Painful White Bumps Near the Anus: Causes and Solutions

Small white bumps protruding from the anus that are painful?

Hello, doctor.
My question is a bit long, and I appreciate your understanding.
Regarding my history of anal diseases, I have internal hemorrhoids and have previously had external hemorrhoids.
I have undergone several ligation procedures.
The last examination by a clinic doctor was around August of last year, and the doctor mentioned that I only have a very small internal hemorrhoid left, which is too small to be ligated again.
Overall, my hemorrhoids are relatively well-controlled.
My questions are as follows: On the 2nd of this month (January 2), I experienced diarrhea, having about four bowel movements in a short period, and I was in significant abdominal pain, possibly due to food poisoning or a bacterial infection.
After the diarrhea, I noticed a noticeable lump at the anal opening while showering, which was not very painful.
I believe that was my hemorrhoid, but it disappeared after a sitz bath and some sleep, so overall, it wasn't a major issue.
However, I am quite worried because the next day, a small protrusion appeared near my anus, with a small white spot on the surface.
I am unsure if this is due to skin injury from the diarrhea or if it is an infection of the glands caused by food poisoning.
This protrusion looks similar to a small pimple on the face, and it is quite painful when touched during a shower.
After looking in the mirror, I noticed it was somewhat red, but there was no bleeding or pus.
I applied the hemorrhoid ointment prescribed by the clinic, but it was extremely painful to apply.
Walking does not seem to be affected, but there is occasional pain likely due to friction.
The size of this white spot has not changed significantly since then, and the pain fluctuates.
However, another similar small protrusion has appeared nearby, which is also quite red.
I researched online and am very concerned that it might be an anal abscess (even though I do not have a fever or any pus or blood discharge, and the protrusion has not increased in size over the past week, it also hasn’t decreased or disappeared with the ointment, possibly due to friction with stool during bowel movements).
Although the pain is not severe and does not significantly impact my daily life, touching it during a shower is still very painful.
I am worried about the possibility of an abscess or fistula, as my anal health is not great.
Additionally, I am currently studying abroad, and accessing medical care is challenging and cumbersome (it takes a long time).
The family doctor I applied to is not a colorectal specialist, and I have about 11 months until I graduate and can return to Taiwan, making it difficult to find time to see a doctor there.
In the UK, if an abscess issue arises, my limited financial situation does not allow for drainage procedures, and I cannot purchase prescription antibiotics at the pharmacy.
All these factors make me very concerned about the potential for complications or serious conditions, so I would like your assessment of the possible scenarios and recommended actions.
Here is a picture of the protrusion with the white spot: https://imgur.com/a/9xEEmaY.
Doctor, do you think this is more likely to be folliculitis or an anal abscess? Or could there be other possibilities? Thank you for your patience in reading and answering my questions.

Xiao Bai, 20~29 year old female. Ask Date: 2020/01/08

Dr. Ke Fangxu reply Surgery

The link you provided could not be accessed due to verification requirements (safety concerns).
The small white spots you mentioned are more likely to be caused by anal fissures due to diarrhea.
While the possibility of a fistula or abscess is not zero, it is more likely if there is no swelling or discharge.
I recommend addressing the bowel movement issues first, along with warm sitz baths, which can help alleviate pain, maintain cleanliness, and promote blood circulation.
You can also purchase hemorrhoid suppositories at the pharmacy for relief.
If symptoms persist without improvement, it is best to consult a physician for evaluation.

Reply Date: 2020/01/08

More Info

Understanding painful white bumps near the anus can be concerning, especially given your history of hemorrhoids and recent gastrointestinal issues. Based on your description, there are a few potential causes for the symptoms you are experiencing, and I will outline these along with some suggestions for management.

Possible Causes
1. Hemorrhoids: Given your history of internal and external hemorrhoids, the "meatball" you felt after your diarrhea could indeed be a hemorrhoid. Hemorrhoids can become inflamed and painful, especially after episodes of diarrhea, which can irritate the area. The small white bump you mentioned could be a thrombosed hemorrhoid, which occurs when a blood clot forms in an external hemorrhoid, leading to swelling and pain.

2. Skin Irritation or Infection: The appearance of a small white bump with redness could suggest a skin infection or irritation. This could be due to friction from bowel movements, especially if you have been experiencing diarrhea. Conditions such as folliculitis (infection of hair follicles) or a simple skin irritation can present similarly.

3. Perianal Abscess: While you mentioned that you do not have fever or pus drainage, a perianal abscess is a possibility, especially if the bump is painful and has not improved with topical treatments. Abscesses can form due to blocked glands in the anal area, often following trauma or infection.

4. Fungal or Viral Infections: Conditions like herpes simplex or fungal infections can also cause painful bumps in the anal area. These typically present with additional symptoms, such as itching or burning.

Recommendations
1. Maintain Hygiene: Keep the anal area clean and dry. After bowel movements, consider using gentle wipes or a bidet to avoid further irritation. Avoid harsh soaps or scrubs that could exacerbate the irritation.

2. Topical Treatments: While you have already applied hemorrhoid cream, consider using a soothing ointment like hydrocortisone cream to reduce inflammation and discomfort. However, avoid using it for prolonged periods without consulting a healthcare provider.

3. Warm Sitz Baths: Taking warm sitz baths can help soothe the area and promote healing. This can be particularly beneficial if you are experiencing discomfort.

4. Monitor Symptoms: Keep an eye on the bump. If it becomes larger, increasingly painful, or if you develop fever or systemic symptoms, it would be advisable to seek medical attention, even if it requires visiting a local healthcare provider.

5. Seek Professional Help: Given your concerns about potential complications like abscesses or fistulas, it is essential to consult a healthcare professional. If your current family doctor is not specialized in colorectal issues, consider seeking a referral to a gastroenterologist or colorectal surgeon. Many countries have urgent care facilities that can address such issues without requiring a long wait.

6. Consider Dietary Changes: Since you experienced diarrhea, it may be beneficial to evaluate your diet. Ensure you are consuming enough fiber to prevent constipation and reduce straining during bowel movements, which can aggravate hemorrhoids.

Conclusion
While it is understandable to be anxious about your symptoms, many conditions affecting the anal area can be managed effectively with proper care and attention. It is crucial to monitor your symptoms and seek medical advice when necessary. If you find it challenging to access healthcare due to your current situation abroad, consider reaching out to telemedicine services that may provide consultations with specialists. Your health is important, and addressing these symptoms early can prevent more severe complications in the future.

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