Step 4: Read and complete the decision guide to learn more about your symptoms.
Rectal Pain or Itching
Because your medical history puts you at extra risk for an abscess next to your rectum, your symptoms require the attention of your doctor today. If an abscess is present, drainage is necessary to prevent it from enlarging or causing more serious illness.
An anal abscess is the most concerning diagnosis that could be the cause of your symptoms, but it is one of several likely explanations:
Hemorrhoids are veins just beneath the inside surface of the rectum and anus. Hemorrhoids can become overfilled and bulging, particularly when straining to push out a bowel movement repeatedly interferes with normal circulation out of these veins. A bulging hemorrhoid can develop a weak area that can allow small amounts of blood to spill into the rectum. Hemorrhoids can cause itching or can soil or moisten your underwear. Most hemorrhoids do not cause pain, but some can be extremely painful. Pain from hemorrhoids usually comes after a blood clot forms, creating a "thrombosed" hemorrhoid.
An anal abscess is also known as a "perianal abscess" or a "perirectal abscess." Injury or inflammation in the lining of the rectum may permit bacteria to contaminate one of the mucus glands that surround the rectum. The mucus glands are normal structures that help to lubricate your rectum. When they become infected, the infection may quickly intensify to create a pocket of pus. An anal abscess may cause pain with bowel movements or continuous pain. It commonly causes irritation of the nearby skin so it can create a red, tender or itchy patch of skin within an inch or two of the anus. Frequently, white or yellow pus can be seen through the center of this skin patch as the abscess prepares to drain pus. It is possible for an abscess in this area to make you dangerously ill. An anal abscess requires drainage by your doctor.
As described above, an anal abscess may drain pus through a break in the skin. An abscess can also drain pus through a break in the rectum lining. A draining pathway to the skin or rectum wall can persist for a long time without healing. A draining pathway that has not healed is called an anal fistula. An anal fistula usually causes a moist discharge from the rectum or skin. A fistula may look like an open sore or a pus-filled bump near the anus. An anal fistula requires professional treatment as directed by your doctor.
A cut or tear at the anal opening can occur if the anus is overstretched by trauma or by very hard stools, or it can occur if there is an infection within the rectum.
An open sore in the lining of the rectum is called a rectal ulcer. The most common cause of a rectal ulcer is a herpes infection. Swelling around a rectal ulcer can cause a sensation that your rectum will not completely empty. Rectal ulcers can also cause you to pass mucus with or between your stools.
Inflammatory bowel disease (Crohn's disease or ulcerative colitis)
Inflammation in the rectum or colon can be the result of an autoimmune illness (an attack by your own immune system). If your symptoms have been persistent or recurrent, one of the autoimmune conditions known as "inflammatory bowel disease" may fit well as an explanation. Most inflammatory bowel disease is eventually identified as one of two conditions: "Crohn's disease" or "ulcerative colitis." Any of the anal or rectal problems above can be caused by inflammatory bowel disease. These conditions are more likely to begin when you are a young adult, although older adults can develop inflammatory bowel disease as well.
Conditions that are less common but are concerning include:
Cancer in the rectum can cause pain or itching in the rectum, and it commonly causes rectal bleeding. You are at a higher risk for colorectal cancer (cancer in the colon or rectum) if you have a family history of polyps or cancer in the colon, or if you are over the age of 50.
Cancer at the rim of the anus is sometimes the result of a sexually passed infection, human papillomavirus. Anal cancer is more likely to result from this virus if you are infected with HIV (human immunodeficiency virus). Anal cancer may look like a skin sore that will not heal. It commonly causes bleeding with bowel movements.
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