Anal pain
Pain in or around the anus is common and often caused by minor issues like haemorrhoids or anal fissures. However, severe pain, bleeding, or fever may indicate an abscess or infection requiring urgent care.
🚨 Seek urgent help if
Anal pain with any of these:
- Severe, throbbing pain and fever (possible abscess)
- Profuse bleeding from rectum (bright red or clots)
- Inability to pass stool or gas (possible anal stricture or obstruction)
- Necrotic or foul‑smelling discharge (Fournier’s gangrene – rare emergency)
- Trauma with uncontrolled pain
📞 When to see a GP
Make an appointment if you have:
- Mild to moderate pain lasting >2 days
- Small amounts of blood on toilet paper (likely fissure or haemorrhoids)
- Itching, swelling, or a lump near the anus
- Pain after bowel movements that resolves
- Recurrent anal pain
Common Symptoms & Possible Causes
| Pain description / associated symptom | Possible condition |
|---|---|
| Sharp, tearing pain during bowel movement + blood streak | Anal fissure |
| Dull ache, swelling, itchy lump(s) around anus | Haemorrhoids (piles) |
| Constant throbbing pain, fever, redness | Perianal abscess / fistula |
| Pain when sitting, dull ache in rectum | Levator ani syndrome (muscle spasm) |
| Itching, burning, moisture | Pruritus ani or skin irritation |
Causes by category
Haemorrhoids: swollen veins in anal canal – internal or external.
Anal fissure: tear in anal lining, often due to constipation.
Perianal abscess: infected cavity near anus, requires drainage.
Anal fistula: abnormal tunnel from anal canal to skin.
Proctalgia fugax: sudden, brief rectal pain (muscle spasm).
Proctitis: inflammation of rectal lining (IBD, infection, radiation).
Sexually transmitted infections: herpes, gonorrhoea, chlamydia (LGV).
Cryptitis: infection of anal glands.
Hidradenitis suppurativa: chronic skin condition affecting perianal area.
Levator ani syndrome: chronic pelvic floor muscle tension.
Coccydynia: tailbone pain referred to anus.
Foreign body: trauma or insertion.
Tumours: rare (anal cancer, rectal cancer).
Diagnostic procedures
Digital rectal exam
Palpation to assess tone, tenderness, masses.
Anoscopy
Direct visualisation of anal canal and haemorrhoids.
Proctoscopy / sigmoidoscopy
Examines lower rectum and sigmoid colon.
MRI pelvis
Detailed imaging for fistulas, abscesses, or tumours.
Endoanal ultrasound
Evaluates sphincter complex and fistulas.
STI testing
Swabs for gonorrhoea, chlamydia, herpes if indicated.
