Anal pain
Almost nobody asks about this out loud, and almost everybody has been through it. Pain around the anus is an ordinary complaint, and most of its causes are…
On this page
- Sharp pain on opening your bowels and a spot of bright blood: anal fissure
- Pain with a lump and swelling: a thrombosed pile
- Constant throbbing pain with a fever: an abscess
- Itching, burning and pain with nothing to see
- What actually helps a fissure
- Signs you must not wait on
- What the doctor will do
- Online consultation
Medicines commonly prescribed for Anal pain
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: ORAL SOLUTION/SUSPENSION, Ibuprofen 2% (100 mg/5 ml)Active substance: ibuprofenManufacturer: Pharmex Advanced Laboratories S.L.Prescription not requiredDosage form: ORAL SOLUTION/SUSPENSION, 600 MGActive substance: ibuprofenManufacturer: Zambon S.A.U.Prescription requiredDosage form: TABLET, 400 mgActive substance: ibuprofenManufacturer: Aurovitas Spain, S.A.U.Prescription required
Almost nobody asks about this out loud, and almost everybody has been through it. Pain around the anus is an ordinary complaint, and most of its causes are harmless and treat well — yet this is precisely the area where putting off an appointment costs the most. People put up with it for months out of embarrassment about showing a doctor a part of the body that the doctor looks at several times a day.
It is easier to work through this by the character of the pain than by the names of diseases: when it comes on, how long it lasts, whether there is blood, a lump, a fever. Those questions separate the causes fairly cleanly. Below are the main pictures, and at the end the signs that must not be sat on.
Sharp pain on opening your bowels and a spot of bright blood: anal fissure
This is the commonest cause of all, and it is constantly mistaken for piles — including by patients themselves, who spend years treating haemorrhoids while a fissure sits alongside them.
The picture is very distinctive. At the moment of passing a stool there is a sharp, cutting pain, as if glass had been drawn across the anus. The pain then does not stop but turns into a burning ache lasting anywhere from half an hour to several hours. On the paper, or on the surface of the stool, there is a little bright red blood — drops or a streak. On the surface, not mixed through it: that distinction matters.
A fissure is a tear in the lining of the anal canal, usually caused by hard stool or, just as often, by a prolonged bout of diarrhoea. A circle then sets in: it hurts, so the person avoids the toilet, so the stool gets harder, so it tears again next time. On top of that the sphincter clamps down reflexively against the pain, the blood supply to that spot worsens, and the tear does not heal. That is why treatment starts with softening the stool rather than with an ointment.
How a fissure differs from piles. With haemorrhoids the main sensation is usually not a sharp pain but itching, discomfort, a feeling of something being there and a soft lump coming down; there is often more blood, sometimes enough to colour the water. Uncomplicated internal haemorrhoids frequently do not hurt at all. So a burning pain after a bowel movement argues for a fissure, not for piles.
Pain with a lump and swelling: a thrombosed pile
A different scenario: the pain came on suddenly, often after straining, lifting something heavy, a long spell of sitting or childbirth. Next to the anus you can feel a firm, tender ball the size of a pea or a cherry, with bluish or purple skin over it. Sitting hurts, walking hurts, and the pain is constant rather than tied to the toilet.
Most often this is a thrombosed external haemorrhoid: blood has clotted inside the pile, which has swollen and stretched the skin. It is extremely painful but not dangerous. The pain peaks over the first two or three days, then eases, and over two to three weeks the lump settles, sometimes leaving a soft skin tag behind.
There is still a point in being seen quickly. Within the first two or three days the clot can be removed under local anaesthetic in a small procedure, and the pain goes at once. After that it is no longer worth doing — the body clears it — and painkillers, softer stools and a cold pack on the first day will carry you through.
Constant throbbing pain with a fever: an abscess
This is the one picture on the page where the clock runs in hours rather than days. The signs: pain that is constant, bursting and throbbing, unrelated to going to the toilet and worse each day; it interferes with sitting and sleeping; beside the anus there is a hot, firm, tender swelling with red skin over it; there is fever, shivering and a wiped-out feeling. Sometimes foul-smelling pus breaks through, after which it feels easier — but the problem has not been solved.
This is a perianal abscess, a collection of pus in the tissues around the rectum. Pus does not reabsorb on its own. It has to be let out, and a surgeon does that.
What matters just as much here is what not to do. Warm baths, hot compresses and a hot water bottle do not help a collection of pus; they fan the inflammation. Ointments and suppositories will not reach it. Antibiotics without drainage usually just blur the picture. And waiting "until Monday" is risky: pus spreads through the surrounding tissue, and a neglected abscess can progress to severe infection — particularly fast in people with diabetes, with a weakened immune system, or taking medicines that suppress immunity. With this picture you need a doctor the same day, and with a high fever and rapidly worsening pain, emergency care.
If there was an abscess in the past and it left a track that intermittently leaks pus or fluid, that is an anal fistula. It too closes only with surgery. In a young person, repeated abscesses and fistulas around the anus are a reason to have the bowel checked for Crohn's disease.
Itching, burning and pain with nothing to see
Not every pain fits the three pictures above.
