Rectal pain /anorectal pain

When Sitting, Bowel Movements or Everyday Life Starts to Hurt

Pelvic health for every body

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Maybe it started as a sharp pain during a bowel movement. Perhaps you began noticing a deep ache inside the rectum after sitting for a long time, or sudden spasms that appear without warning and disappear just as quickly. You may feel pressure as though you are sitting on something, burning after using the bathroom, or discomfort that makes you hesitate every time you feel the need to have a bowel movement.

But sometimes the bigger question is not only whether hemorrhoids are present. It is why you are straining so much in the first place.

Constipation, hemorrhoids, bowel habits, and the pelvic floor can be closely connected. Constipation and repeated straining are recognized contributors to symptomatic hemorrhoids, while some people with chronic constipation have difficulty relaxing and coordinating the pelvic floor muscles during a bowel movement.

At Peloraa

This is why at Peloraa we do not assume that every rectal pain problem comes from a tight pelvic floor—or that every painful bowel movement is “just hemorrhoids.” The first step is understanding where the pain occurs, when it happens and what may be contributing to it.

Understand your journey

What You Should Know About Rectal pain /anorectal pain

Find clear, supportive answers to common questions about urinary incontinence, bladder leakage, symptoms, treatment, and pelvic health physiotherapy.

What Is Rectal Pain?

Rectal pain refers to discomfort felt inside or around the rectum and anus. The pain may be sharp, burning, aching, throbbing, cramping or pressure-like. Some people experience…

Rectal pain refers to discomfort felt inside or around the rectum and anus. The pain may be sharp, burning, aching, throbbing, cramping or pressure-like. Some people experience symptoms only during or after a bowel movement, while others notice discomfort with sitting, sexual activity, exercise or without an obvious trigger.

The pattern can offer clues. A sharp cutting pain during and after a bowel movement may occur with an anal fissure, while a painful swollen lump may occur with a thrombosed external hemorrhoid. Deep aching that worsens with sitting may suggest pelvic floor involvement such as levator ani syndrome, while sudden intense attacks lasting only seconds or minutes may fit the pattern of proctalgia fugax.

Because several very different conditions can produce similar symptoms, persistent rectal pain deserves appropriate assessment rather than self-diagnosis based only on where it hurts.

Rectal Pain Is Not One Condition — Here’s How Common Causes Can Differ

ConditionWhat Is Happening?What You May NoticeHow Pelvic Floor Physiotherapy May FitAnal FissureA small tear in the lining of the anal canal, often related to trauma from passing…

Condition

What Is Happening?

What You May Notice

How Pelvic Floor Physiotherapy May Fit

Anal Fissure

A small tear in the lining of the anal canal, often related to trauma from passing hard stool or straining.

Sharp or cutting pain during bowel movements, often followed by burning or pain afterward, sometimes with bright-red bleeding.

Physiotherapy does not heal the fissure itself, but may help address constipation, excessive straining or pelvic floor guarding that develops around painful bowel movements.

Hemorrhoids

Enlarged or symptomatic hemorrhoidal tissues around the anus or lower rectum.

Bleeding, itching, pressure, prolapse, swelling or pain, particularly when thrombosed.

Pelvic floor retraining and biofeedback are recommended firPhysiotherapy does not remove hemorrhoids, but may help address constipation, poor bowel mechanics and excessive straining when these contribute.st-line treatments when pelvic floor dyssynergia is diagnosed.

Anal Abscess / Fistula

An abscess is an infected cavity near the anus or rectum; a fistula is a tunnel that may remain after an abscess.

Significant pain, swelling, redness, drainage or fever.

These require medical or colorectal assessment. An acute abscess typically requires drainage; physiotherapy is not the primary treatment.

Levator Ani Syndrome

Pelvic floor muscles, particularly the levator ani/puborectalis region, are painful, tender or overactive.

Deep rectal aching or pressure, often lasting 30 minutes or longer and frequently worse with sitting.

Pelvic floor physiotherapy and biofeedback may be helpful when examination confirms pelvic floor tenderness or dysfunction.

Proctalgia Fugax

Brief episodes of functional anorectal pain, possibly related to muscle spasm or nerve sensitivity.

Sudden sharp rectal pain lasting seconds to minutes, up to about 30 minutes, with no pain between attacks.

Pelvic floor assessment may sometimes identify muscle or nerve contributors, although treatment differs from chronic levator ani pain.

