The anus is an opening in the lower part of the digestive tract. It’s separated from the rectum (where stool is held) by the internal anal sphincter.

When stool fills the rectum, the sphincter muscle relaxes, letting stool pass through the anus and out of the body. The external anal sphincter closes off the anus when stool has passed.

Lumps that form around the anus — for a variety of reasons — can cause it to feel hard. There may also be swelling, pain, and discharge.

The anus is comprised of skin and internal intestinal tissue, which consists of mucus glands, blood vessels, lymph nodes, and sensitive nerve endings. When these things become irritated, infected or blocked, lumps can form, making the anus feel hard.

In most cases, anal lumps aren’t life-threatening, but they still require evaluation. See a doctor immediately, however, if you notice persistent bleeding or anal pain that gets worse, spreads, or occurs with a fever.

Some causes of anal hardness or lumps include:

External hemorrhoids

Hemorrhoids are dilated blood vessels that form in the anal lining and can appear as lumps.

They are common — in fact, according to the American College of Gastroenterology, 50 percent of Americans will have had one by age 50.

Hemorrhoids are caused by high pressure in the vessel wall, which can occur with pregnancy, straining during a bowel movement, or heavy lifting. Symptoms include:

  • swollen, bulging lump
  • pain
  • itching
  • bleeding

Perianal hidradenitis suppurativa (HS)

Perianal HS is an inflammatory skin disorder that affects hair and sweat glands in the anus.

In one study published in the journal Clinics in Colon and Rectal Surgery, 93 percent of the people who had it were male, with African-American men being at higher risk.

Perianal HS appears as painful nodules just under the skin. They:

  • form pus and smell when drained
  • produce scarring
  • are associated with inflammatory diseases, like Crohn’s disease, which causes inflammation of the digestive tract

Perianal hematoma

A perianal hematoma is a blood vessel in the anal region that has burst, usually because of straining to have a bowel movement, vigorous coughing, or heavy lifting. Symptoms are:

  • pain
  • swollen, purplish bulge around the anus, which can be as large as a baseball

Anal warts

Also called condyloma acuminata, anal warts, which appear in and around the anus, are caused by the human papilloma virus (HPV). HPV is usually transmitted via sexual intercourse, although it can also be contracted from the bodily fluids of an infected person.

These soft, moist, skin-colored lumps can:

  • itch
  • produce mucus
  • bleed
  • vary in size (they can start out at the size of a pinhead and grow to cover the entire anus)

Molluscum contagiosum

This is a skin infection that results from the molluscum contagiosum virus. The lesions can appear anywhere on the body where the skin has come into contact with the virus.

The virus can spread to the anus through sexual contact, by touching your anus after touching a lesion somewhere else on your body, or by sharing sheets or towels that have been infected by another.

The lesions are:

  • generally small, ranging from the size of a pinhead to a pencil eraser
  • pink, flesh-colored, or white, and raised with a pit in the middle
  • sometimes itchy and swollen
  • usually harmless

The lesions can take from six months to five years to go away.

Constipation

Having infrequent bowel movements or passing hard, dry stools can create a fullness in your anal area that can give you the perception of having a hard anus. Constipation is often caused by eating a low-fiber diet and not drinking enough fluids. It’s technically defined as:

  • passing fewer than three stools a week
  • straining to pass stools
  • having stools that are hard and lumpy

Anal cancer

Anal cancer is rare, affecting just 1 in 500 people, according to the American Society of Colon and Rectal Surgeons. Comparatively, 1 in 22 will have colon cancer. However, the incidence of anal cancer is growing.

The biggest risk factor is having HPV, but other things that increase your chances of contracting anal cancer are smoking, having multiple sex partners, and having chronic, inflamed skin around the anus. Symptoms of anal cancer include:

  • mass near or in the anus
  • pain
  • anal bleeding
  • anal itchiness
  • bowel movement changes

Foreign object

Things like swallowed bones, enema tips, thermometers, and sex toys can inadvertently get stuck in the anus, causing pressure and a hard feeling.

Not every bump and lump will produce pain. Some that typically don’t are:

  • anal warts
  • molluscum contagiosum
  • some hemorrhoids

Doctors have a variety of tools available to help diagnose anal disorders, including anal lumps.

Hemorrhoids, anal warts, and molluscum contagiosum can typically be seen or felt during a physical exam. A doctor may insert a gloved finger into your anus, called a digital exam, to feel for growths.

In an anoscopy, a rigid, lighted instrument allows doctors to view your anus and rectum.

If your doctor wants to look further up your digestive tract and rule out things like colon cancer, they may recommend one of these procedures:

  • barium enema, which is essentially an X-ray of the colon
  • sigmoidoscopy, a procedure that uses a long, flexible tube with a light and a camera to visualize your lower intestinal tract
  • colonoscopy, in which your doctor uses a lighted device called a colonoscope to view your colon and look for things like ulcers and growths

Treatment varies depending on the condition affecting your anus.

External hemorrhoids

  • over-the-counter (OTC) pain relievers
  • cold compresses
  • sitz baths
  • hemorrhoid creams, which contain a numbing agent to dull the pain
  • surgically cutting away the hemorrhoid, especially if it contains a blood clot
  • banding, in which a doctor will tie a small rubber band around the base of the hemorrhoid to cut off its blood supply and allow it to shrink
  • sclerotherapy, which involves injecting the hemorrhoid with a chemical that burns it (and effectively shrinks it)

According to research published in the journal Gastroenterology & Hepatology, a hemorrhoid treated with sclerotherapy has a 30 percent chance of recurring within four years.

Perianal hidradenitis suppurativa (HS)

  • antibiotics to fight inflammation and any infection
  • cortisone to reduce swelling and irritation
  • adalimumab (Humira) to quiet the body’s inflammatory response

Perianal hematoma

  • OTC pain relievers
  • cold compresses
  • surgical draining if pain is severe or persistent

Anal warts

Since the virus that causes anal warts can lie dormant in the body, recurrences aren’t uncommon. You may need repeat procedures as new warts arise.

  • cryosurgery, which involves injecting the warts with liquid nitrogen to freeze and shrink them
  • surgical removal (usually done under a local anesthetic on an outpatient basis)
  • fulguration (using a high-frequency electric current to burn off the wart)
  • podophyllin, trichloroacetic acid, and bichloroacetic acid (if the warts are small and external)

Molluscum contagiosum

  • prescription cream containing imiquimod, a drug that helps the immune system fight the virus that cause these wart-like lesions

Constipation

  • OTC laxatives and stools softeners
  • lubiprostone (Amitiza), which adds water to your stools, making them easier to pass
  • eating more fiber (aim for 25 to 35 grams) by adding foods like fresh fruits, vegetables, and whole grains to your diet
  • drinking more water

Anal cancer

Foreign object

Low-lying objects can be removed with an instrument like forceps. Objects that aren’t easily removed manually may need surgery. Anal dilation under general anesthesia is often performed.

Hardness around the anus is usually caused by noncancerous lumps and growths. But because these lumps can be painful and worrisome, it’s a good idea to get them checked out. Don’t delay getting medical treatment if you have:

  • bleeding that won’t stop
  • pain that seems to be getting worse or is spreading to other areas of your body
  • changes in your bowel movements
  • anal pain or bleeding that is accompanied by a fever

Anal hardness can be accompanied by pain, lumps, and a bloody discharge — worrisome symptoms for anyone. But the majority of causes of anal hardness are noncancerous and treatable with medications, surgical procedures, and at-home remedies.