue on my first visit. She is kind, caring, thorough and incredibly knowledgeable. She listens, spends time with you and doesn't talk over you. I've needed extra time to discuss my case many times and she has always taken the time that I needed. I've brought to her research I've read, and she always already knows about the publications. The staff are kind and helpful. I dont know what I would have done without finding her. Another health care provider recommended her highly as do I. ”
“ Best colorectal surgeon I’ve ever met. Dr. Akhtar is compassionate, gentle, warm, and caring. I came to her in Glendale after having a horrific exp... Best colorectal surgeon I’ve ever met. Dr. Akhtar is compassionate, gentle, warm, and caring. I came to her in Glendale after having a horrific experience with a general surgeon in Flagstaff (where I live). The Flagstaff surgeon caused a hemorrhage that almost cost me my life, and then I developed stenosis after the emergency room surgeon “fixed” the hemorrhage. Dr. Akhtar was kind enough to take me as a patient (most surgeons will not take a patient who has already been operated by another surgeon due to liability). She was very respectful and gentle in the examination, and was even able to fit me in for an outpatient procedure under sedation the very same day (knowing that I drove over 2 hours to see her). I could not be happier with her. She took the time to personally call me the next day to check on my progress. You do not see this type of doctor very often anymore. She is someone who is in it for the patient, and you can tell. I will continue to drive over 4 hours there and back to receive her high quality care and expertise. Cannot recommend her highly enough. ”
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