Pelvic Floor Dyssynergia

The pelvic floor tightens or fails to relax appropriately when you try to have a bowel movement.

Straining, incomplete emptying, stool feeling “stuck,” constipation and sometimes rectal pressure or pain.

Pelvic floor retraining and biofeedback can help improve relaxation and bowel coordination when dyssynergia is present.

Pudendal Neuralgia / Nerve Pain

Irritation or sensitization of nerves supplying the pelvic, genital and rectal region.

Burning, tingling, electric, stabbing or pressure-type pain, often aggravated by sitting.

Physiotherapy may address associated pelvic floor and musculoskeletal factors, but neurological or pain-specialist assessment may also be needed.

Why Can Bowel Movements Cause Rectal Pain?

A bowel movement requires more coordination than most of us realize. Your abdominal muscles create gentle pressure while the pelvic floor and anal muscles need to relax enough for…

A bowel movement requires more coordination than most of us realize. Your abdominal muscles create gentle pressure while the pelvic floor and anal muscles need to relax enough for stool to pass comfortably.

If stool is hard or large, passing it may stretch irritated tissues or reopen an anal fissure. If hemorrhoidal tissues are inflamed, straining may increase pressure and discomfort. If your pelvic floor is overactive, the muscles may tighten when they should be relaxing, making bowel movements difficult and painful.

Pain itself can then change the way you use the bathroom.

You begin expecting the bowel movement to hurt, so your body braces. You hold your breath, tighten the pelvic floor or delay going to the bathroom. Stool may become harder, requiring even more pushing the next time.

This can create a cycle where pain leads to guarding, guarding makes bowel emptying harder, and difficult emptying creates more pain.

What Does the Pelvic Floor Have to Do With Rectal Pain?

The pelvic floor forms the muscular support underneath the pelvis and surrounds the openings of the bladder, bowel and reproductive system. Several of these muscles, including the…

The pelvic floor forms the muscular support underneath the pelvis and surrounds the openings of the bladder, bowel and reproductive system. Several of these muscles, including the puborectalis and levator ani, play an important role in bowel control and emptying.

When the pelvic floor becomes overactive or painful, some people develop a deep ache or pressure inside the rectum. The discomfort may be especially noticeable during prolonged sitting and can sometimes feel as though there is a ball or object inside the rectum even when nothing is there.

This pattern may occur with levator ani syndrome, a functional anorectal pain condition. Rome IV criteria describe levator ani syndrome as recurrent or chronic rectal aching lasting at least 30 minutes with pelvic floor tenderness on examination after other causes of rectal pain have been excluded.

The phrase “after other causes have been excluded” is important. Before chronic rectal pain is attributed to pelvic floor dysfunction, medical conditions such as fissures, abscesses, inflammatory bowel disease, thrombosed hemorrhoids and structural abnormalities may need to be considered.

When Rectal Pain Feels Like a Deep Ache: Levator Ani Syndrome

Levator ani syndrome often feels different from the sharp pain of a fissure or the sudden episode of proctalgia fugax. Many people describe a persistent deep ache, heaviness or…

Levator ani syndrome often feels different from the sharp pain of a fissure or the sudden episode of proctalgia fugax. Many people describe a persistent deep ache, heaviness or pressure higher inside the rectum or pelvis. Sitting for a long time may make the pain worse, while standing or lying down may provide relief.

Pelvic floor overactivity and difficulty coordinating the muscles during bowel emptying appear to play an important role in many people with this pattern of pain. The 2026 European Association of Urology chronic pelvic pain guideline recognizes pelvic floor overactivity in chronic primary anal pain and recommends biofeedback treatment for chronic anal pain.

A randomized controlled trial involving 157 people with levator ani syndrome found particularly strong benefit from biofeedback in those who had tenderness of the levator muscles on examination.

This is why assessment matters. The same treatment should not automatically be applied to every person experiencing rectal pain.

What If the Pain Comes Suddenly and Disappears Quickly?

Some people describe a very different experience. Everything feels normal, and then suddenly there is an intense cramping, stabbing or spasm-like pain inside the anus or rectum.…

Some people describe a very different experience. Everything feels normal, and then suddenly there is an intense cramping, stabbing or spasm-like pain inside the anus or rectum. It may stop within seconds or minutes and leave you completely symptom-free afterward.