- Itching with burning and sore-looking skin. Usually the care routine is to blame: vigorous wiping, scented paper and wet wipes, shower gels and soap, washing too often with detergents. The skin here is thin and easily tipped into dermatitis. Also worth considering are fungal infection, psoriasis and eczema, and in children — or in adults living with children — threadworm, whose itch is worse at night.
- Pain with ulcers, blisters, discharge or enlarged groin glands. This can be a sexually transmitted infection: herpes, syphilis, gonorrhoea, chlamydia. Anal sex without a condom makes it more likely. Ointments will not sort it out; it needs tests and the right specific treatment.
- Sudden severe pain felt deep inside, with nothing visible. The attack lasts from a few seconds to a few minutes, often at night, wakes the person, then passes without trace. This is proctalgia, a spasm of the pelvic floor muscles. It is agonising but harmless, and the main task is to have a doctor confirm that nothing lies behind it.
- A dull, aching pain that is worse after long sitting. That is how pelvic floor muscle pain and tailbone pain behave, particularly after a fall onto the coccyx.
- Pain after radiotherapy to the pelvis is a separate situation and should be reported to the team treating you.
What actually helps a fissure
All home treatment rests on one thing: while the stool is hard, nothing will heal. So the first item is not an ointment.
- Soft stools. More fluid through the day and more plant fibre: vegetables, fruit, grains, bran, pulses. Build fibre up gradually over a week or two, otherwise you get bloating. If that is not enough, a doctor or pharmacist can pick a gentle laxative — one of those that hold water in the stool rather than whipping the bowel along.
- Do not sit on the toilet for ages and do not strain. No phone in the bathroom. When the urge comes, go straight away rather than putting it off.
- Warm sitz baths. Plain warm water, ten to fifteen minutes, two or three times a day and always after a bowel movement: this relaxes the clenched sphincter and takes a noticeable amount of the pain away. There is no need to add soap, antiseptic or herbal infusions.
- Gentle hygiene. Rinse with warm water and no soap instead of using dry paper, and pat rather than rub. No scented wipes.
- Topical treatment. A doctor may prescribe an ointment that relaxes the sphincter — that one works on the cause, not only the symptom. Creams and suppositories with a local anaesthetic give temporary relief; preparations containing corticosteroids are not used for long, as they thin the skin.
- Painkillers by mouth — plain paracetamol. Anti-inflammatory painkillers are best avoided without medical advice while there is bleeding from the back passage.
Be patient: an acute fissure heals over several weeks, not three days, and all of the above has to be kept up daily rather than until it first feels better. If the pain persists beyond six to eight weeks, the fissure counts as chronic and will not close on its own. That is a job for a doctor: there are medicines that relax the sphincter, botulinum toxin injections and a small operation that settles the matter reliably.
Signs you must not wait on
Plainly and separately: "it will sort itself out" is a bad bet once there is blood in the stool. Bowel cancer begins with exactly the same complaints — blood, discomfort and a change in bowel habit — and people put them down to piles, because they genuinely do have piles. One does not rule out the other. Having haemorrhoids is no proof that the blood is coming from them.
See a doctor if any one of these applies:
- the blood is dark or tarry, or mixed through the stool rather than sitting on the surface;
- the stool has changed shape — thin or ribbon-like — or your usual bowel pattern has changed and stayed changed for several weeks;
- you feel you have not fully emptied, get false urges, or pass mucus;
- you are losing weight without trying, and feel weak or look pale;
- the pain wakes you at night or stops you sleeping;
- there is a lump, a swelling or a sore that will not heal beside the anus;
- fever, shivering and increasing throbbing pain — that points to an abscess and needs a doctor the same day;
- the pain has lasted more than a few weeks despite everything you are doing at home;
- bleeding from the back passage has gone on for more than two or three weeks;
- you are over fifty, or bowel cancer, polyps or inflammatory bowel disease run in the family — the threshold for being seen is lower.
An ambulance or emergency department is needed for heavy bleeding that will not stop — the water in the toilet turning red, clots being passed; for weakness, dizziness, cold sweat and a racing heart alongside bleeding; and for severe pain with a high fever and confusion. In most of the countries this site serves, the ambulance is called on the single European number 112.
What the doctor will do
The examination takes a few minutes and is usually far less unpleasant than the wait for it. The doctor will look at the area from outside and, if needed, do an internal examination with a finger — though with an obvious fissure they often skip even that, because the pain is severe and the diagnosis is already visible. Proctoscopy, a brief look inside the anal canal through a small instrument, may be added.
If the complaints do not fit a simple picture, if there is blood, if bowel habit has changed, or if age and family history call for caution, a colonoscopy will be arranged. That is not because the worst is suspected but in order to rule it out and close the question.
Treatment then follows the finding: laxatives and topical medicines for a fissure, drainage for an abscess, banding or surgery for piles, a specific regimen for infection. Surgery is needed by a minority — but where it is needed, delay only makes the operation bigger.
Online consultation
This is a subject worth starting online: you can describe everything calmly and with nobody else in earshot. An online doctor will work through the questions that identify what your pain resembles, separate a fissure from piles and from an abscess, tell you what to do this evening, and put together a home routine that actually works. They will assess the red flags separately and say plainly whether a colonoscopy is needed and how soon. And if the description adds up to an abscess, they will send you straight to a surgeon.
This material is for information only and does not replace medical advice.
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