Anal pain (pain in the bottom) can be distressing, but it's often just the result of a minor, treatable problem. The medical name for pain in and around the anus or rectum is proctalgia.
Common causes of anal pain
Anal fissures
An anal fissure is a small tear in the skin of the anus that can be caused
by passing a large or hard poo.
Symptoms of an anal fissure include:
-
a severe, sharp pain when doing a poo
-
a burning or gnawing pain that lasts several hours after doing a poo
-
rectal bleeding – you may notice a small amount of blood on the toilet paper after you wipe
Anal fissures can be very painful, but many heal on their own in a few weeks.
Eating more fibre, drinking plenty of fluids and taking laxatives and over-the-counter painkillers can help.
​
If the pain persists, you may need special ointment that relaxes the ring of muscle around your anus.
Occasionally, you may need surgery to help the fissure heal. Read more about treatments for anal fissures.
Piles (haemorrhoids)
Piles) are swollen blood vessels that are found inside or around your bottom (anus).
​
They're often thought to be caused by straining on the toilet as a result of
constipation. In many cases, piles do not cause symptoms. If you do have symptoms, they may include:
-
bleeding after doing a poo
-
an itchy bottom
-
feeling like there's a lump in or around your anus
-
soreness and redness around your anus
-
anal pain, if the blood supply to the pile becomes blocked
Anal fistulas and abscesses
An anal fistula is a small tunnel that develops between the end of the bowel and the skin near the anus. It's usually caused by an infection near the anus resulting in a collection of pus (an abscess).
Symptoms of an anal fistula or abscess can include:
-
a constant, throbbing pain that may be worse when you sit down
-
skin irritation around the anus
-
passing pus or blood when you poo
-
swelling and redness around your anus
-
a high temperature
Your GP may prescribe antibiotics if an abscess is picked up early on. If it persists, it may need to be drained in hospital, possibly under general anaesthetic (while you're asleep).
​
If a fistula develops, you'll usually need surgery because they rarely heal by themselves.
Read more about treatments for anal fistulas.
Less common causes of anal pain
Less common causes of anal pain include:
-
proctalgia fugax – a condition that causes episodes of sudden, severe anal pain that last for a few minutes at a time; medicine that relaxes the muscles in the pelvis may help.
-
levator ani syndrome – an aching or pressure sensation in and around the anus that may be constant or last for hours or days at a time; treatment to relax the muscles in the pelvis may help.
-
an inflammatory bowel disease such as Crohn's disease – other symptoms can include tummy cramps, bloody diarrhoea and weight loss; treatments are available to help relieve the symptoms.
-
an infection – such as a fungal infection or rectal sexually transmitted infection (STI)
-
a bone-related problem – such as coccydynia (tailbone pain) or pain that spreads from your lower back, pelvis or hips, caused by arthritis or bone tumours.
-
a urinary tract problem – such as prostatitis (inflammation or infection of the prostate gland).
-
cancer of the anus or lower rectum – this can have symptoms similar to those of piles and anal fissures, but is much rarer.
When to get medical advice
Many common causes of anal pain improve with simple self-care treatments, so you do not always need to see your GP.
​
But it's a good idea to see your GP if:
-
your pain is severe
-
your pain does not improve after a few days
-
you have rectal bleeding
Do not feel embarrassed to see your GP – anal pain is a common problem that they're used to seeing. Your GP can try to work out what the problem is and give you treatment advice. They'll probably ask to see your bottom and may carry out a rectal examination (where they gently insert a gloved finger into your bottom) to check for any abnormalities.
​
If the cause is not immediately obvious, they may refer you to a specialist for advice and further tests.
​
Foods to improve gut health
Fill up on fibre to prevent constipation
It's a good idea to try to eat more fibre or roughage, as most people in the UK do not get enough.
​
A diet rich in fibre can help digestion and prevent constipation. Aim for the recommended dietary intake of 30g of fibre a day.
​
For a healthy bowel, you need fibre from a variety of sources, such as:
-
wholemeal bread
-
brown rice
-
fruit and veg
-
beans
-
oats
Some people find cereals and grains bring on bloating and irritable bowel syndrome. If that's the case, get your fibre from fruit and vegetables instead.
Find out how to boost your fibre intake
Drink plenty of fluids to aid digestion
It's important to keep drinking, especially water. It encourages the passage of waste through your digestive system and helps soften poo. Fibre acts like a sponge, absorbing water. Without fluid, the fibre cannot do its job and you'll get constipation.
​
A good way to make sure you're getting enough fluids is to drink a glass of water with every meal. Avoid caffeine drinks as they can cause heartburn.
Learn how to choose healthier drinks
Cut down on fat for a healthy gut
Fatty foods, such as chips, burgers and fried foods, are harder to digest and can cause stomach pain and heartburn.
Cut back on greasy fried foods to ease your stomach's workload. Try to eat more lean meat and fish, drink skimmed or semi-skimmed milk, and grill rather than fry foods.
Go easy on spice to avoid tummy troubles
Many people love spicy food and it does not bother their digestive system. Others find their tummy is upset when they have spicy food. It's not just scorching hot foods like chillies that trigger heartburn. Milder but flavourful foods like garlic and onion can also bring it on.
​
If spicy foods give you heartburn, stomach pain or diarrhoea, go easy on them in future.
If you already have a problem like heartburn or an irritable bowel, avoid them completely.
Beware gut symptom triggers
Some people find particular foods cause them problems. Acidic foods, such as tomatoes, citrus fruits, salad dressings and fizzy drinks, can trigger heartburn, while wheat and onions may cause irritable bowel syndrome.
If you cannot digest lactose, the sugar in milk, you'll develop wind and diarrhoea after drinking milk or eating dairy products, including cream, cheese, yoghurt and chocolate.
​
Try to stay away from foods and drinks that trigger your digestive symptoms. Keep a food diary to work out which foods cause your symptoms.
​
Choose the right drinks to ease digestion
Drinks with caffeine, such as coffee, colas, tea and some fizzy drinks, boost acid in the stomach, leading to heartburn in some people.
​
Fizzy drinks in general tend to bloat the tummy, which can also lead to heartburn.
To make digestive problems less likely, choose drinks that are not fizzy and do not contain caffeine, such as herbal teas, milk and plain water.
​
If you cannot do without your coffee or tea, limit your intake to 1 or 2 cups a day.
​
information taken from www.nhs.uk
​