Painful Bowel Movements and Anal Growth: Hemorrhoids or Fissures?

Severe pain and bleeding during bowel movements, with a small lump near the anus?

Hello Dr.
Ke: I have been experiencing constipation for the past two months, and my daily routine has been quite irregular.
I notice bright red blood during bowel movements, and the amount is significant, although it is not extremely painful.
I usually need to wipe 3 to 4 times to feel clean, and the toilet water gets stained red.
Two days ago, I had severe pain during a bowel movement, which was so intense that I curled up.
However, there was only a small amount of very faint blood when I wiped.
While showering that day, I felt a small round lump at the 12 o'clock position of the anus, but it is neither painful nor itchy, and I don't feel anything when I pinch it.
I took a photo of the anus with my phone and noticed several small fissures.
Today, I took another photo and, when I spread the anus, I found yellowish material in the folds, along with some white discharge.
The small lump is still there, but it feels like it has only a thin layer of skin remaining.
Dr.
Ke, could this be external hemorrhoids or a polyp resulting from an anal fissure? Thank you, Dr.
Ke!

Zia, 10~19 year old female. Ask Date: 2016/06/29

Dr. Ke Fangxu reply Surgery

Based on your description, it seems to be an anal fissure.
The typical symptoms include pain during bowel movements accompanied by slight bleeding.
If there is concurrent bleeding from hemorrhoids, the amount of blood may be more significant.
The primary cause of anal fissures is usually hard stools; however, diarrhea, frequent bowel movements, or prolonged straining can also lead to fissures.
It is recommended to improve bowel habits and perform warm sitz baths to alleviate symptoms.
Topical ointments and suppositories can also be used for treatment.
If symptoms persist for more than a week without improvement, it is advisable to consult a physician for further evaluation to identify the underlying issue.
If there is a hard lump, it is more likely to be a polyp associated with the fissure, but a definitive diagnosis cannot be made without a physical examination.

Reply Date: 2016/06/29

More Info

Based on your description, it seems that you are experiencing a combination of symptoms that could be indicative of either hemorrhoids or anal fissures, both of which are common conditions that can cause pain during bowel movements and may involve the presence of blood.

Hemorrhoids are swollen veins in the lower rectum or anus, and they can be either internal or external. Internal hemorrhoids are usually not visible and may not cause pain, but they can lead to bleeding during bowel movements. External hemorrhoids, on the other hand, can be seen and felt as lumps around the anus and can be quite painful, especially if a blood clot forms within them (thrombosed hemorrhoids). The bright red blood you are seeing could be from hemorrhoids, especially if it appears on the toilet paper or in the toilet bowl after a bowel movement.

Anal fissures are small tears in the lining of the anus, often caused by passing hard stools. They can be extremely painful, leading to sharp pain during and after bowel movements, and may also cause bleeding. The presence of a "small round lump" you mentioned could be a skin tag, which sometimes develops after a fissure heals, or it could be an external hemorrhoid. The yellow and white discharge you observed could be a sign of irritation or infection, which can occur with fissures or hemorrhoids.

Given that you have been experiencing constipation and irregular bowel habits, it is crucial to address these issues to prevent further complications. Here are some recommendations based on your symptoms:
1. Dietary Changes: Increase your fiber intake by consuming more fruits, vegetables, and whole grains. This can help soften your stools and make them easier to pass, reducing the strain during bowel movements.

2. Hydration: Drink plenty of water throughout the day. Staying hydrated is essential for maintaining soft stools.

3. Regular Bowel Habits: Try to establish a regular routine for bowel movements. Do not ignore the urge to go, as this can lead to harder stools and increased straining.

4. Avoid Straining: When you do have a bowel movement, try to relax and avoid straining. If you find that you are straining frequently, consider using a stool softener or a fiber supplement, but consult your healthcare provider first.

5. Warm Baths: Soaking in a warm bath can help relieve pain and discomfort associated with hemorrhoids or fissures. This can also promote healing.

6. Topical Treatments: Over-the-counter creams or ointments designed for hemorrhoids can provide relief from pain and itching. However, if you have an anal fissure, you may need a prescription medication to help with healing.

7. Consult a Specialist: Given the presence of blood and the changes you have observed, it is essential to consult a healthcare provider, preferably a gastroenterologist or a colorectal surgeon. They can perform a thorough examination and may recommend further diagnostic tests, such as a colonoscopy, to rule out other conditions.

In summary, while your symptoms may suggest hemorrhoids or anal fissures, it is vital to seek medical advice for an accurate diagnosis and appropriate treatment. Addressing your bowel habits and dietary choices can significantly improve your symptoms and overall gastrointestinal health.

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