Pain in the rectum often feels like a deep-seated pain in the buttocks. While most of us are accustomed to occasional buttock pain, rectal pain tends to make us uneasy and rightfully so. While many of the causes of rectal pain are not due to serious conditions and can be easily treated or even resolve without treatment, some conditions that cause pain in the rectum can be very serious, and even life-threatening. Sometimes the pain is the only symptom while at other times it may be accompanied by changes in bowel movement, bleeding and fecal incontinence.
What is proctalgia?
Proctalgia is the medical term for pain in the rectum and anus. Rectalgia is the term specifically for pain in the rectum. However, both terms are often used interchangeably. It is often difficult to isolate deep-seated pain in the buttocks from arising within the rectum, anal canal/anus, sigmoid colon or surrounding structures like the sacrum. Even accompanying symptoms like difficulty passing stool along with pain in this region may not necessarily be originating from the rectum.
Location of Rectum
It is important to understand where the rectum is located when discussing rectal pain. The rectum is located towards the back of the pelvic cavity. It is the last part of the large intestine joining the terminal portion of the colon to the anal canal. It is essentially a continuation of the sigmoid colon. The rectum is about 12cm (4.7in) long and lies behind the prostate in men or vagina in women. It is also in close proximity to the urinary bladder.
Symptoms with Rectal Pain
Pain in the rectum is a symptom and not a disease on its own. It can be associated with several conditions as discussed above and other symptoms may also be present. This includes:
- Rectal bleeding where blood is seen upon wiping after a bowel movement, soils the underwear or stains the stool and water in the toilet bowl.
- Diarrhea or constipation
- Mucus in the stool
- Difficulty sitting or lying on the back
- Changes in gait due to the pain
Although most of these symptoms may indicate a problem in the rectum itself, it can also occur with diseases that do not involve the colon, rectum or anus in any way. It is therefore important to have rectal pain assessed by a medical professional.
Causes of Rectal Pain
The are many different possible causes of rectal pain but the most common and the most serious are covered here in detail in no specific order.
The sacrum is the last part of the spine (vertebral column) made up of fused bones that ends with the coccyx. In adults the coccyx (tailbone) may also be fused. A fracture of the sacrum or coccyx will cause deep seated pain and can also make passing stool difficult and painful. Falls are usually one of the more common causes of a sacral/coccygeal fracture.
Hemorrhoids is one of the most common causes of rectal and anal pain. It occurs when the veins in the rectal and anal area become inflamed. Often there is rectal bleeding particularly when wiping, pain and burning along with the feeling of an incomplete bowel movement even after passing stool. There are a number of different causes of hemorrhoids including constipation or diarrhea, age-related changes to the region, prolonged sitting on the toilet among other causes.
Diarrhea and Constipation
Both diarrhea and constipation can lead to rectal pain either due to an infection, inflammatory disease or injury to the rectum. The hard stools with constipation can injure the rectum especially with straining. Fecal impaction may also cause rectal injury when it occurs in severe constipation.
Proctitis simply means that the rectum and/or anus is inflamed. This inflammation may be due to a number of different diseases ranging from mechanical or chemical trauma, to infections and other non-infectious inflammatory diseases of the rectum. Sexually transmitted diseases of the anus and rectum may also be responsible particularly with anal intercourse.
Surgery to the lower bowel and perineal area may also cause pain in the rectum or pain that is suspected of arising in the rectum. This includes procedures such as a colectomy, prostatectomy, hysterectomy and so on. A post-operative infection of the perineum can also cause pain and it is therefore to have rectal pain assessed if it arises or is worsening after surgery.
Foreign Body in the Rectum
Although a foreign body in the rectum is not among the more common causes, it is not entirely uncommon as well. It is relatively frequently seen in the emergency room (ER). Often it is associated with sexual habits in adult males and females. It may also be seen in children and psychiatric patients. Sometimes the insertion of an object was intended for medicinal purposes but unlike medical suppositories the object does not dissolve and instead causes an obstruction in the rectum or leads to inflammation.
Inflammation of the prostate gland may also be perceived as rectal pain since the prostate and rectum lie next to each other. An infection of the prostate can also spread towards the rectum and other perineal structures. Rectal pain in men associated with changes in urination may be a sign of prostatitis.
Pelvic Inflammatory Disease
Pelvic inflammatory disease (PID) is a condition where there is inflammation of the female reproductive organs such as the ovaries, fallopian tubes and/or uterus. It often causes pelvic pain in women that seems to be arising from the rectum. Since PID is often due to an infection, it is possible that the infection can spread to the rectum due to the close proximity of these organs.
Cancer of the rectum or anus can also be a cause of rectal pain. Rectal cancer often occurs with colon cancer and is therefore collectively referred to as colorectal cancer. It arises with abnormal cell division in the region leading to a malignant tumor. A strong family history is one of the major risk factors. Sometimes the cancer originates elsewhere and spread to the rectum like with malignant spread of prostate cancer.
There are a host of other causes of rectal pain including:
- Cancer of the prostate, vagina, sacrum/coccyx and other pelvic organs.
- Inflammatory bowel disease
- Rectal/vaginal fistula