Rectal pain

Rectal pain
Other names: Anal pain, anorectal pain, proctalgia, pain in the bottom[1]
SpecialtyGeneral surgery
CausesCommon: Anal fissures, hemorrhoids, anal fistulas, anal abscess[1]
Less common: Prostatitis, anal cancer, sexually transmitted infections, inflammatory bowel disease, tailbone pain, levator ani syndrome[1]
FrequencyCommon[1]

Rectal pain is the symptom of pain in the area of the rectum.[1] The pain maybe worsened with a bowel movement.[1] Associated symptoms may include rectal bleeding, perianal itching, or fever.[1]

Common causes include anal fissures, thrombosed hemorrhoids, anal fistulas, and anal abscesses.[1] Less common causes include prostatitis, anal cancer, sexually transmitted infections, inflammatory bowel disease, tailbone pain, and levator ani syndrome.[1]

Seeing a healthcare provider is recommended in those who have severe pain, pain lasts more than a few days, or if bleeding is present.[1] Rectal pain is a common symptoms.[1]

Differential diagnosis

Anal fissures

One of the most common causes of rectal pain is an anal fissure.[2] It involves a tear in the anal canal probably due to trauma from defecation[3] and are usually treated effectively with sitz baths, stool softeners, and analgesics.[2]

Anorectal abscess

An anorectal abscess is an infection that forms a pocket of pus within the tissues around the anus. It is generally treated surgically by incision and drainage.[2]

Infections

Bacterial, viral, and protozoal infections may occur in the area surround the rectum. These may be the result of a sexually transmitted disease.[2] Specifically herpes may result in rectal pain.[4]

Other

Hemorrhoids or rectal foreign body.[4]

Functional disorders

After structural diseases have been ruled out a functional disorder may be considered.[5] Two causes of functional anorectal pain are levator ani syndrome (LAS) and proctalgia fugax. Both of these conditions are thought to be caused by muscle spasms of the either the levator ani muscle or the anal sphincter muscle respectively, and may overlap symptomatically with a third less-common condition called coccygodynia which is the result of previous trauma to the coccyx bone. Stress, prolonged sitting, and constipation all seem to be associated with LAS. The majority (90%) of those reporting chronic episodes of such pain are women. Some researchers group these conditions under the medical category of "tension myalgia of the pelvic floor". Less than a third of those experiencing these conditions seek medical treatment for them. Treatment can involve the use of antispasmodic medications as well as the down-training (conscious involvement and relaxation of previously unconscious muscle movements) so that spasms occur less frequently or not at all.[6]

References

  1. 1 2 3 4 5 6 7 8 9 10 11 "Anal pain". nhs.uk. 17 October 2017. Archived from the original on 13 May 2021. Retrieved 17 October 2020.
  2. 1 2 3 4 Janicke DM, Pundt MR (November 1996). "Anorectal disorders". Emerg. Med. Clin. North Am. 14 (4): 757–88. doi:10.1016/S0733-8627(05)70278-9. PMID 8921768.
  3. ↑ Metcalf A (November 1995). "Anorectal disorders. Five common causes of pain, itching, and bleeding". Postgrad Med. 98 (5): 81–4, 87–9, 92–4. doi:10.1080/00325481.1995.11946071. PMID 7479460.
  4. 1 2 Bouchard, D; Pigot, F (February 2017). "[Anal acute pain]". La Revue du praticien. 67 (2): 148–151. PMID 30512847.
  5. ↑ Bharucha, AE; Lee, TH (October 2016). "Anorectal and Pelvic Pain". Mayo Clinic proceedings. 91 (10): 1471–1486. doi:10.1016/j.mayocp.2016.08.011. PMID 27712641.
  6. ↑ Giulio Aniello Santoro; Andrzej Paweł Wieczorek; Clive I. Bartram (27 October 2010). Pelvic Floor Disorders: Imaging and Multidisciplinary Approach to Management. Springer. pp. 601–603. ISBN 978-88-470-1542-5. Archived from the original on 28 April 2016. Retrieved 13 October 2016.
Classification
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