Pain or bleeding from your anus, or bottom opening, can cause problems sitting and going to the toilet. You may feel embarrassed and hesitate to consult your doctor. But how do you know if it is a common problem that will go away on its own, or if it could be something more serious?   Common causes of anal pain or bleeding Haemorrhoids or Piles Haemorrhoids are a common problem, affecting about half of adults by the age of 50. They occur when blood vessels in the anus swell up. Although they are most often relatively harmless, haemorrhoids can cause pain, itching and bleeding, made worse when straining going to the toilet.   Anal Abscess, Fistula or Fissure An abscess occurs when a space in or around the anus becomes infected and filled with pus. Fistulas may occur with repeated abscesses, when pus drains through a tunnel which opens to the skin. Anal fissures are small tears in the thin tissue which lines the anus. Fissures are common in young infants but can occur at any age. They may be caused by straining when going to the toilet.   Polyps Polyps are small clumps of cells that form on the lining of the colon (large intestine) or rectum (back passage). Most people with polyps don’t experience symptoms, but they may cause abdominal pain and rectal bleeding. Most polyps are harmless but over time, some colon polyps can develop into cancer.   Less common but more serious causes of anal pain or bleeding Cancer of the anus, colon or rectum Cancer of the anus is relatively rare. However, colorectal cancer – cancer of the large intestine or back passage – is the third most common and the second most deadly type of cancer.* Symptoms include bleeding or blood in stools (poop), constipation or diarrhoea, pain, itching, swelling or a lump, weakness or fatigue, unexplained weight loss. The best prevention for colon cancer is regular screening for and removal of polyps.   Inflammatory Bowel Diseases Ulcerative colitis is an inflammatory bowel disease (IBD) that causes inflammation and ulcers in the innermost lining of the large intestine (colon) and rectum. Crohn’s disease is a type of inflammatory bowel disease that affects any part of the small or large intestine and often spreads into the deeper layers of the digestive tract. Symptoms of inflammatory bowel diseases may include blood in stools, diarrhoea (often with blood or pus), abdominal pain and cramping, nausea and vomiting, weight loss, fatigue and fever.   What can I do at home to relieve symptoms? Some less serious causes of anal pain and bleeding can be helped by making lifestyle changes such as eating more fibre, drinking more water, being active and avoiding sitting for long periods.   Home treatments which may help include over-the-counter medications, such as topical ointments or creams for haemorrhoids or anal fissures, medications for pain relief or constipation. Soaking the area in a warm-water sitz bath, up to 3 times a day, can also help relieve anal pain. However, if you have severe pain or bleeding, or home remedies are not working then seek medical help.   When should I see a doctor? See your doctor if you have: ● Pain during bowel movements (pooping) ● Rectal bleeding, blood on stools (poop) or toilet paper ● Changes in bowel movements ● Haemorrhoids that don’t improve after a week of home care ● Persistent pain, especially if painkillers are not working.   If you have the following symptoms, you should seek immediate medical attention: ● A significant amount of rectal bleeding or rectal bleeding that won’t stop ● Anal pain that gets much worse or spreads ● You also have fever, chills, dizziness or anal discharge   When is treatment required? Your doctor will be able to advise you on how to manage your symptoms, as well as screen for more serious conditions. Some people with anal fissures may need medication or, occasionally, surgery. Surgery is usually needed to treat anal fistulas. Abscesses often need to be drained as well as antibiotics. Colorectal surgery may be required for more severe disorders, or those that haven’t responded to other treatments.