Anal Fissure and Fistula

Rectal Problems

Topic Overview

Rectal problems are common. Almost everyone will experience some rectal itching, pain, or bleeding at some time during his or her life. These problems are often minor and may go away on their own or with home treatment.

Rectal itching

Rectal itching (pruritus) is usually not a sign of a serious disease. At first, the skin of the anal area may appear red. Itching and scratching may make the skin become thickened and white. Common causes of rectal itching include:

Poor cleaning of the area after a bowel movement. Itching and discomfort may occur when pieces of stool become trapped in skin folds around the anus.
Medicines, especially medicines that cause diarrhea or constipation, such as antibiotics.
Cleaning of the anus with very hot water and strong soaps. The anal area is normally oily, and this barrier protects against the irritation of bowel movements. Repeated cleaning or showering will remove these oils and can lead to a cycle of itching and scratching that can be hard to stop.
The use of scented toilet paper, scented soap, or ointments (such as those that contain benzocaine).
A generalized dry skin condition that affects the entire body. This condition is more common in older adults. For more information, see the topic Dry Skin and Itching.
Hemorrhoids . Hemorrhoids are enlarged veins near the lower end of the rectum or outside the anus. For more information, see the topic Hemorrhoids.
An infection of the anus or rectum, which may be caused by viruses (such as genital warts), bacteria, pinworms, scabies, fungus, yeast, or parasites or passed on by animals. Pinworms are the most common cause of anal itching in children. For more information, see the topic Pinworms, Scabies, or Genital Warts (Human Papillomavirus).
Certain foods, such as coffee, tea, cola, alcoholic beverages, chocolate, tomatoes, spicy foods, and large amounts of vitamin C.
Some people get infections while traveling that cause rectal itching and other problems.

Rectal pain

Rectal pain may be caused by diarrhea, constipation, or anal itching and scratching. Rectal pain caused by these conditions usually goes away when the problem clears up.

Other less common causes of rectal pain include:

Enlarged, swollen veins in the anus (hemorrhoids).
Structural problems, such as anal fissures and fistulas or rectal prolapse.
Infection, such as a sexually transmitted infection, prostate infection, an abscess, or a pilonidal cyst.
Injury from foreign body insertion, anal intercourse, or abuse.
Diseases, such as cirrhosis of the liver, diabetes, lymphoma, Crohn's disease, or ulcerative colitis.
Cancer of the rectum or the prostate or skin cancers, such as squamous cell cancer and Bowen's disease.
Previous treatment, such as surgery or radiation therapy to the rectum or pelvis.
Rectal spasms (proctalgia fugax).

Rectal bleeding

Many people have small amounts of rectal bleeding. Irritation of the rectum from diarrhea or constipation, a small hemorrhoid, or an anal fissure can cause a small amount of bright red blood on the surface of the stool or on the toilet paper. Hemorrhoids and anal fissures usually occur after straining during a bowel movement because of constipation. This type of bleeding can cause pain during a bowel movement and does not make the toilet water bloody. It is not serious if there is only a small amount of blood and the bleeding stops when the diarrhea or constipation stops. Home treatment is usually all that is needed.

Bleeding can occur anywhere in the digestive tract. The blood is digested as it moves through the digestive tract. The longer it takes the blood to move through the digestive tract, the less it will look like blood. Often blood that is caused by bleeding in the stomach will look black and tarry. A tarry stool has a black, shiny, sticky appearance and looks like tar on a road. Blood that has moved quickly through the digestive tract or that begins near the rectum may appear red or dark red.

Certain medicines and foods can affect the color of the stool. Diarrhea medicines (such as Pepto-Bismol) and iron tablets can make the stool black. Eating lots of beets may turn the stool red. Eating foods with black or dark blue food coloring can turn the stool black.

Check your symptoms to decide if and when you should see a doctor.

Check Your Symptoms

Do you have a rectal problem?

This includes symptoms like rectal pain, itching, or bleeding. It could also include a change in your stool other than diarrhea or constipation.

