Pain inside the buttocks, specifically in or around the anal canal and rectum, is extremely common and usually caused by one of a handful of treatable conditions. The most likely culprits are anal fissures, hemorrhoids, muscle spasms, or infections. Where exactly the pain sits, how long it lasts, and what triggers it can help narrow down the cause.
Why Location Matters Inside the Anal Canal
The anal canal has a dividing line roughly halfway up called the dentate line, and the nerve supply is completely different above and below it. Below this line, the tissue is wired with the same type of nerves that supply your skin, so it registers sharp, precise pain and temperature changes. Above the line, the nerves only respond to stretching and pressure, producing vaguer, deeper discomfort rather than a pinpoint sting.
This is why some conditions (like internal hemorrhoids high up in the canal) cause pressure and a sense of fullness without true pain, while a small tear near the opening can be agonizing. If your pain feels sharp and well-defined, the problem is likely near the anal opening. If it feels more like deep rectal pressure or a dull ache, the source is probably higher up.
Anal Fissures
An anal fissure is a small tear in the lining of the anal canal, and it’s one of the most common reasons for sharp pain during and after a bowel movement. The hallmark is a cutting or tearing sensation while passing stool, followed by a burning or throbbing pain that can persist for several hours afterward. Most fissures are caused by passing hard or large stools, chronic constipation, or straining. Diarrhea can also irritate the area enough to create one.
You might also notice a small amount of bright red blood on the toilet paper. Fissures often heal on their own within a few weeks if you keep stools soft and avoid straining, but chronic fissures (lasting more than six to eight weeks) sometimes need medical treatment to relax the surrounding muscle and allow healing.
Hemorrhoids
Hemorrhoids are swollen blood vessels inside or just outside the anal canal. Internal hemorrhoids, the ones higher up, are graded on a four-point scale based on severity. Grade I hemorrhoids simply bleed but stay inside the canal. Grade II prolapse during a bowel movement but slide back in on their own. Grade III protrude and need to be pushed back in manually. Grade IV are permanently prolapsed.
Internal hemorrhoids are normally painless. Their primary symptom is bright red bleeding during bowel movements, sometimes with a feeling of pressure, incomplete evacuation, or mild itching. When people feel true pain and blame hemorrhoids, the cause is often something else: a fissure, a thrombosed external hemorrhoid (where a blood clot forms in a vein near the anal opening), or a perianal abscess. A thrombosed hemorrhoid creates a firm, tender lump you can usually feel near the anus, with intense pain that peaks over the first 48 to 72 hours.
Muscle Spasms in the Pelvic Floor
Two functional disorders cause rectal pain without any visible injury or disease, and they’re more common than most people realize.
Proctalgia fugax is a sudden, intense, stabbing pain deep in the rectum that strikes without warning and typically disappears within 20 minutes. Episodes can wake you from sleep and feel alarming, but they resolve on their own. The cause is a brief spasm of the muscles surrounding the rectum.
Levator ani syndrome involves the same group of pelvic floor muscles but produces a different pattern. The pain is typically a dull, persistent ache or pressure sensation high in the rectum, and it can last for hours or come and go throughout the day. Sitting often makes it worse. People sometimes describe it as feeling like they’re sitting on a ball. Stress, prolonged sitting, and chronic tension in the pelvic floor muscles are common contributors.
Perianal Abscess
An abscess is a pocket of pus that forms near the anus, usually from an infected gland just inside the anal canal. The most obvious sign is a swollen, red, warm lump near the edge of the anus that is extremely painful and may throb constantly. Unlike a hemorrhoid, which tends to feel firm, an abscess is warm and tender to the touch. As the infection progresses, you may develop fever, chills, and flu-like symptoms.
Abscesses do not resolve on their own. Left untreated, the infection can spread and potentially form a tunnel (called a fistula) between the inside of the anal canal and the surrounding skin. If you feel a painful, warm lump near your anus along with fever or chills, that combination needs prompt medical attention.
Proctitis
Proctitis is inflammation of the rectal lining, and it can cause deep anorectal pain, a persistent urge to have a bowel movement (even when nothing comes), and mucus or pus-like discharge. The most common causes fall into two categories: sexually transmitted infections and inflammatory bowel disease.
Among STIs, gonorrhea, chlamydia, herpes, and syphilis are the most frequent causes, particularly in people who have receptive anal contact. The symptoms can mimic inflammatory bowel disease or even be mistaken for something more serious like a tumor, which sometimes delays the correct diagnosis. Inflammatory bowel disease, especially ulcerative colitis, can also inflame the rectum and produce similar symptoms. If you’re experiencing rectal pain with discharge, bleeding, or a constant urge to go, getting tested for both STIs and inflammatory conditions is important.
How to Manage Mild Rectal Pain at Home
For fissures, mild hemorrhoid symptoms, and general soreness, a few straightforward strategies can make a significant difference.
Sitz baths are one of the simplest and most effective remedies. Fill a basin or shallow tub with warm water (around 104°F or 40°C) and soak the area for 15 to 20 minutes. You can do this three to four times a day when symptoms are active. The warm water relaxes the muscles of the anal sphincter, improves blood flow, and eases pain.
Fiber intake is critical for keeping stools soft enough to pass without straining. The general recommendation is 25 grams per day for women and 38 grams per day for men. Most people fall well short of this. Adding whole grains, beans, fruits, and vegetables, or supplementing with a fiber powder mixed into water, softens stool and reduces the mechanical trauma that causes fissures and worsens hemorrhoids. Increasing water intake alongside the fiber keeps everything moving comfortably.
Avoiding prolonged sitting on the toilet, not straining during bowel movements, and gently cleaning the area with water instead of dry toilet paper can all prevent further irritation while you heal.
Signs That Need Medical Attention
Most causes of internal rectal pain are manageable and not dangerous, but certain symptoms should prompt a visit to your doctor or, in some cases, urgent care. Seek immediate attention if you experience heavy rectal bleeding that won’t stop, especially if you feel lightheaded or dizzy. Pain that rapidly worsens, spreads, or comes with fever, chills, or anal discharge also warrants urgent evaluation, as these can signal an abscess or spreading infection.
Schedule a routine appointment if pain lasts more than a few days and isn’t improving with home care, or if you notice a change in bowel habits alongside the pain. Rectal bleeding in anyone over 40 should be evaluated to rule out less common but serious conditions like colorectal cancer, even when the most likely explanation is something benign.