What conditions cause anal pain?
There are many conditions which can cause a pain in the bottom area. In most of these, an abnormality is seen or felt on examination or investigation. Possible causes include:
- Piles (haemorrhoids). These are a common cause of anal pain, particularly when one of the piles gets a blood clot in it (a thrombosed haemorrhoid). If this is the case, you may be able to feel a tender lump.
- Anal fissure. This is a split in the skin around the anus, usually caused by passing a hard poo. The pain is much worse when you do a poo, and there may be some blood when you poo.
- Cancer. Cancer of the anus or rectum can cause pain. It is usually a more constant pain, and may be worse when you poo. You may have blood on your underwear or mixed with your poo.
- Anogenital warts. These are a sexually transmitted infection (STI) and if you have them you can usually see or feel small bumps around the anus. Other STIs such as herpes can also cause a pain in this area. Again, usually you can see a blister or blistery rash.
- Crohn's disease and ulcerative colitis. These are conditions where the gut is inflamed. They usually cause other symptoms such as diarrhoea, blood and mucus in the poo, and tummy (abdominal) pains.
- Rectal prolapse. This is a condition where the muscles of the end of the gut are weak, and some of the inside of the gut may come out (prolapse). You would notice you have difficulty holding your stools in, and you may feel a lump.
- Prostatitis. This is an inflammation or infection of the prostate gland. Men only - women don't have a prostate gland.
- Coccydynia. This is a pain around the tailbone (coccyx) and is very painful when you sit down. Usually this is set off by a fall on to your bottom.
- Irritable bowel syndrome (IBS). Usually, IBS causes loose stools or constipation, and tummy pains and bloating, but it may sometimes be accompanied by pain in the anal area.
- An infection, such as a collection of pus (an abscess).
There are many other less common causes.
What causes proctalgia fugax and levator ani syndrome?
It is not exactly understood. It is believed to be due to spasms of the muscles of the anus. The muscles here are very strong, as these are the muscles you use to hold your poo in, or relax to let the poo out.
Most of the time it is not obvious what has set it off. In some people, it starts after an operation - for example, an injection for piles, or after a hysterectomy. It seems to be more common in people who have IBS, and in people who have anxiety symptoms.
Further reading and references
Jeyarajah S, Purkayastha S; Proctalgia fugax. CMAJ. 2013 Mar 19185(5):417. doi: 10.1503/cmaj.101613. Epub 2012 Nov 26.
Chiarioni G, Asteria C, Whitehead WE; Chronic proctalgia and chronic pelvic pain syndromes: new etiologic insights and treatment options. World J Gastroenterol. 2011 Oct 2817(40):4447-55. doi: 10.3748/wjg.v17.i40.4447.
Guidelines on Chronic Pelvic Pain; European Association of Urology (2015)
The attacks described on this forum are exactly the same as what i've been experiencing for 4-5years now. I get a stabbing/pressure pain in my butt that feels really deep inside and like something in...Guest
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