Yes

Rectal problem

How old are you?

Less than 12 years

12 years or older

Are you male or female?

Male

Female

The medical assessment of symptoms is based on the body parts you have.

If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
If your symptoms aren’t related to those organs, you can choose the gender you identify with.
If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.

Do you have moderate or severe belly pain?

This is not the cramping type of pain you have with diarrhea.

Yes

Abdominal pain

Do you have symptoms of shock?

The symptoms in an adult or older child are different than the symptoms in a young child.

Yes

Symptoms of shock

Are your stools black or bloody?

Yes

Black or bloody stools

Have you had:

At least 1 stool that is mostly black or bloody?

At least 1 stool mostly black or bloody

At least 1 stool that is partly black or bloody?

At least 1 stool partly black or bloody

Streaks of blood in your stool?

Streaks of blood in stool

Are you bleeding from your rectum?

Yes

Bleeding from rectum

How much blood has there been?

More than 2 tablespoons (30 mL)

More than a few streaks but no more than 2 tablespoons (30 mL)

Streaks of blood on the toilet paper

Has there been a recent injury to the rectum or vagina?

Physical or sexual abuse and other injuries to these areas can cause problems like rectal pain and bleeding, urination problems, constipation, and vaginal bleeding.

Yes

Recent injury to rectum or vagina

Do you think the rectal problem may be causing a fever?

Infections and other rectal problems can sometimes cause pain and a fever.

Yes

Possible fever

Do you have pain in the rectal area?

Yes

Rectal pain

How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?

Signs of pain in an adult or child are different than signs of pain in a baby or toddler.

8 to 10: Severe pain

Severe pain

5 to 7: Moderate pain

Moderate pain

1 to 4: Mild pain

Mild pain

How long have you had the pain?

Less than 1 day (24 hours)

Rectal pain for less than 1 day

One day to 1 week

Rectal pain for 1 day to 1 week

More than 1 week

Rectal pain for more than 1 week

Is there any swelling, a lump, a sore, or a new growth in the rectal area?

Yes

Swelling, lump, or sore in rectal area

Has it been there for longer than 1 week?

Yes

Swelling, lump, or sore in rectal area for more than 1 week

Is there an object in the rectum?

Yes

Object in rectum

Is there any itching in the rectal area?

Yes

Rectal itching

Have you had any stool leaking from your rectum for more than 2 days?

Yes

Leakage of stool for more than 2 days

Have you tried any home treatment for the itching for more than 1 week?

Yes

Tried home treatment for more than 1 week for rectal itching

Have you had other signs of illness, such as weight loss, fatigue, or a rash, for more than 1 week?

Yes

Other signs of illness present for more than 1 week

Have your symptoms lasted longer than 2 weeks?

Yes

Symptoms for more than 2 weeks

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

Your age. Babies and older adults tend to get sicker quicker.
Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

Try home treatment to relieve the symptoms.
Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

HomeTreatment

RelatedInformation

WhereToGo

Blood in the stool can come from anywhere in the digestive tract, such as the stomach or intestines. Depending on where the blood is coming from and how fast it is moving, it may be bright red, reddish brown, or black like tar.

A little bit of bright red blood on the stool or on the toilet paper is often caused by mild irritation of the rectum. For example, this can happen if you have to strain hard to pass a stool or if you have a hemorrhoid.

Certain medicines and foods can affect the color of stool. Diarrhea medicines (such as Pepto-Bismol) and iron tablets can make the stool black. Eating lots of beets may turn the stool red. Eating foods with black or dark blue food coloring can turn the stool black.

If you take aspirin or some other medicine (called a blood thinner) that prevents blood clots, it can cause some blood in your stools. If you take a blood thinner and have ongoing blood in your stools, call your doctor to discuss your symptoms.

Rectal itching is most often caused by dry or irritated skin in the rectal area. It can also be a sign of pinworms, especially in children.

Itching may be more serious if it occurs with a rash or if it does not improve with home treatment.

