Rectal Pain in Males: Causes, Red Flags, and How Pelvic Floor Therapy Can Help

Rectal pain in men is more common than most people realize — but almost no one talks about it.

It can feel sharp, aching, burning, throbbing, or like pressure deep inside the pelvis. Some men notice it when sitting. Others feel it after a bowel movement, during stress, or seemingly out of nowhere.

If you’re experiencing rectal pain, it does not automatically mean something is “wrong” structurally, and it definitely doesn’t mean you have to live with it.

Let’s break down the most common causes.

Common Causes of Rectal Pain in Men

1. Hemorrhoids

Swollen veins in the rectum or anus can cause:

• Sharp pain

• Burning

• Itching

• Bleeding with bowel movements

Hemorrhoids are usually worse with constipation, straining, or prolonged sitting.

2. Anal Fissures

Small tears in the anal lining can cause:

• Severe pain with bowel movements

• Pain that lingers afterward

• Bright red blood on toilet paper

These often occur with hard stools or chronic constipation.

3. Prostatitis

Inflammation or irritation of the prostate (sometimes infectious, sometimes not) can cause:

• Deep rectal aching

• Perineal pain

• Pain with urination or ejaculation

• Urinary frequency or urgency

Chronic cases are often muscular and tension-driven rather than infectious.

4. Levator Ani Syndrome (Pelvic Floor Muscle Spasm)

This is one of the most overlooked causes of rectal pain in men.

The levator ani muscles form part of the pelvic floor and sit directly around the rectum. When these muscles become tight, overactive, or spasm, men may feel:

• Deep aching inside the rectum

• Pain with sitting

• Pain after bowel movements

• Pain that improves when standing or walking

• A sensation of a “golf ball” in the rectum

This is muscular. Not dangerous, but very uncomfortable.

5. Chronic Pelvic Pain Syndrome (CPPS)

Often labeled as “non-bacterial prostatitis,” Chronic pelvic pain syndrome frequently includes:

• Rectal pain

• Perineal pain

• Testicular discomfort

• Urinary changes

• Erectile dysfunction

In many cases, the pelvic floor muscles are a major contributor.

6. Pudendal Nerve Irritation

The pudendal nerve runs through the pelvic floor and supplies sensation to the rectum, penis, and perineum.

When irritated (often from prolonged sitting, cycling, tension, or poor posture), it can cause:

• Burning rectal pain

• Numbness or tingling

• Pain that worsens with sitting

• Relief when standing

When Rectal Pain Is a Red Flag

You should seek medical evaluation immediately if you have:

• Fever

• Severe swelling

• Unexplained weight loss

• Persistent bleeding

• Sudden severe pain

Conditions like abscesses, infections, or inflammatory bowel disease need medical treatment.

But once serious pathology is ruled out, many men are left with “everything looks normal” yet the pain continues.

That’s where the pelvic floor comes in.

Why Pelvic Floor Muscles Cause Rectal Pain

The pelvic floor:

• Wraps around the rectum

• Helps control bowel movements

• Coordinates with breathing

• Responds to stress

In men especially, stress, sitting, weightlifting, constipation, and even posture (forward head posture, thoracic stiffness, decreased lumbar lordosis) can create a chronic state of tension in these muscles.

When muscles stay “on” all day:

• Blood flow decreases

• Nerves become sensitized

• The brain perceives pain

This becomes a tension–pain cycle.

What Pelvic Floor Physical Therapy Does

Pelvic floor physical therapy for rectal pain focuses on:

1. Reducing Muscle Overactivity

Many men are told to “do Kegels,” but tight muscles need relaxation and coordination, not strengthening.

2. Internal and External Muscle Assessment

A trained pelvic PT can identify:

• Trigger points

• Muscle guarding

• Asymmetry

• Nerve sensitivity

3. Breathing & Pressure System Training

Your diaphragm, rib cage, abdominal wall, and pelvic floor all work together. Poor rib mobility and bracing patterns often drive pelvic tension.

4. Bowel Mechanics

Improving stool consistency, coordination, and reducing straining decreases rectal irritation.

5. Nervous System Downregulation

Chronic pelvic pain often involves a sensitized nervous system. Therapy helps calm this response.

Why Sitting Makes It Worse

Men with rectal pain often notice:

• Worse pain after long car rides

• Pain during desk work

• Relief when lying down or standing

Prolonged sitting compresses:

• The pelvic floor muscles

• The pudendal nerve

• The perineal region

Add poor posture and abdominal bracing and the rectum becomes the “pressure point.”

The Bottom Line

Rectal pain in men is common.
It is often muscular.
It is treatable.

If imaging is normal and antibiotics haven’t helped, the missing piece may not be the rectum. It may be the pelvic floor muscles and nervous system driving the pain.

Pelvic floor physical therapy offers a conservative, evidence-informed approach that addresses the root contributors rather than masking symptoms.

You don’t have to live with rectal pain and you don’t have to guess what’s causing it. Reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at receptionmadison@pelvichealthnj.com.