This pattern may be associated with proctalgia fugax.

Rome IV criteria distinguish proctalgia fugax from levator ani syndrome primarily by the duration and pattern of symptoms. Proctalgia fugax involves recurrent attacks lasting seconds to minutes, up to 30 minutes, with no anorectal pain between episodes. Levator ani syndrome typically produces pain lasting 30 minutes or longer.

Both are diagnoses of exclusion, meaning other causes of anorectal pain should be considered before symptoms are labelled as a functional pelvic floor pain condition.

Why Can Constipation Make Rectal Pain Worse?

Constipation and rectal pain often influence each other. Hard stool can create more stretching and pressure through the anus. Repeated straining can aggravate hemorrhoids and anal…

Constipation and rectal pain often influence each other.

Hard stool can create more stretching and pressure through the anus. Repeated straining can aggravate hemorrhoids and anal fissures, while incomplete emptying may increase pelvic floor tension and pressure.

Some people also have pelvic floor dyssynergia, where the pelvic floor tightens or does not relax properly during attempted defecation. Instead of the outlet opening while the abdomen provides pressure, the muscles work against each other. This may create excessive straining, incomplete emptying and rectal discomfort.

When this pattern is present, simply adding more pushing is unlikely to solve the problem. Treatment may need to focus on coordinating breathing, abdominal pressure and pelvic floor relaxation.

How we support you

The Peloraa Way

The Peloraa Way: We Look Beyond Where It Hurts

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At Peloraa, we understand that rectal pain can be difficult to talk about. You may have spent months saying “I think I have hemorrhoids” because that feels easier than explaining the pressure, spasms, burning or deep ache you are actually experiencing.

Our approach begins with a different question:

What does your pain pattern tell us about what may be happening?
We look at whether your symptoms occur during bowel movements, afterward, while sitting, during intimacy or without an obvious trigger. We consider whether constipation, straining, bowel urgency, incomplete emptying, tailbone pain, pelvic pain or other symptoms occur alongside the rectal discomfort.

Most importantly, we do not assume from the beginning that the pelvic floor is responsible.

First, We Listen to Your Story

Your Peloraa assessment begins with a private conversation about when the pain started, where you feel it, what it feels like and how long episodes last. We may discuss stool consistency, constipation, straining, bleeding, incomplete emptying, bowel urgency, prolonged sitting, childbirth, pelvic surgery, bladder symptoms, sexual pain and previous medical diagnoses or treatments.

The timing of your pain can be especially useful. Sharp pain immediately after bowel movements tells a different story from a deep ache that becomes worse after two hours of sitting. Sudden ten-minute spasms are different again.

Those details help determine whether pelvic floor physiotherapy may be appropriate or whether further medical or colorectal evaluation should come first.

We Assess the Whole Rectal–Pelvic Floor Connection

When pelvic floor involvement is suspected, your physiotherapist may assess your breathing, abdominal pressure, hip and pelvic mobility, pelvic floor relaxation, bowel mechanics and the positions or activities that trigger symptoms.

An internal rectal pelvic floor assessment may sometimes help identify tenderness or overactivity in muscles such as the levator ani and puborectalis and evaluate whether the muscles contract and relax appropriately.

However, an internal rectal examination is never mandatory. We can begin externally, explain why an internal assessment might provide useful information and proceed only with your informed consent.

If symptoms suggest an anal fissure, abscess, fistula, significant hemorrhoidal disease, inflammatory bowel disease or another colorectal condition, medical assessment takes priority over pelvic floor treatment.

We Help an Overactive Pelvic Floor Learn to Let Go

When rectal pain is associated with pelvic floor muscle overactivity, more strengthening is not automatically the answer.

Treatment may focus on diaphragmatic breathing, pelvic floor relaxation, muscle lengthening, bowel mechanics, movement, posture and carefully selected hands-on approaches when appropriate.

For chronic primary anal pain with pelvic floor involvement, the European Association of Urology recommends biofeedback and recognizes treatment of pelvic floor overactivity as part of management.

The goal is not simply to make the muscles “looser.” We want them to become better coordinated—able to support bowel control when needed and relax appropriately during bowel emptying.

We Retrain Bowel Coordination When Needed

If pain occurs alongside constipation, excessive straining or incomplete emptying, we may look at how your abdomen and pelvic floor coordinate during a bowel movement.

