Rectal pain without bleeding: causes, red flags and when to get it checked

Rectal pain with no bleeding is most often caused by something local and benign: piles, a small tear in the anus, constipation, or tension and spasm in the muscles of the pelvic floor. Because several quite different conditions can produce the same ache, the details of the pain matter: whether it is sharp or dull, constant or fleeting, linked to going to the toilet or to sitting, and whether you have other symptoms.

Persistent or worsening pain that has no clear explanation, or that comes with weight loss, a change in bowel habit, a lump, fever or difficulty passing urine, should be examined by a GP. An examination is usually all that is needed to find the cause, and the NHS says doctors and nurses are used to discussing these symptoms.

The causes below are the ones described in NHS and Guts UK pages, grouped by what the pain tends to look like.

The NHS says piles are swollen blood vessels in and around the bottom. They often get better on their own after a few days. Symptoms include bright red blood after you poo, an itchy anus, a feeling that you still need to poo after going, mucus on underwear or paper, lumps around the anus and pain around the anus. Not everyone with piles bleeds, so a painful lump without blood is still consistent with piles.

An anal fissure is a small tear in the anus that causes sharp pain when you poo and burning that may last hours afterwards. The NHS says other causes of pain around the anus and bleeding include piles, and that if a GP is not sure whether you have a fissure or something more serious may be causing it, you may be referred for an examination under general anaesthetic.

Home care recommended by the NHS for both includes paracetamol, plenty of fluid and fibre to keep poo soft, a warm bath, keeping the area clean and dry, and not ignoring the urge to poo or straining. It advises against painkillers containing codeine because they cause constipation.

The NHS describes constipation as not pooing as often or finding it hard to poo, with poo that is unusually large or small, dry, hard or lumpy, and straining or pain when you poo. It says to see a GP if constipation is not getting better with treatment, if you have blood in your poo, have lost weight without trying or notice sudden changes in your bowel habits.

Long-term constipation can lead to faecal impaction, where poo has built up in the last part of the large intestine. The NHS says the main symptom is diarrhoea leaking through the build-up of solid poo, and that it may be treated with stronger laxatives, a suppository, a mini enema, or removal of some of the poo by a healthcare professional, which you should not attempt yourself.

Guts UK notes that excessive straining can lead to the rectal wall protruding through the anus (rectal prolapse), and that bleeding from piles or a painful tear at the anus are common in people with constipation.

In men, pain felt in the bottom can come from the prostate. The NHS says prostatitis is inflammation of the prostate and lists pain when peeing that may feel like stinging or burning, difficulty or straining to pee, needing to pee more often, pain in the penis, scrotum, testicles or bottom, pain on ejaculation and a high temperature as symptoms. It needs treatment with antibiotics and, the NHS says, can be serious and needs urgent medical help; being unable to pee is a reason for urgent advice.

Pelvic organ prolapse, in which the womb, bladder or bowel bulge into the vagina, can cause a feeling of heaviness or pressure and problems pooing, according to the NHS. Irritable bowel syndrome can cause pelvic pain as one of its less common symptoms, and the NHS says IBS cramps are usually better after doing a poo.

The NHS notes that tummy pain in inflammatory bowel disease may come with blood or mucus in the poo, but that tiredness and weight loss can be present without bleeding. A fleeting, sharp rectal pain that comes and goes, a pattern clinicians call proctalgia fugax, is covered on a separate page.

Rectal pain on its own is rarely an emergency, but the following features need prompt attention according to NHS and Cancer Research UK guidance.

• Severe pain, non-stop bleeding or large blood clots: go to A&E or call 999.

• Pain with a very high temperature, shivering and feeling generally unwell, or pus leaking from the bottom: ask for an urgent GP appointment or call NHS 111.

• Being unable to pee with pain in the bottom or genitals, which the NHS lists as a reason for urgent advice with prostatitis.

• Unexplained weight loss, a lump in the back passage or tummy, a change in how often you poo, or pain that is getting worse over weeks. Cancer Research UK lists these among the possible symptoms of bowel cancer.

• Constipation with rectal pain: Guts UK says to see your GP promptly if constipation comes with rectal pain, bleeding or weight loss.

The NHS says a GP will ask about your symptoms, general health and family history, may feel your tummy and may do a rectal examination, where a gloved finger is placed in the back passage to check for lumps. You will be asked to undress from the waist down, you can ask for a male or female clinician and for someone else to be present.

Depending on the findings, the GP may arrange a stool test or FIT kit, a blood test, treatment for constipation, piles or prostatitis, or a referral for further tests such as flexible sigmoidoscopy or colonoscopy. The NHS stresses that an urgent referral does not mean you definitely have cancer.

Treatment depends on the cause: laxatives and fibre for constipation, creams or procedures for piles and fissures, antibiotics for prostatitis, and specialist assessment for pelvic floor problems.