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. Pinworms are the most common cause of anal itching in children. For more information, see the topics 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.

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 disease, 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. Blood that has moved quickly through the digestive tract or that begins near the rectum may appear red or dark red.

Use the Check Your Symptoms section to decide if and when you should see a doctor.

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Author:	Jan Nissl, RN, BS	Last Updated: April 24, 2009
Medical Review:	Kathleen Romito, MD - Family Medicine William M. Green, MD - Emergency Medicine H. Michael O'Connor, MD - Emergency Medicine
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