Home treatment for rectal itching includes things like:

Keeping the area clean and dry.
Washing the area with water several times a day and after bowel movements.
Sitting in a few inches of warm water in a bathtub.
Wearing loose-fitting cotton underwear.
Using a nonprescription hydrocortisone (1%) cream on the area.

Pain in adults and older children

Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.

Pain in children under 3 years

It can be hard to tell how much pain a baby or toddler is in.

Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.

Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.

Adults and older children often have several symptoms of shock. These include:

Passing out (losing consciousness).
Feeling very dizzy or lightheaded, like you may pass out.
Feeling very weak or having trouble standing.
Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.

Shock is a life-threatening condition that may occur quickly after a sudden illness or injury.

Babies and young children often have several symptoms of shock. These include:

Passing out (losing consciousness).
Being very sleepy or hard to wake up.
Not responding when being touched or talked to.
Breathing much faster than usual.
Acting confused. The child may not know where he or she is.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

Call your doctor today to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don't have one, seek care today.
If it is evening, watch the symptoms and seek care in the morning.
If the symptoms get worse, seek care sooner.

HomeTreatment

RelatedInformation

WhereToGo

Make an Appointment

Based on your answers, the problem may not improve without medical care.

Make an appointment to see your doctor in the next 1 to 2 weeks.
If appropriate, try home treatment while you are waiting for the appointment.
If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

HomeTreatment

RelatedInformation

WhereToGo

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

Call your doctor now to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don't have one, seek care in the next hour.
You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.

HomeTreatment

RelatedInformation

WhereToGo

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Abdominal Pain, Age 11 and Younger

Abdominal Pain, Age 12 and Older

Home Treatment

Home treatment for rectal itching depends on the cause of the itching.

Treat causes of anal itching

Try these home treatment measures for the following causes of anal itching:

Poor hygiene. Clean the area gently with water-moistened cotton balls, a warm washcloth, or premoistened towelettes, such as Tucks or "baby wipes." A mild ointment, such as A+D Ointment or Desitin, can be applied lightly to help soothe the skin and protect it against further irritation.
Scented or colored toilet paper or scented soaps, lotions, or creams.
- Buy white, unscented toilet paper.
- Do not use scented soaps, which can irritate skin.
- Apply an ointment that contains 1% hydrocortisone. Do not use other steroid creams on this sensitive area of your body, because skin damage can occur. Hydrocortisone cream should not be used for longer than 7 to 10 days without talking with your doctor. Do not use creams or ointments, such as Benadryl cream, that contain antihistamines. Note: Do not use the cream on children younger than age 2 unless your doctor tells you to. Do not use in the rectal or vaginal area in children younger than age 12 unless your doctor tells you to.
Excessive sweating. For anal itching caused by excessive sweating, avoid wearing tight-fitting underwear, and wear cotton, rather than synthetic, undergarments. You may use talcum powder to absorb moisture, but do not use cornstarch. Cornstarch may cause a skin infection. Before applying talcum powder, dry your rectal area with a hair dryer set on the low setting.

To control itching

To control itching, try the following:

Break the itch-scratch cycle, because further scratching leads to more itching. Take an oral antihistamine at night to help lessen your nighttime itching. Don't give antihistamines to your child unless you've checked with the doctor first.
Take a warm sitz bath 3 times each day and after each bowel movement. Following the bath, dry the anus carefully. You may wish to use a hair dryer set on low.
Avoid foods that can increase rectal itching, such as coffee, tea, cola, alcoholic beverages, chocolate, tomatoes, spicy foods, and excessive amounts of vitamin C, for a minimum of 2 weeks. Gradually add the items back to your diet, one item at a time, to help determine the cause of the itching.
Trim your fingernails short if you find yourself scratching irritated skin at night. Wear cotton gloves or socks on your hands at night to help stop the unconscious scratching that can occur while you sleep.
Control your stress. Being under stress and feeling anxious or worried can cause some people to experience skin itching. If you find you are scratching your anal area when you are anxious, try to take relaxation breaks throughout the day, especially before bedtime. For more information, see the topic Stress Management.

