Anal Pain

Anal pain can be experienced before, during or after a bowel movement and can vary in severity from a mild ache that can progress over time to pain so significant that you are not able to perform your daily activities. It has a variety of causes, most of which are common and benign. However, anal pain that does not resolve within a 24-48 hour window should be evaluated by a physician. The symptoms of anal pain and fever may require seeing a physician more urgently than pain alone.

What are the most common causes of anal pain?

1. Thrombosed External Hemorrhoid

A thrombosed external hemorrhoid is a blood clot of the small blood-filled sacs on the outside of your anus (hemorrhoid tissue). This often comes with sudden onset of a painful anal mass that may worsen over the first 48 hours, but subsides gradually over the next few days. You may notice bleeding as well, if the overlying skin opens. Treatment involves either removing the thrombosed hemorrhoid or conservative management, including warm tub baths (sitz baths) for comfort, pain medications, and stool softeners. Removal is typically a short, well-tolerated procedure that can be done in the office or in the emergency room under local anesthesia. It is most often done if you see your doctor in the first couple of days after symptoms begin.

2. Anal Fissure

An anal fissure (fissure-in-ano) is a small, oval shaped tear in skin at the opening of the anus. Fissures typically cause severe pain and bleeding with bowel movements. Fissures are quite common in the general population, but are often confused with other causes of pain and bleeding, such as hemorrhoids. The most common treatment for an acute anal fissure consists of making the stool more formed and bulky with a diet high in fiber, topical anesthetics for pain, and taking warm sitz baths for 10-20 minutes several times a day (especially after bowel movements). The baths are soothing and promote relaxation of the anal muscles, which may help the healing process. Occasionally, a chronic fissure may require surgery.

3. Abscess and Fistula

An anal abscess is an infected cavity filled with pus found near the anus or rectum. An anal fistula (also commonly called fistula-in-ano) is the tunnel that forms under the skin and connects the clogged, infected glands to the abscess. Under most circumstances, the treatment of an abscess is surgical drainage. Surgery is most often necessary to cure an anal fistula. Although surgery can be fairly straightforward, it may also be complicated, occasionally requiring staged or multiple procedures.

4. Fungal Infection or Sexually

Transmitted Diseases Patients with a fungal infection or one resulting from sexually transmitted disease may have prolonged symptoms of mild to severe anal or perianal pain, not necessarily associated with bowel movements. Sexually transmitted diseases can include gonorrhea, chlamydia, herpes, syphilis, etc. Patients may complain of mild anal bleeding, infected looking discharge, and itching. Treatment typically includes appropriate antibiotics or antifungals, either topically or by mouth.

5. Dermatologic Conditions

Skin disorders occurring in other parts of the body (i.e., psoriasis, warts) may occur in skin surrounding the anus as well. You may have anal itching and bleeding, in addition to pain that may come and go. The key is early diagnosis that allows the appropriate therapy to begin. In some cases, a skin biopsy is needed. Treatment depends on the evaluation of the skin biopsy and/or clinical diagnosis.

6. Cancer

While most cases of anal pain are benign, tumors can cause progressive pain over time, bleeding, a mass, and often changes in bowel habits. Any pain or anal bleeding that does not resolve and gets progressively worse needs to be evaluated by a physician. Treatment of anal cancer or other anal tumors may involve chemotherapy, radiation and/or surgery. On the first examination, the physician will do a thorough physical exam that will include anoscopy (exam of the anal canal with a special lighted scope) and biopsy of the mass. If you are in too much pain to be examined in the office, your surgeon may need to take you to the operating room. Giving you anesthesia will allow a proper examination to rule out cancer.

When should I seek help from my medical provider?

Pain that is recurrent or persistent, or when you can feel a painful, bleeding mass which has progressed over time needs to be evaluated by a physician.

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