What is an anal injury?

An anal injury is an injury to the perianal region (the area around the anus), the anus and rectum.

The rectum is the final part of your bowel, located just inside your bottom. It stores your solid waste (stool, poo or faeces) until you are ready to go to the toilet. The anal opening (the anus) is where the waste leaves your body.

What causes anal injuries?

Injuries to the anal region, such as anal fissures or haemorrhoids, are often caused by changes in bowel function such as diarrhoea or constipation. These can cause pain and irritation, damage the skin around the anus, and sometimes lead to bright red blood spotting on toilet paper or in the toilet bowl.

Sometimes the muscles in and around the anal region go into spasm (cramp), and this makes passing stool painful. It can also cause a tear, called an anal fissure, which can bleed.

Anal injuries can also be caused by sexual activity and insertion of objects, fingers or a penis through the anus and into the rectum. Rubbing, sharp edges or rough behaviour can tear the sensitive skin and lining of the rectum, which can cause pain, inflammation and bleeding.

Obstetric anal sphincter injury (OASIS) is another anal injury that is caused during birth. It is a third- or fourth-degree perineal tear that includes the anal sphincter and anal tissue.

When should I see my doctor?

You should call triple zero (000) and ask for an ambulance if you have an anal injury and you:

• start to bleed heavily
• are unable to move
• feel faint or as if you might pass out

What if something is stuck inside my anus?

If an object, such as a sex toy, is stuck in the rectum, it needs to be removed urgently by a doctor. Go to the nearest emergency department (ED).

Do not try to remove an object stuck in your rectum by yourself or let anybody else try to remove it. This may cause more damage, if it is done by someone who is not medically trained.

It is important that the object is not left inside because it can damage the lining of the rectum and other internal organs or lead to serious, sometimes life-threatening problems.

How are anal injuries treated?

Some anal injuries, such as those caused by anal fissures and haemorrhoids, will improve with good self-care, such as eating a high-fibre diet, drinking lots of water and careful anal hygiene.

But if you have severe sudden pain, the pain doesn’t improve in a few days, or you bleed from your bottom, it is important to seek medical advice.

Treatment will depend on what has caused the anal injury:

• Anal fissures: options include laxatives to soften your stool (poo) and in severe cases, surgery.
• Haemorrhoids: options include having a high-fibre diet, drinking more water and avoiding straining when doing a poo. Surgery may be needed to remove severe haemorrhoids.
• Foreign bodies: any object in the rectum or anus should be removed to prevent serious complications. The method used to remove the object will depend on the location of the object. An object close to the anus may be able to be removed in the emergency department. If the object is far into the rectum, an operation under general anaesthetic may be needed.

Self-care of anal injuries

If your anal area is extremely painful and swollen, a cold compress or covered ice pack, such as a bag of frozen peas wrapped in a clean towel, may relieve your pain and swelling. Don’t keep the ice pack on the area for more than 20 minutes.

Protect the area while seeking medical attention so that you don’t cause any further damage to the surrounding areas.

If you are in pain, get advice on pain relief medicines you can take.

If you have any pain or bleeding from the anal area, stop anal sex and don’t have sex again until you have seen a doctor. If you have anal sex when your skin is broken or damaged, you are at increased risk of HIV or sexually transmitted infections (STIs). It can also lead to further damage of the area.

What if I suspect deliberate injury?

If you are worried that the injury was not the result of an accident, and that it was deliberately inflicted or through sex without consent, you should seek help from a healthcare professional as soon as possible. This could be a nurse or doctor at an emergency department or a doctor’s surgery, or a health visitor or school nurse.

Any concern about deliberate injury to children and/or young people should be reported to the relevant authority in your state or territory — if a health professional suspects abuse, they will also report it.

Find contact details to report abuse in your state and territory.

Can anal injuries be prevented?

Good anal care and hygiene, drinking plenty of water and eating fibre-rich foods may prevent conditions that can injure the anus.

To prevent injuries during sex, it is important to ask your sexual partners to remove any rings and trim their fingernails if they’ll be engaging in anal activities, understand your own boundaries and only engage in activities that your body feel comfortable with and use plenty of water-based lubricants.

Resources and support

Seek urgent medical help if you have heavy bleeding, pain or an object is stuck inside your rectum — call triple zero (000) and ask for an ambulance.

If it is not a medical emergency, you can call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.

Read the information sheet on anal health and injuries at Sexual Health Quarters.

If you are concerned about an anal injury, or need self-care advice, you can discuss your concerns with your doctor, or any health professional at a sexual health clinic.