For rectal bleeding

When you have rectal bleeding, do not take aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin and other NSAIDs, such as ibuprofen, can cause bleeding in the digestive tract, which can increase the amount of blood in your stools. These medicines can also make bleeding hemorrhoids bleed more. If you need to use something for pain, try taking acetaminophen, such as Tylenol.

Rectal bleeding can be caused by constipation, diarrhea, or hemorrhoids.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

Pain increases or does not improve.
The blood in your stool increases, or your stools become red, black, or tarry.
Swelling or a lump in or around your anus develops.
Symptoms become more severe or more frequent.

Prevention

To prevent rectal problems:

Use white, unscented toilet paper.
Do not use scented soaps. These can irritate the skin.
Practice good hygiene. Gently wipe the area with toilet paper after each bowel movement. If irritation starts, use water-soaked cotton balls to clean the area and then pat the area dry with dry cotton balls. Premoistened pads, such as Tucks or "baby wipes," may be less irritating.
Do not sit on the toilet for long periods of time.
Eat a high-fiber diet that includes plenty of fruits and vegetables and bran cereal every day.
Avoid foods that can cause rectal problems. Examples of such foods include:
- Regular or diet cola.
- Coffee.
- Beer and other alcoholic beverages.
- Dairy products.
- Any other items that you know cause you to have gas or indigestion.
Avoid constipation. For more information, see the topic Constipation, Age 11 and Younger or Constipation, Age 12 and Older.
Avoid diarrhea. For more information, see the topic Diarrhea, Age 11 and Younger or Diarrhea, Age 12 and Older.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

Is your main problem rectal pain, itching, or bleeding?
Are your symptoms:
- Present all the time, or do they come and go?
- Present only with bowel movements?
- Steady?
- Getting worse?
How long have you had this problem? Did it come on suddenly or gradually?
Have you ever been treated for a similar problem? If so, what was the treatment? Did it help?
What home treatments have you tried for your current problem? Have they helped?
Have you had leaking of mucus or stool from your rectum?
Have you noticed a change in the color, consistency, size, or frequency of your stool?
Do you have a history of hemorrhoids or rectal disease?
Do you have a family history of colon cancer, ulcerative colitis, inflammatory bowel disease, or Crohn's disease?
If you have had a full-term pregnancy, did you have a vaginal delivery?
Have you ever had radiation therapy to your pelvic area?
Did your symptoms begin after an injury, insertion of a foreign body, anal intercourse, or a bowel movement?
Do you think that your problem may be related to sexual activity?
Do you engage in high-risk sexual behavior, such as having unprotected sex or multiple sex partners?
Have you ever been treated for a sexually transmitted infection (STI)?
Do you have other symptoms such as fatigue, unexplained weight loss, fever, or pain elsewhere in your body?
Have you recently traveled to a foreign country?
What prescription and nonprescription medicines do you take?
Do you have any health risks?

For rectal itching

Is there itching or a rash present on any other part of your body?
Are other members of your family also experiencing rectal itching?

For rectal pain

How severe is your pain? Is it constant, or does it come and go? Is it getting worse? Is it related only to having a bowel movement?
Does the pain feel like it is coming from the inside or the outside of your anus?

For rectal bleeding

What does the blood in your stools look like? Is the stool mixed with blood, or does the blood coat the outside of formed stools? Are there large clots of blood in the toilet water?
Do you have bleeding from your gums, blood in your urine, large skin bruises, or a skin rash that looks like measles?
Is your rectal bleeding painful?
Is the blood bright red or dark purple?

Related Information

Credits

Current as of: June 26, 2019

Author: Healthwise Staff

Medical Review:

William H. Blahd Jr. MD, FACEP - Emergency Medicine

Adam Husney MD - Family Medicine

Kathleen Romito MD - Family Medicine