I Have Bleeding and Rectal Pain: Do I Have an Anal Fissure?

Anal fissures are one of the top causes of rectal pain and bleeding. However, a fissure isn’t the only problem that’s potentially responsible for your symptoms.

Getting early treatment is essential, not only to give you relief from your symptoms, but also because rectal pain and bleeding may signal the presence of an infection or a serious condition like anal cancer.

Nina Paonessa, DO, FACOS, at Paonessa Colon & Rectal Surgery offers comprehensive care for all rectal conditions and symptoms, beginning with getting to the root cause of your bleeding and pain.

What you should know about rectal bleeding

Rectal bleeding isn’t the same as bleeding from a cut or wound. Instead of a stream of blood, rectal (anal) bleeding is usually bright red and appears on toilet paper and in the toilet bowl after a bowel movement. You may also notice some spotting on your underwear.

When you have blood in your stool, it may look red, maroon, or black. Maroon and black colors indicate the bleeding originated higher up in your intestines. For example, you may have polyps that are bleeding.

If you have severe rectal bleeding, consider it an emergency that needs immediate medical attention. Without prompt treatment to stop the bleeding, your blood pressure may drop and you could lose consciousness.

About anal fissures

An anal fissure is a tear in the thin tissue that lines your anus. The tear typically occurs near the anal opening and often develops due to hard, dry bowel movements. Prolonged diarrhea or anal trauma may also cause a fissure. In some cases, inflammatory bowel disease or straining during bowel movements may result in a tear.

The tissues lining your anus are sensitive, so a fissure often causes severe pain, especially during and after a bowel movement. You may have pain for up to several hours after going to the bathroom. Most people notice bright red blood after having a bowel movement.

Between bowel movements, you may not have any symptoms. However, people frequently try to avoid going to the bathroom due to the pain it causes.

Other conditions cause rectal bleeding and pain

Of all the other conditions that cause rectal bleeding and pain, the most common include hemorrhoids, anal abscesses and fistulas, and proctitis.


Hemorrhoids develop when excessive pressure causes enlarged veins inside your rectum (internal hemorrhoids) or around the anus (external hemorrhoids). This type of pressure often comes from straining during bowel movements, chronic constipation or diarrhea, pregnancy, and sitting on the toilet too long.

Internal and external hemorrhoids may cause bleeding during bowel movements. External hemorrhoids are more likely to hurt. But either type can turn painful if the hemorrhoid develops a blood clot.

Anal abscess or fistula

An abscess develops when a small cavity inside your anus gets infected. In most cases, the infection develops in the glands lining your anus.

An anal fistula is a small tunnel that develops due to an abscess. The tunnel creates an abnormal connection between the infected abscess and the skin around your anus.

Both conditions cause pain, swelling, and red skin around your anus. An abscess causes pain around the anus that’s constant or occurs during bowel movements. Though abscesses and fistulas cause bleeding, it’s also common to have a discharge that contains pus and blood.

Your risk of developing an anal abscess or fistula increases if you have inflammatory bowel disease or chronic diarrhea.


Proctitis occurs when the rectal lining becomes inflamed. The inflammation often develops due to an infection, inflammatory bowel disease, or cancer treatment.

In addition to causing rectal bleeding and pain around your anus, you may have symptoms such as frequently feeling the urge to have a bowel movement, passing mucus, and not completely emptying your bowel.

Anal cancer symptoms

Anal cancer isn’t as common as colon cancer, but you should still be aware of its symptoms so you can get help as early as possible.

The symptoms include:

  • Bleeding from the rectum
  • Pain in the anal area
  • Itching in or around the rectum
  • A lump or mass at the anal opening
  • Narrowing of stool or other changes in bowel movements
  • Abnormal discharge from the anus
  • Loss of bowel control (fecal incontinence)

Minor bleeding that’s similar to anal fissures and hemorrhoids is the earliest symptom of anal cancer.

Don’t put off getting help for rectal bleeding or pain. Call one of our offices in Brielle and Manahawkin, New Jersey.



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