Rectal Masses: When to Seek Further Medical Evaluation

There is a round mass inside the anus?

Hello doctor, I have a question.
I can feel a round, flesh-like mass about half a finger's width, approximately 5 to 8 centimeters inside my rectum.
No matter how much fruit and vegetables I eat or how much water I drink, I only feel bloated and have no urge to have a bowel movement.
I visited a doctor recently, but after a digital rectal examination, he said there was nothing significant; however, he only inserted his finger about the length of one joint.
Should I see another doctor? He prescribed a stool softener (MiraLAX) for two weeks, which was effective, but right at the end of the two weeks, even with straining, I still had no urge to defecate.
After a day, I passed some stool, but it was between normal and diarrhea in shape.
Then, two days later, I passed some more, which appeared somewhat pellet-like.
Today, I visited a clinic, and the doctor listened to my abdomen and said it was gastroenteritis, but can gastroenteritis cause constipation? Also, I haven’t experienced any diarrhea.
Do you think I need to undergo a colonoscopy? Thank you for your response!

Niming, 10~19 year old female. Ask Date: 2017/10/11

Dr. Ke Fangxu reply Surgery

Based on your description, it seems more like a thrombosed hemorrhoid caused by excessive straining during bowel movements, which typically resolves on its own within one to two weeks and does not require excessive concern.
At the age of 17, a colonoscopy is generally not recommended.
It is advisable to increase your intake of fruits and vegetables, drink plenty of water, and maintain good lifestyle habits.
However, if the symptoms do not improve, it is best to consult a physician for further evaluation.

Reply Date: 2017/10/11

More Info

When it comes to rectal masses and gastrointestinal symptoms, it's essential to approach the situation with caution and thoroughness. Based on your description, you have identified a mass-like structure in your rectal area, along with persistent abdominal bloating and altered bowel habits. Here’s a comprehensive understanding of your situation and recommendations for further medical evaluation.

Understanding Your Symptoms
1. Rectal Mass: The presence of a palpable mass in the rectal area, especially one that feels like a "meat-like" structure, warrants further investigation. While it could be benign, such as a hemorrhoid or a polyp, it could also represent something more serious, such as a rectal tumor. The size and characteristics of the mass, along with your symptoms, are critical in determining the next steps.

2. Bloating and Altered Bowel Habits: The sensation of bloating and the irregularity in your bowel movements—specifically, the difficulty in passing stool despite the use of stool softeners—are concerning. While gastrointestinal inflammation can lead to changes in bowel habits, it typically does not cause a mass sensation. Constipation can occur due to various factors, including diet, hydration, and underlying gastrointestinal conditions.

3. Gastroenteritis and Constipation: Your doctor’s diagnosis of gastroenteritis may not fully explain your symptoms, especially if you are not experiencing diarrhea. Gastroenteritis typically involves inflammation of the stomach and intestines, leading to diarrhea, vomiting, and abdominal pain. However, it can also cause changes in bowel habits, including constipation, particularly if there is significant bloating or discomfort.

Recommendations for Further Evaluation
Given your symptoms and the findings, it is advisable to seek further medical evaluation. Here are some steps you should consider:
1. Consult a Gastroenterologist: A gastroenterologist specializes in digestive system disorders and can provide a more comprehensive evaluation of your symptoms. They may perform a physical examination and discuss your symptoms in detail.

2. Colonoscopy: A colonoscopy is a critical diagnostic tool that allows direct visualization of the colon and rectum. It can help identify any abnormalities, such as polyps, tumors, or inflammatory conditions. Given the presence of a rectal mass and your gastrointestinal symptoms, a colonoscopy is highly recommended.

3. Imaging Studies: In addition to a colonoscopy, imaging studies such as an abdominal ultrasound or CT scan may be useful to assess the abdominal organs and the mass you have felt. These studies can provide additional information about the nature of the mass and any potential complications.

4. Symptom Monitoring: Keep a detailed record of your symptoms, including bowel habits, any changes in the mass, and any new symptoms that may arise. This information can be invaluable for your healthcare provider in making a diagnosis.

5. Diet and Hydration: While you mentioned consuming fruits and vegetables, ensure you are adequately hydrated and consider discussing dietary adjustments with a nutritionist or your doctor. Sometimes, dietary changes can significantly impact bowel habits.

Conclusion
In summary, while your initial evaluation did not reveal significant concerns, the presence of a rectal mass and your ongoing symptoms necessitate further investigation. A gastroenterologist can provide a thorough assessment and recommend appropriate diagnostic procedures, such as a colonoscopy. Early detection and diagnosis are crucial for effective management, especially when it comes to potential rectal masses. Do not hesitate to seek a second opinion or further evaluation to ensure your health and well-being.

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