Anal, rectal pain

Anal pain is common, and almost always benign.  Most people think that anal pain is caused by hemorrhoids.  This is not correct.  The most common cause of anal pain is an anal fissure (a crack within the anal canal).  Anal fissures may lead to a small lump at the edge of the anus, called a ‘sentinel pile’.  Patients (and doctors) often confuse this small lump with a painful hemorrhoid.  The only time an internal hemorrhoid can cause pain is if it thromboses (clots).  This is fairly rare.  A thrombosed hemorrhoid will cause steady pain for a week, whereas the pain from a fissure is more often related to bowel movements.  A perianal hematoma can cause severe anal pain for a week and is also associated with a larger lump at the edge of the anus.  An abscess is a collection of pus and is very painful and needs to be drained.  Finally, anal cancer can cause severe anal pain once it starts penetrating into deeper tissues.  But anal cancer is rare, and should be readily diagnosed by an experienced examiner.

Some patients complain of sudden, very severe pain, deep in the rectum.  It can last anywhere from a few seconds to 30 minutes or so and will often wake them up from sleep.  This may be due to severe spasms in the muscles of the pelvic floor.  See Proctalgia Fugax.

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