Anorectal pain

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"How many embarrassed middle aged gentlemen does it take to change a lightbulb..."


A right royal pain in the arse.



Pretty common, especially if you work in GP or A&E.

Clinical and Associated Features

Obviously the biggest symptom is pain.

Accompanying it can be:

Differential Diagnosis

Systemic, serious or common.

  • Haemorrhoids - often accompanied with feeling of "grapes" out of the bum, with fresh blood on the toilet paper when wiping. Can be linked to portal hypertension.
  • Crohn's disease - can cause pain or discomfort.
  • Cancer - especially when accompanied by blood or weight loss.
  • Rectal prolapse - occurs in older people, where the rectum comes out the bum. At first it is retractable, then less and less so.
  • Trauma - sometimes from anal sex, or from embarrassing A&E admissions to remove foreign bodies.

Local skin damage

  • Fistulae - common in Crohn's, new channels in skin.
  • Anal fissure - split in the anal skin.
  • Pilonidal sinus/abscess - infected spots or swellings.
  • Perianal abscess - abscess in the skin near the anus.
  • Proctalgia fugax - is a severe, episodic, rectal and sacrococcygeal pain. Caused by cramp of the pubococcygeus or levator ani muscles.