Anal Pain: Causes and Treatment
Anal pain is more common than most people think, and it can significantly affect daily life. Sitting, walking, or going to the bathroom may become uncomfortable or even painful. Anal pain is not a single disease but a symptom that can appear for many different reasons.
The most frequent causes include haemorrhoids, anal fissures, fistulas and local inflammation, as well as infections such as sexually transmitted infections (STIs). Each condition requires a precise evaluation to choose the right treatment and avoid complications.
Haemorrhoids
Haemorrhoids are swollen veins in the anus or lower rectum. They commonly cause pain, itching, bleeding, or a persistent feeling of discomfort.
Mild cases can improve with medication and lifestyle changes —such as increasing fibre intake and avoiding straining during bowel movements. In more advanced or recurrent cases, a surgical procedure may be the best option for long-term relief.
Anal fissure
An anal fissure is a small tear in the lining of the anal canal that produces sharp, intense pain, especially during and after bowel movements.
Most fissures heal with medicated creams that relax the anal sphincter, alongside bowel-habit adjustments. When the fissure becomes chronic or does not heal properly, the surgeon may recommend a simple procedure to release sphincter tension and allow adequate healing.
Anal fistula
Anal fistulas are abnormal tunnels that connect the inside of the anus to the surrounding skin. They usually originate from a previous infection that leaves a persistent tract.
They often cause pain, swelling and discharge. Unlike other conditions, fistulas rarely heal on their own. For this reason, surgery is usually required, choosing the technique that best fits the fistula type and the patient’s anatomy to ensure healing while preserving continence.
Inflammation and Sexually Transmitted Infections (STIs)
Anal pain can also result from inflammation related to inflammatory bowel disease —such as Crohn’s disease— or from sexually transmitted infections.
These infections may cause pain, itching, discharge and persistent discomfort. Early diagnosis is key to starting the right treatment and preventing the infection from spreading.
Diagnosis: why a complete evaluation matters
A thorough medical history and a careful physical examination are essential. In some cases, additional tests may be required, such as:
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Anal ultrasound, useful for identifying fistulous tracts and abscesses.
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MRI, the gold-standard technique to assess anal anatomy in depth.
These tools help confirm the diagnosis and plan a personalised, safe and effective treatment.
Treatment options
Treatment depends on the underlying cause and may include:
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Creams, ointments or suppositories
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Antibiotics or targeted medication in case of infection
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Minimally invasive procedures
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Surgery, especially for fistulas or advanced haemorrhoids
The surgeon’s role is not only to perform the procedure when necessary, but also to guide the patient through diagnosis, treatment decisions and postoperative follow-up.
If you experience anal pain or persistent symptoms, request a specialist evaluation to identify the cause and recover your quality of life.