Pain during a bowel movement is almost always caused by a problem in or around the anus itself, not deeper in the digestive tract. The two most common culprits are anal fissures (small tears in the lining) and hemorrhoids (swollen blood vessels). Both are treatable, and most cases resolve on their own or with simple home care within a few weeks.
Anal Fissures: The Most Common Cause
If the pain feels sharp, tearing, or burning and hits right as stool passes through, an anal fissure is the most likely explanation. A fissure is a small tear in the lining of your anal canal. That lining is made of the same thin, delicate tissue as the rest of your large intestine, which makes it easy to tear when stretched by a hard or large stool.
The pain can be intense but brief, or it can linger for minutes to hours afterward. Some people feel it radiate into their buttocks, thighs, or lower back. You might also notice a small amount of bright red blood on the toilet paper. Fissures tend to create a cycle: the tear causes the muscles around your anus (the sphincters) to tighten up, which reduces blood flow to the area and makes the tissue even more prone to re-tearing the next time you go.
Most fissures heal within a few days to weeks with basic self-care. A fissure that lasts longer than eight weeks is considered chronic, and treatment for a chronic fissure can take another six to twelve weeks to fully work.
Hemorrhoids: Internal vs. External
Hemorrhoids are swollen blood vessels in or around the anus. They’re extremely common, and the type you have determines what you feel. External hemorrhoids form under the skin around the outside of the anus. These are the ones that hurt. They can feel like hard, tender lumps, and they tend to ache when you sit or wipe. Internal hemorrhoids form inside the rectum and typically don’t cause pain unless they prolapse, meaning they push out through the anus during a bowel movement. Internal hemorrhoids are more likely to cause painless bleeding than actual discomfort.
If you feel a bulge during or after a bowel movement along with soreness, an external hemorrhoid or a prolapsing internal one is a strong possibility. Straining, sitting on the toilet for long periods, and passing hard stools all make hemorrhoids worse.
Infections and Inflammation
Infections in the anal area can also cause pain during bowel movements. A perianal abscess, which is a pocket of pus from an infected anal gland, creates intense throbbing pain that often gets worse with sitting or straining. If an abscess drains on its own or isn’t fully treated, it can form a fistula, an abnormal tunnel between the inside of the anal canal and the skin outside.
Sexually transmitted infections are another cause, particularly for people who have receptive anal contact. Gonorrhea, chlamydia, herpes, and syphilis can all cause proctitis, which is inflammation of the rectal lining. Proctitis typically shows up as deep aching, a feeling of urgency or incomplete emptying, and sometimes discharge. Herpes-related proctitis tends to be especially painful.
Crohn’s Disease and Other Chronic Conditions
Inflammatory bowel disease, particularly Crohn’s disease, can cause complications around the anus that make bowel movements painful. Crohn’s-related inflammation can lead to fissures, abscesses, and fistulas near the anus. Fistulas near or around the anal area are actually the most common type of fistula in Crohn’s disease. If you’re experiencing anal pain alongside other symptoms like persistent diarrhea, unintended weight loss, or abdominal cramping, an underlying inflammatory condition is worth investigating.
Less common causes include rectal ulcers, levator ani syndrome (a condition where the pelvic floor muscles spasm), and pudendal neuralgia, which involves the nerve that supplies sensation to the area. These tend to produce pain that’s less clearly tied to the act of passing stool and more constant or unpredictable.
What You Can Do at Home
The single most effective thing you can do is soften your stool so it passes without straining or stretching. That means getting more fiber and more water. The federal dietary guidelines recommend 14 grams of fiber per 1,000 calories you eat, which works out to roughly 25 to 35 grams a day for most adults. If your current intake is low, increase gradually over a week or two to avoid bloating. A fiber supplement can help bridge the gap.
Sitz baths provide real relief for fissures and hemorrhoids. Fill a basin or your bathtub with a few inches of warm water (around 104°F or 40°C) and soak the area for 15 to 20 minutes. Doing this three to four times a day, especially after bowel movements, can ease pain and promote healing. Pat the area dry gently afterward rather than rubbing.
A few other habits that help: don’t sit on the toilet longer than necessary, avoid straining or pushing, and use unscented wipes or water instead of dry toilet paper if wiping is painful. Over-the-counter pain relievers and topical creams with lidocaine can take the edge off while you heal.
When Fissures Don’t Heal on Their Own
For chronic fissures that resist home treatment, doctors sometimes prescribe a topical ointment that relaxes the sphincter muscles and improves blood flow to the tear. These prescription creams heal about 49% of fissures compared to about 36% with a placebo, so they help but aren’t a guarantee. The most common side effect is headache, which can be severe enough that about 1 in 5 people stop using the medication. If topical treatment fails, a minor procedure to relax the sphincter muscle is typically the next step.
What a Doctor’s Visit Looks Like
If your pain lasts more than a few days without improving, or if it comes with bleeding, fever, chills, or discharge, it’s worth getting checked out. For people over 40, rectal bleeding should always be evaluated to rule out more serious conditions.
The exam itself is usually quick. A doctor can often diagnose fissures and external hemorrhoids just by looking. If they need to see inside, an anoscopy uses a short, narrow scope (about 3 inches long) to view the anal canal directly. It takes seconds and doesn’t require sedation. If the doctor suspects inflammation higher up, a flexible sigmoidoscopy uses a longer, thin instrument to examine the rectum and lower colon, and allows for tissue samples if needed. This is more comfortable than it sounds and is typically done without full sedation.
Seek emergency care if you experience heavy rectal bleeding that won’t stop, especially with dizziness or lightheadedness, or if anal pain rapidly worsens and comes with fever or discharge. These can signal an abscess or another condition that needs immediate treatment.