Treatment may include toileting position, breathing strategies, reducing breath-holding and straining, pelvic floor relaxation and biofeedback when appropriate.

For someone whose rectal pain is associated with pelvic floor dyssynergia, learning to relax the pelvic floor while generating appropriate abdominal pressure can address part of the mechanism that keeps bowel movements difficult.

The goal is not:
“Push harder.”
It is:
“Coordinate better.”

We Look at Sitting and Everyday Movement Too

When deep rectal pain becomes worse with prolonged sitting, changing how you load the pelvis may provide useful information.

We may assess sitting tolerance, posture, hips, lower back, pelvic movement and how frequently you remain in one position throughout the day. Movement breaks or temporary changes to sitting may help during a sensitive period, but our long-term goal is not to make you afraid of sitting.

We want you to gradually return to working, driving, exercising and everyday activities without constantly monitoring your rectum or pelvic floor.

Rectal Pain Care Often Works Better as a Team

Rectal pain is a symptom where collaborative care is particularly important because the cause may be colorectal, gastrointestinal, neurological, musculoskeletal or pelvic-floor related.

Depending on your symptoms, Peloraa may work alongside or recommend assessment from your family physician, gastroenterologist, colorectal surgeon, gynecologist, urologist, pain specialist, neurologist or another appropriate healthcare provider.

An anal fissure may require bowel management and medical treatment. A thrombosed hemorrhoid may need colorectal assessment. An anal abscess generally requires prompt medical treatment and surgical drainage rather than physiotherapy. Inflammatory bowel disease requires medical management, while suspected pudendal neuralgia or other nerve pain may benefit from specialist evaluation.

When pelvic floor dysfunction is one part of the problem, Peloraa can complement medical treatment by addressing muscle tension, bowel coordination, movement, breathing, sitting tolerance and the physical consequences of persistent pain.

Medical investigation and pelvic floor rehabilitation can work together.

We Help You Return to the Life Rectal Pain Has Interrupted

For many people, the goal is not complicated.

You want to sit through your workday without a deep ache. Have a bowel movement without anticipating sharp pain. Drive without constantly shifting positions. Exercise, travel or experience intimacy without worrying about another flare.

At Peloraa Physiotherapy, our approach to rectal pain, anal pain, levator ani syndrome, pelvic floor muscle spasm, painful bowel movements and pelvic floor physiotherapy in Barrhaven and Ottawa begins with understanding what type of pain you are experiencing and whether the pelvic floor is actually part of the problem.

When it is, we help address pelvic floor tension, bowel coordination, breathing, movement and everyday function while collaborating with your healthcare providers when medical or colorectal treatment is needed.

Listen. Understand. Collaborate. Release. Retrain. Restore Comfort.
That's the Peloraa Way.
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A little more clarity

Short FAQs About Rectal Pain

What causes rectal pain?

Rectal pain can have many causes, including anal fissures, hemorrhoids, constipation, abscesses, infections, inflammatory bowel conditions, pelvic floor muscle pain and nerve-related conditions. Persistent pain should be assessed rather than automatically attributed to hemorrhoids.

Can a tight pelvic floor cause rectal pain?

Yes. Overactive or tender pelvic floor muscles may contribute to deep rectal aching or pressure, particularly in levator ani syndrome. However, other anorectal conditions must be excluded before pelvic floor dysfunction is assumed to be the cause.

Why does my rectum hurt after a bowel movement?

Pain after bowel movements may occur with conditions such as an anal fissure, hemorrhoids, constipation or pelvic floor muscle spasm. Sharp cutting pain is particularly associated with anal fissures.

What is the difference between levator ani syndrome and proctalgia fugax?

Levator ani syndrome generally causes deeper aching or pressure lasting at least 30 minutes and may worsen with sitting. Proctalgia fugax causes sudden episodes lasting seconds to minutes, up to 30 minutes, with no pain between attacks.

Can pelvic floor physiotherapy help rectal pain?

It may help when pelvic floor overactivity, muscle tenderness, poor bowel coordination or levator ani syndrome contributes to symptoms. Biofeedback has particularly good evidence for selected patients with chronic primary anal pain and pelvic floor tenderness.

Should I do Kegels for rectal pain?

Not automatically. If your pelvic floor is already overactive or painful, repeated contractions may not be appropriate. Assessment can determine whether relaxation, coordination or strengthening is needed.

