The Facts About Rectal Pain and Men's Health

The Conditions That Cause Rectal Pain and How They Affect Men's Health

Human colon

We have all heard or used the phrase "a pain in the butt." We can all chuckle but in reality, rectal pain is a very real men's health problem. In fact, it's not only a men's health issue. It can also be an issue for women living with HIV as well. The cause of rectal pain can be trivial and easy to remedy or can be very serious and sometimes fatal. What are the causes of rectal pain and what should be done if rectal pain strikes you?

What Are the Rectum and Anus?

The term rectum is sometimes used interchangeably with the term anus. When people refer to rectal pain, they usually are including pain in the anus as well. In practice, the rectum and anus are two different things.

  • Rectum - The rectum is an 8-inch long chamber that connects the colon to the anus. Think of the anus as a storage area, storing stool that is ready to be expelled from the body. When stool or gas enters the rectum, sensors in the rectum send a message to the brain telling it there is a stool that needs to be expelled. If the time is right (you are in the restroom), the rectum pushes the stool through the anus and out of the body. If the time is not right (you are in the car on the way home from work), the rectum holds the stool until you can get to a restroom.
  • Anus - The anus is the very end of the intestinal tract that connects the rectum to the outside world. Waste is pushed from the rectum through the anal canal and out of the body through the anus.

    Common Causes of Rectal and Anus Pain

    As we mentioned earlier, there are numerous causes of rectal and anus pain. In fact, the causes of rectal pain are too numerous to list all of them here. Some are a nuisance but not very serious. Others signal there is a serious problem brewing that requires immediate evaluation.

    The key is to figure out which is which. Let's look at six of the most common causes of rectal and anal pain in HIV positive and HIV negative people.

    1. Anal Fissure

    A fissure is a long tear in the skin, tissue or mucous. An anal fissure is a long tear of the tissue in or around the anus and rectum.


    • Anal and rectal pain
    • Bleeding
    • Blood in the stool, in the toilet, or on the toilet paper


    • Hard stool as a result of constipation
    • Large stool
    • Straining to move the bowels
    • Anal sex


    • Stool softeners and laxatives
    • Drinking lots of water
    • Soaking in warm water to relieve pain and speed healing
    • Pain relief in the form of oral and topical medications
    • In severe cases, surgery may be needed to close the fissure

    2. Rectal Abscess

    An abscess is a pocket or collection of pus that results from an infection within the tissue. These types of localized infections often occur in and around the rectum.


    • Pain and swelling in the anus or buttocks area
    • Fever and/or night sweats
    • Painful lump in the anus or rectum
    • Painful bowel movements
    • Abdominal pain


    Abscesses are related to the glands in and around the anus and rectum. Much like a pimple caused by clogged pores, the glands of the anus and rectum often get clogged, leading to inflammation and pus accumulation.

    When these areas burst, their pus is released into the surrounding tissues of the rectum and anus, resulting in an abscess. People with suppressed immune systems, including HIV-positive people, are at risk for this type of infectious scenario. In other cases, skin breaks such as anal fissures can allow bacteria to populate the area often resulting in a rectal abscess.


    • Antibiotics treat the infection that has caused the abscess. The specific antibiotic depends on what infectious organism has caused the abscess. Whether the abscess is drained or not, antibiotics are always used to treat the underlying infection.
    • Needle aspiration of the abscess to remove the infectious fluid. This can be done on superficial abscesses that can be reached by a needle and syringe.
    • For those abscesses inaccessible by a needle, surgical drainage is done. The skin and tissue are opened surgically and the infectious fluid is drained.

    3. Hemorrhoids

    A hemorrhoid is an enlarged, blood engorged vein or collection of veins in and around the rectum.


    • Rectal pain and/or itching
    • Blood on the surface of the stool or on the paper after wiping
    • Incomplete bowel movements
    • Soft lump protruding from the anus


    • Straining to move the bowels (related to constipation)
    • Violent coughing, sneezing, or vomiting
    • Pregnancy
    • Cirrhosis of the liver
    • Anal sex
    • Anal fissures or infection

    Treatment - Non-Invasive

    • Soaking in warm water several times ice day
    • Ice packs to reduce the swelling
    • Medicated creams, prescription and over the counter, can be applied to shrink the size of the hemorrhoids or to relieve pain and itching.
    • Keeping the area clean by patting instead of wiping
    • Wearing loose fitting underwear to decrease irritation

    Treatment - Invasive

    • Ligation - using a rubber band or suture to cut off hemorrhoid's blood supply. After about a week, hemorrhoid dries up and falls off.
    • Sclerotherapy - a chemical is injected into the tissue surrounding hemorrhoid, dramatically reducing hemorrhoid's blood supply, causing hemorrhoid to shrink
    • Hemorrhoidectomy - surgical removal of the hemorrhoids

    4. Colitis (Ulcerative Colitis or Crohn's Disease)

    Colitis is an inflammation of the intestinal tract. Ulcerative colitis is limited to the large intestine while Crohn's can involve the entire digestive system. Both cause inflammation that causes rectal pain.


