Pain In The Anus In Women : Causes, Symptoms, Diagnosis & Treatment

Last Updated: 01/07/2022

Pain in the anus in women occurs with diseases of the rectum, female genital organs, urinary system. It happens constant, short-term, sharp, dull, sharp, burning, pulsating, pressing, aching, stabbing, pulling. Sometimes combined with stool disorders, tenesmus, blood, mucus. The causes of the symptom are established on the basis of the data of the survey, external, proctological and gynecological examination, anoscopy, sigmoidoscopy, ultrasound, anal manometry, coprogram, analysis for worm eggs, biopsy studies. For treatment, rectal suppositories, microclysters, physiotherapy, and general preparations are used.

Why does pain occur in the anus in women

External stimuli

The most common cause of pain in women in the absence of pathological changes is uncomfortable underwear, especially thongs that rub the skin and put increased pressure on the anus. During menstruation, pain can be provoked by the use of poor-quality pads. Sometimes pressing sensations are observed when using tampons, more often against the background of an empty bowel.

anal fissure

Patients with an acute form of the disease note severe soreness that appears with the onset of defecation, sometimes radiating to the sacrum or perineum. In chronic pathology, the pain syndrome is provoked by a spasm of the anus, worries after defecation, persists for a long time, and intensifies in a sitting position. Bloody discharge is scanty. Possible itching.


With uncomplicated chronic hemorrhoids, the pain is dull, pulling, aching, there is a predominance of burning, bursting. Unpleasant manifestations occur during the act of defecation, gradually disappear in the period from several minutes to several hours. Thrombosis of hemorrhoids is characterized by constant severe pain in the perineum and anus, not associated with defecation.

Soreness in thrombosis increases with the development of inflammation, worries at night, combined with a sensation of a foreign body, sometimes with weakness, weakness, fever. Pain and inflammation are also present with prolapsed hemorrhoids, especially in the final stages of the disease. There is anal itching, frequent bleeding. The development of the infectious process is evidenced by increased symptoms, severe pain, general hyperthermia.

Pain in the anus in women



The main symptoms of proctitis are pain, aggravated at the time of bowel movement, itching, defecation disorders. In acute proctitis, the pain is severe, appears suddenly, and is combined with tenesmus. Sometimes it gives to the genitals, perineum, lower back. Body temperature subfebrile, rarely febrile. The nature of the symptoms varies somewhat depending on the form of the disease:

  • catarrhal proctitis. Pathology develops within a few days, all manifestations are moderately expressed. Constipation is replaced by periodic diarrhea.
  • Erosive proctitis. The increase in stool predominates. Tenesmus is possible, followed by discharge of a mixture of mucus and blood. In a severe case, there is gaping of the anus, free flow of liquid feces, bloody-mucous discharge.
  • Ulcerative proctitis. The signs are the same as in other forms, but the course is more severe. A significant amount of blood covers the formed feces or is located in the form of inclusions in liquid feces.
  • Radiation proctitis. Symptoms appear during or after radiation therapy. Painful urge to defecate. Mucus is released from the anus, less often - blood.

In patients with chronic proctitis, the signs of pathology are mild or moderate, the pain is dull, and the condition is satisfactory. There are periodic relapses with symptoms resembling the clinical picture of acute proctitis.


Pain in the anus is caused by muscle spasm, is not associated with the act of defecation, occurs at any time of the day, including at night. Feels like stabbing, sharp, spasmodic. It can give to the perineum, coccyx, hip joints. Spasm of the anal sphincter develops suddenly, lasting minutes or hours. Over time, attacks often become more frequent.


The symptom is provoked by benign and malignant tumors. Polyps and villous tumors are hidden for a long time. The symptom appears with large neoplasia, accidental injury, the development of inflammation, the appearance of erosion. With cancer, melanomas of the anorectal region, the clinical manifestations progress rapidly, the pains intensify, from dull they become sharp, supplemented by tenesmus, blood and mucus.

Trauma and foreign bodies

Soreness in the anus is often observed after anal intercourse, due to multiple microtraumas of the mucous membrane, can be supplemented by burning, stool disorders, fecal incontinence. Foreign bodies enter the rectum through the gastrointestinal tract, are introduced into the anus during non-standard sexual practices, when trying to independently perform medical procedures, mental disorders.

