Health Library Rectal ProblemsFrom Healthwise

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.

Review the Emergencies and Check Your Symptoms sections to determine if and when you should see your health professional.

• Signs of shock

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first.

• Rectal pain caused by constipation or leakage of stool: Go to the topic Constipation, Age 11 and Younger or Constipation, Age 12 and Older.
• Problems caused by diarrhea: Go to the topic Diarrhea, Age 11 and Younger or Diarrhea, Age 12 and Older.
• If you have been diagnosed with hemorrhoids and are having symptoms from them: Go to the topic Hemorrhoids.

	Yes	Have you had a bowel movement that is black, bloody, or left blood in the toilet water?
When to See a Doctor See significance of black or bloody stools if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: Call 911 or other emergency services if you have blood in your stool and any signs of shock, such as: Weakness, dizziness, and fainting. Cool, pale, clammy skin. Weak fast pulse. Shallow, fast breathing. Extreme thirst, nausea, or vomiting. Confusion or anxiety. Certain foods and medicines can change how the stool looks. Taking medicines that contain bismuth, such as Pepto-Bismol, or iron tablets can make the stool black, and eating lots of beets may turn the stool red. Some food colorings also can change the color of your stool. Eating foods that contain black or dark blue food coloring can turn your stool black. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Have you had 1 or more normal-size to large stools that are mostly black or bloody? Yes Do you have rectal bleeding and a fever? Call your health professional today if you answer "Yes" to any of the following questions. Yes Have you had 1 or more normal-size to large stools that are partly black or bloody? Yes Have you had 1 or more small stools that are mostly black or bloody? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Have you had streaks of blood in your stools? Yes Have you had a normal bowel movement but there is a small amount of blood in the toilet water? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have rectal bleeding without a bowel movement?
When to See a Doctor See the significance of rectal bleeding without a bowel movement if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Have you had a large amount rectal bleeding, but you do not have signs of shock? Yes Have you had a moderate amount of rectal bleeding more than 1 time? Yes Have you had rectal bleeding with any other symptoms, such as bleeding gums or easy bruising? Yes Do you have rectal bleeding and a fever? Yes Do you think your rectal bleeding is caused by abuse? Call your health professional today if you answer "Yes" to any of the following questions. Yes Have you had a moderate amount of rectal bleeding? Yes Have you had a small amount of rectal bleeding several times in the past 24 hours? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Have you had a small amount of rectal bleeding more than 1 time? Yes Have you had ongoing rectal bleeding that has been checked by your doctor, but the bleeding is not getting better or is getting worse? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a rectal problem and a fever?
When to See a Doctor See significance of fever if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you need information on how to take a temperature, see the topic Body Temperature. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have a fever of 103 °F (39 °C) or higher? Yes Do you think that you have a high fever, but you are unable to measure your temperature? Yes Do you have a fever and rectal pain? Yes Do you have rectal bleeding? Yes Do you have pus draining from your anus and a fever? Yes Do you have diabetes? Yes Do you have a disease or take a medicine that causes problems with your immune system? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have a fever of 100 °F (38 °C) to 103 °F (39 °C)? Yes Do you think you have a mild to moderate fever, but you are unable to measure your temperature? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have rectal pain?
When to See a Doctor See significance of rectal pain if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have severe rectal pain? Yes Do you think an object in the rectum is the cause of your pain? Yes Do you have a fever and rectal pain? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had moderate rectal pain for longer than 24 hours? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Have you had mild to moderate rectal pain for longer than 1 week after trying home treatment? Yes Have you had rectal spasms (proctalgia fagux) off and on for longer than 1 week but you do not have other symptoms? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have swelling, a lump, a sore, or a new growth in or around your anus?
When to See a Doctor See significance of swelling, a lump, a sore, or a new growth if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have swelling in or around your anus and moderate to severe pain? Yes Do you have swelling in or around your anus and a fever? Yes Do you have swelling in or around your anus and think that you have a moderate fever, but you are unable to measure your temperature? Yes Do you have diabetes? Yes Do you have a disease or take a medicine that causes problems with your immune system? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have swelling in or around your anus and think that you have a mild fever, but you are unable to measure your temperature? Yes Do you have a painful lump, sore, or growth in or around your anus? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had a lump or swelling in or around your anus without other symptoms for longer than 2 weeks? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think your rectal problem is caused by abuse?
When to See a Doctor See significance of abuse if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have a rectal problem because someone hurt you? Yes Do you think that your child's rectal problem was caused by abuse? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think that a medicine is causing your rectal problem?
When to See a Doctor See significance of a medicine causing a rectal problem if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Do you think that a medicine is causing your rectal problem? Note: If your answer is Yes: Call the health professional who prescribed the medicine the same day to determine whether you should stop taking the medicine or take a different one. An appointment may not be needed. If you are taking a medicine that was not prescribed by a health professional, stop taking the medicine. Call your health professional if you feel you need to keep taking the medicine or if you need help to control your symptoms after you stop taking it. If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Does your child have rectal itching, especially at night?
When to See a Doctor See significance of rectal itching in children if you need information to help you answer the question below. Review health risks that may increase the seriousness of your child's symptoms. You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Does your child continue to have anal itching after 72 hours of home treatment? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have rectal itching?
When to See a Doctor See significance of rectal itching if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had leakage of stool (fecal incontinence) for longer than 24 hours? Yes Have you had other signs of illness, such as weight loss, rash, weakness, or increased thirst and urination, for longer than 1 week? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Do you continue to have rectal itching after 1 to 2 weeks of home treatment? Note: If you think your rectal itching may be caused by exposure to a sexually transmitted disease: Do not have sexual contact until you have been treated by a health professional. Your partner may need to be treated as well. If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have the following symptom?