    • Rectal pain
    • Bowel urgency
    • Nausea
    • Bloody diarrhea
    • Fatigue
    • Weight loss
    • Mucus and pus in stool

    Causes - Ulcerative Colitis

    The cause or causes of ulcerative colitis are not entirely understood. Most believe it's an abnormal autoimmune response in the large intestine, possibly associated with food or the GI bacteria Escherichia coli (E-coli).

    Causes - Crohn's

    Blockages within the intestinal mucosa cause swelling, inflammation, ulcerations, and abscesses that are common to Crohn's. Like ulcerative colitis, the cause of Crohn's is not well understood but is thought to be autoimmune in nature.


    The treatment of ulcerative colitis and Crohn's is aimed at minimizing inflammation which causes the symptoms common to these conditions. Treatments can include steroids that slow the inflammation process. Medications can be taken orally or in some cases in the form of enemas in order to apply the medication directly to the areas of the intestinal tract involved. In extreme cases or in cases of intestinal tract damage, surgical interventions are done to reduce symptoms and eliminate severely damaged lengths of the bowel. Unfortunately, there is no cure for ulcerative colitis and Crohn's.

    5. Trauma Related to Anal Sex

    Men and women practice a variety of voluntary sexual activities, and all forms of sexual activity come with varying levels of risk. Risk of physical trauma related to anal sex is greatly reduced when practiced safely and with care, but some of the most common injuries associated with sexual intercourse are related to anal penetration. While most of these injuries are minor and can resolve with little intervention, they can be uncomfortable and worrisome.

    Types of Injuries

    • Anal fissure or tearing
    • Rectal perforation (more common if foreign objects are used during anal sex)
    • Mucosal tears in and around the rectum and anus
    • Sphincter injuries (can again be related to foreign objects or aggressive anal sex)
    • Rectal prolapse (part of rectum protruding from the anus)


    • Rectal pain during and after sex
    • Bleeding during and after sex
    • Pain when moving the bowels
    • Palpable mass or a lump near the anus


    • Pain relief
    • Refraining from anal sexual activity until fully healed
    • Stool softener to decrease the potential of a hard bowel movement
    • No straining, bearing down, or heavy lifting while healing
    • In extreme cases, surgical repair may be required.

    6. Anal and Rectal Lesions

    Lesions or growths in and around the anus can cause rectal pain. Two of the most common anal lesions are genital warts and herpes simplex:

    • Genital warts are smooth, flesh-colored round lesions that are caused by human papillomavirus (HPV)
    • Genital herpes is one of many types of herpes. Herpes are caused by the herpes simplex virus. They are painful, fluid-filled blisters around the anus. These lesions break, drain, and sometimes form ulcers of the rectum and anus.

    Symptoms - Genital Warts

    The most common symptom of genital warts are clusters of flesh-colored lumps that some say resemble cauliflower. The clusters themselves are painless but often interfere with bodily functions such as moving the bowels, making that process painful.

    Symptoms - Genital Herpes

    • Painful, fluid-filled lesions that break and heal
    • Flu-like symptoms
    • Fever
    • Swollen glands

    Treatment - Genital Warts

    Whether or not to treat genital warts is up to you. Treatment can be in the form of topical creams or surgical removal. The virus that causes genital warts can't be cured even if the warts are removed or treated.

    Treatment - Genital Herpes

    The lesions that are characteristic of genital herpes come and go but there is no cure. Topical medications such as Zovirax Cream and oral medications such as acyclovir and Valtrex can shorten outbreaks and decrease their frequency.​​

    The Bottom Line

    The important thing to remember is that rectal pain signals that there is a problem. The problem can be something simple and easy to remedy like like hemorrhoids or something very serious and potentially fatal like anal cancer. If you experience anal or rectal pain, regardless of severity, you should make an appointment with your doctor and get an evaluation. That evaluation can save your life.


    ​​American Academy of Dermatology Brochure; "Genital Warts"; 2006.

    Geist, R.; "Sexually Related Trauma"; Emergency Medicine Clinics of North America; 6 Aug 1988; 439-66.

    Myers, D.; "Anus"; Colon Cancer; 8 Aug 2007.

    Myers, D.; "What is the Rectum?"; Colon Cancer; 12 Jan 2008.

    USA Today Health Encyclopedia - Diseases and Conditions; "Hemorrhoids"; USA Today 4 Apr 2007.

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