Piles aren’t the only cause of pain and bleeding from the back passage. But there are treatments, so don’t be embarrassed to take these symptoms to your GP

Doctor wrong? Writing yourself a checklist will help you get the most out of your appointment. ©iStock

Piles are common (up to a third of us have them), but pain and bleeding from the anus and rectum may even be early signs of cancer, so don’t ignore symptoms.

Your doctor will do her best to minimise any embarrassment and discomfort, and you can have a chaperone during any examination if wished. She may be able to treat you, but may suggest a two-week referral for a telescope test (colonoscopy) or scan.


These swollen blood vessels may pop out when straining (constipation, being overweight or pregnant, heavy lifting, coughing), or be linked to ageing, pelvic-floor weakness, too much sitting or a family history of piles.

They can be very painful or bleed, or stay out, making wiping difficult, and leading to itching.

Prevent and treat them by eating more fibre and drinking lots of water, avoiding constipating medicines, such as codeine, losing weight, taking regular exercise, and opening your bowels promptly when you feel the need.

Pharmacies sell creams and suppositories to relieve symptoms, but if they’re troublesome, surgical treatment may help.

Anal fissure

This crack in the ‘rubber band’ muscle of the anus causes a stabbing pain and/or bleeding when you open your bowels.

It’s common (affecting 10% of us at some time) and is usually triggered by passing a large or hard stool, but can also develop in pregnancy/childbirth, inflammatory bowel disease (Crohn’s disease or ulcerative colitis).

Laxatives and lifestyle changes (see piles advice) can help; your doctor can prescribe anaesthetic creams, glyceryl trinitrate cream to speed healing, or refer you for surgery or Botox injections.

Soreness, blisters and lumps

Moisture and stool contents irritate skin and can lead to chapping or thrush (yeast infection – may also be linked to diabetes). Try to wash or use cleansing wipes after opening your bowels, and dry skin well; see your doctor if it persists.

Some common skin conditions, such as psoriasis, can also affect this area.

Occasionally, sexually transmitted infection, such as herpes, which causes painful blisters, may be to blame, or human papilloma virus (HPV) which produces flat or soft fronded warts around the anus and vulva. HPV sometimes leads to cancer, so it’s important to get these checked/treated.

A perianal abscess is an infection around the anus and rectum; it’s extremely painful and may cause fever or discharge pus. You’ll need surgery and antibiotics, and treatment for any underlying cause, such as Crohn’s disease.

Proctalgia is an unpleasant recurring pain in the rectum for no apparent reason. It may be a muscular/neurological disorder and can be relieved with medication once serious causes are ruled out.


This is very distressing; the commonest cause is constipation and ‘overflow’ (loose stool trying to bypass a solid/impacted stool). It can also be caused by diarrhoea, pelvic-floor or anal-muscle weakness, or nerve damage in multiple sclerosis, diabetes or dementia.

A proper diagnosis can lead to effective treatment and/or appropriate aids, so see your GP. Find out more from bladderandboweluk.co.uk or call 0161 607 8219.

6 symptoms you shouldn’t ignore

1. Blood on the toilet paper or in your stools. Get it checked, even if you know you have piles or have had a satisfactory bowel-cancer screening test.

2. Clear or discoloured mucus/jelly as a discharge or in your stools.

3. Itching, soreness or incontinence.

4. A change in your bowel habit lasting more than three weeks, especially looser or more frequent stools.

5. Persistent pain or a lump in your tummy or bottom.

6. Unexplained loss of weight