Injuries to the anal region are often caused by changes in bowel function like 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, and this can lead to a tightening of the sphincter that 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 involving insertion of objects, fingers or a penis through the anus and into the rectum. Friction, sharp edges, or rough behaviour can tear the sensitive skin and lining of the rectum, causing pain, inflammation and bleeding.

Treating anal injuries

Any injury that causes large amounts of blood loss, persistent pain and inflammation, or the lodging of a foreign object inside the rectum must be seen by a doctor.

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

You must not try to remove the foreign body by yourself, or allow anybody else to try — trying to remove it may cause more damage if it is done by someone who is not medically trained. It is vital that the object is not left inside because it can damage the lining of the rectum and other internal organs or lead to serious, potentially life-threatening problems.

Self-care of anal injuries

If the 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 be used to relieve the pain and swelling. Do not keep the ice pack on the area for more than 30 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.

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

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

Suspicion of deliberate injury

If there is any suspicion that the injury was not the result of an accident and that it was deliberately inflicted, 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.

You can also search for local services and agencies that can offer confidential advice in the National Health Services Directory.