With a recently introduced blunt object, the pain is aching, pressing, arching. Foreign bodies with pointed edges, fish bones, toothpicks cause damage to the intestinal wall, which is manifested by severe pain, frequent urges. Unbearable excruciating pain is evidence of damage to the intestinal wall and the release of a foreign object beyond its limits.

As a kind of foreign body, a fecal stone can be considered. Small stones are asymptomatic, with large stones there are spastic pain, chronic constipation, alternating with bouts of diarrhea. After injury to the intestine, the symptom intensifies.

Other proctological diseases

For acute paraproctitis, acute twitching throbbing pains, swelling, suppuration, signs of general intoxication are typical. In women with chronic paraproctitis, the symptom occurs against the background of blockage of the fistula. Regular arching pain during defecation, followed by an improvement in the condition, is noted with an incomplete internal fistula. In patients with rectal prolapse, pain in the lower abdomen predominates at the time of prolapse. Unpleasant sensations in the anus may be associated with compression and the development of inflammation. Other possible reasons are:

  • cryptite;
  • papillitis;
  • perianal dermatitis;
  • pararectal dermoid cyst;
  • coccygodynia.

Sharp painful urges with the inability to hold feces can be observed in women suffering from fecal incontinence. Pathology often manifests itself after childbirth, less often occurs some time after the birth of a child.

Stool disorders

Pain with constipation is provoked by the pressure of fecal masses, injuries of the anus in the process of emptying the intestines. Acute and chronic diarrhea also leads to soreness of the anus, which is explained by spasms, overstretching of the sphincter, and the development of perianal dermatitis.

Physiological conditions in women

Some women report dull pressure pain in the anus during premenstrual syndrome due to the accumulation of fluid in the utero-rectal cavity. Soreness often worries during pregnancy. The causes are constipation, pressure of the enlarged uterus. The likelihood of developing pain syndrome increases in the presence of proctological diseases, previous injuries, and operations.

Diseases of the female reproductive system

The symptom accompanies the following diseases of the internal genital organs:

  • Adnexitis. Soreness is more pronounced in the acute process. There is pain in the lower abdomen, radiating to the anus, the region of the sacrum. Possible pathological discharge from the vagina, violations of the general condition, bloating, dysuria.
  • Endometriosis of the rectum. Cyclic pain occurs during menstruation or a few days before it begins. They can be local or spilled, cover the anus, perineum. Increased during intercourse. With the germination of the deep sections of the intestinal wall, they become more intense, accompanied by constipation, bloating.
  • Ectopic pregnancy. When the fetal egg is rejected, a sharp pain appears in the lower abdomen, radiating to the anus, legs, lower back. Spotting or bleeding from the vagina, tachycardia, decreased blood pressure, severe weakness, loss of consciousness are detected.
  • Apoplexy of the ovary. The pain is constant or paroxysmal, cramping, stabbing. It is localized in the lower abdomen, gives into the anus, rectum, perineum, navel, lower back. Fainting, weakness, vomiting, cold sweat are possible.
  • Rectovaginal fistula. Soreness in the projection of the anus is combined with a burning sensation in the vagina, perineal area. Increases during sexual intercourse. Gases, feces are released from the vagina.

Diseases of the genitourinary system

Irradiation to the anus in women is observed with cystitis, stones in the bladder. The clinical picture is complemented by cutting, aching or pressing pains in the lower abdomen, pronounced dysuric phenomena. With urolithiasis, acute attacks are possible, followed by the appearance of blood impurities in the urine.

Proctological examination



The cause of pain in the anus is determined by a proctologist. Women with suspected pathology of the reproductive system are referred to a gynecologist. With signs of damage to the urinary tract, an examination by a urologist is required. The examination program includes the following methods:

  • External inspection . When examining the anus, the perianal zone, rashes, maceration, fistulous passages, prolapsed hemorrhoids or rectum can be detected.
  • Digital rectal examination. Helps to confirm the presence of enlarged hemorrhoids, neoplasms, inflammatory infiltrates, foreign bodies, areas of intussusception. Complemented by examination using rectal mirrors.
  • Examination on a chair (gynecological). It is carried out to assess the condition of the vagina and external genitalia, detect fistulas, endometriosis sites. Palpation examines the perineum, urethra, pelvic floor muscles, uterus, appendages.
  • Anoscopy and sigmoidoscopy. They allow to visualize signs of inflammation, erosion, ulcerative defects, volumetric processes, cracks, enlarged and inflamed hemorrhoids, foreign bodies, fistulous tracts, cicatricial changes.
  • Sonography. Ultrasound of the rectum is performed to diagnose traumatic injuries, hemorrhoids, fistulas, pararectal cysts, polyps, tumors. Contraindicated in acute conditions. Ultrasound of the pelvic organs in women reveals mass formations, ectopic pregnancy, endometriosis, and other gynecological pathologies.
  • Anal manometry. It is prescribed to determine the decreased or increased tone of the sphincter during incontinence and muscle spasm. May be supplemented with electromyography.
  • Laboratory tests . According to the coprogram, inflammation, signs of bleeding from erosions, ulcers and neoplasms, parasitosis are confirmed. Microbiological examination makes it possible to clarify the nature of the causative agent of the inflammatory process, morphological analysis - to establish the structure and degree of differentiation of tumors.
  • Other techniques . According to indications, women are prescribed colonoscopy, irrigoscopy, diagnostic laparoscopy, biochemical studies of feces.


Help at the prehospital stage

A woman needs to exclude everyday and sexual causes of pain: use comfortable underwear, high-quality pads, prevent functional constipation by dieting, exclude anal sex and sexual games with elements of anal masturbation. Reception of medicines before establishment of the diagnosis is not shown. Increasing pain, worsening of the general condition, copious discharge of blood from the anus are the reason for an urgent consultation with a proctologist.

Conservative therapy

The program of conservative treatment of proctological diseases includes the following methods:

  • Diet. Women are advised to give up spicy, salty and fatty foods to prevent constipation, reduce the amount of coarse fiber to form soft feces, reduce the intensity of pain and trauma to the anus during defecation.
  • Rectal suppositories . Suppositories with analgesic, emollient and anti-inflammatory action reduce the severity of symptoms, have an enveloping effect, protect the rectal mucosa from damage during bowel movements.
  • Antibiotics . Recommended for women with acute inflammatory processes: proctitis, paraproctitis, papillitis, cryptitis, complications of non-inflammatory diseases.
  • Hormonal agents . Corticosteroids are prescribed during an exacerbation of hemorrhoids, with severe proctitis. Quickly eliminate swelling and inflammation. Used in a short course if there are sufficient indications.
  • Phleboprotectors . Shown to patients with hemorrhoids. They help strengthen veins, slow down the increase in nodes, reduce the risk of bleeding and thrombosis.
  • local procedures . Effective microclysters with oil solutions, chamomile decoction, local anesthetics, perineal shower, sitz baths with a solution of potassium permanganate.
  • Physiotherapy . In diseases of the rectum and perianal zone, ultrasound, laser therapy, diadynamic therapy are used.

For diseases of the female genital area, antibiotic therapy, hormone therapy, and pain medication may be required. Systemic therapy is complemented by local procedures and physiotherapy.


Women with proctological pathologies may be shown the following operations:

  • Hemorrhoids : sclerotherapy, electrocoagulation, laser coagulation, desarterization, infrared photocoagulation, radio wave removal, evacuation of thrombosed nodes, hemorrhoidectomy with an ultrasonic scalpel, Milligan-Morgan, Longo, Ferguson, Parkes techniques.
  • Anal fissure : excision, treatment of anal fissures with laser and Botox.
  • Formations, foreign bodies : removal of polyps, coprolites, neoplasms, foreign bodies.
  • Rectal prolapse : reduction, rectopexy, Delorme, Altmeyer, Zerenin-Kummel operations.
  • Malignant neoplasia : resection or extirpation of the rectum.
  • Pathologies of the pararectal zone : opening of paraproctitis, excision of fistulas and dermoid cysts.

With lesions of the reproductive system, the following interventions may be required:

  • Adnexitis : puncture of the vaginal fornix, therapeutic laparoscopy, adnexectomy.
  • Intestinal endometriosis : resection of affected areas, in severe cases - removal of the uterus with appendages.
  • Ectopic pregnancy : laparoscopic tubotomy or tubectomy, milking.
  • Ovarian apoplexy: wedge resection, oophorectomy, adnexectomy.
  • Rectovaginal fistula : plastic replacement with auto- or allograft, collagen plug, according to indications - vaginoplasty, levatoroplasty a, sphincteroplasty.

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