Do I need an internal rectal assessment?

No. An internal rectal assessment can provide useful information about pelvic floor tenderness and coordination in some situations, but it is never mandatory. Treatment can begin externally and progress according to your comfort and consent.

When should rectal pain be medically investigated?

New, severe, persistent or worsening rectal pain should be medically assessed, especially when associated with bleeding, swelling, drainage, fever, changes in bowel habits or unexplained weight loss.

Rectal Pain Shouldn't Be Something You Are Too Embarrassed to Ask About

You do not need to know whether your pain comes from hemorrhoids, a fissure, the pelvic floor, a nerve or another condition before seeking help.

You do not need to be ready for an internal rectal examination.

And you do not have to assume persistent rectal pain is simply something you need to tolerate.

The first step is understanding why it hurts.

Book a pelvic floor physiotherapy assessment with Peloraa for rectal pain, levator ani syndrome, painful bowel movements or related pelvic floor concerns in Barrhaven, Ottawa.

Book an assessment

References & Clinical Credits
Rome Foundation. Rome IV Criteria — Functional Anorectal Pain. Defines levator ani syndrome, unspecified functional anorectal pain and proctalgia fugax and emphasizes exclusion of structural and medical causes before diagnosing functional anorectal pain.

European Association of Urology (EAU). Guidelines on Chronic Pelvic Pain, 2026. Provides current evidence-based guidance on chronic primary anal pain, pelvic floor overactivity, physiotherapy, biofeedback and multidisciplinary chronic pain management.

Cleveland Clinic. Anal Pain: Causes & Treatment. Provides clinical information on anal and rectal pain associated with fissures, hemorrhoids, abscesses, infections, pelvic floor disorders, pudendal neuralgia and other conditions.

Cleveland Clinic. Levator Ani Syndrome: Symptoms & Treatment. Updated November 22, 2024. Describes levator ani syndrome, pelvic floor muscle spasm, typical rectal pressure and aching, and treatment options including pelvic floor physiotherapy and biofeedback.

Cleveland Clinic. Proctalgia Fugax: Symptoms, Causes & Treatment. Updated June 7, 2024. Provides information regarding brief episodic anorectal pain, possible pelvic floor and nerve contributors and differential diagnosis.

Chiarioni G, et al. Biofeedback Is Superior to Electrogalvanic Stimulation and Massage for Treatment of Levator Ani Syndrome. Gastroenterology. 2010. Randomized controlled trial demonstrating significant benefit from biofeedback in patients with levator muscle tenderness.

American Society of Colon and Rectal Surgeons (ASCRS). Clinical Practice Guidelines for the Management of Hemorrhoids, 2024. Provides guidance on hemorrhoidal disease, bowel habits, rectal bleeding and appropriate colorectal evaluation.

American Society of Colon and Rectal Surgeons (ASCRS). Clinical Practice Guidelines for Anorectal Abscess and Fistula-in-Ano, 2022. Provides evidence-based guidance regarding anorectal abscesses and fistulas, including prompt drainage of acute abscesses.

Medical Disclaimer
This information is intended for general educational purposes only and does not replace medical diagnosis, individualized medical advice or treatment from a physician or other qualified healthcare professional. Rectal and anal pain can have many causes, including anal fissures, hemorrhoids, abscesses, fistulas, infections, inflammatory bowel disease, constipation, pelvic floor dysfunction, neurological conditions and, less commonly, colorectal or anal cancer.

Pelvic floor physiotherapy may help when pelvic floor muscle overactivity, levator ani syndrome, bowel coordination problems, musculoskeletal dysfunction or other physical factors contribute to rectal pain, but physiotherapy does not independently diagnose or treat every anorectal condition.

Seek prompt medical assessment for severe or rapidly worsening rectal pain, fever or chills, significant swelling or redness around the anus, pus or drainage, persistent or unexplained rectal bleeding, black or tarry stools, unexplained weight loss, anemia, a new or persistent change in bowel habits, a new rectal or anal mass, inability to pass stool or gas, new neurological symptoms, or sudden loss of bladder or bowel control. Anorectal abscesses in particular require prompt medical treatment and drainage rather than pelvic floor physiotherapy.

Peloraa works collaboratively with appropriate healthcare providers when colorectal assessment, gastrointestinal investigation, imaging, medication, pain management, neurological assessment or surgical treatment may be required.