• Abdominal pain: Go to the topic Abdominal Pain, Age 11 and Younger or Abdominal Pain, Age 12 and Older.
• Symptoms of a sexually transmitted disease (STD): Go to the topic Exposure to Sexually Transmitted Diseases.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

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.
  • 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; skin damage can occur. Hydrocortisone cream should not be used for longer than 7 to 10 days without talking with your doctor. 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.
• Reactions to topical creams. Apply an ointment that contains 1% hydrocortisone. Do not use other steroid creams on this sensitive area of your body; skin damage can occur. Hydrocortisone cream should not be used for longer than 7 to 10 days without talking with your health professional. Do not use creams or ointments, such as Benadryl cream, that contain antihistamines.
• 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. Dry your rectal area with a hair dryer set on the low setting before applying talcum powder.

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.
• Take a warm sitz bath, three 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, and hemorrhoids. For more information, see the following topics:

• Constipation, Age 11 and Younger
• Constipation, Age 12 and Older
• Diarrhea, Age 11 and Younger
• Diarrhea, Age 12 and Older
• Hemorrhoids

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• Pain increases.
• Pain does not improve in 24 to 48 hours.
• The blood in your stool increases or your stools become red, black, or tarry.
• Swelling or a lump in or around your anus develops.
• Your stool contains pus.
• You develop a fever.
• Symptoms become more severe or more frequent.

To prevent rectal problems:

• Use white, unscented toilet paper.
• Do not use scented soaps, such as Irish Spring and Coast, which can irritate 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.

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

You can help your health professional 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 disease (STD)?
• 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 where sanitation may have been substandard?
• 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?

• Abdominal Pain, Age 11 and Younger
• Abdominal Pain, Age 12 and Older
• Atopic Dermatitis
• Chlamydia
• Colorectal Cancer
• Constipation, Age 11 and Younger
• Constipation, Age 12 and Older
• Diarrhea, Age 11 and Younger
• Diarrhea, Age 12 and Older
• Dry Skin and Itching
• Exposure to Sexually Transmitted Diseases
• Genital Herpes
• Genital Warts (Human Papillomavirus)
• Gonorrhea
• Hemorrhoids
• Peptic Ulcer Disease
• Pinworms
• Prostatitis
• Psoriasis
• Rectal Prolapse
• Scabies
• Shock
• Stress Management
• Swollen Glands and Other Lumps Under the Skin
• Syphilis

Author:	Jan Nissl, RN, BS	Last Updated: May 22, 2007
Medical Review:	William M. Green, MD - Emergency Medicine H. Michael O'Connor, MD - Emergency Medicine
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