Perineal Bumps: Causes, Concerns, and What to Do Next

A protruding lump in the perineal area... has been a source of confusion for several years. :(

Hello Doctor, I have had sexual intercourse and have never given birth.
I have mild hemorrhoids and often suffer from constipation due to my job, which requires long periods of sitting and irregular hours.
Four years ago, I developed a long, flat growth in the perineal area that is the same color as the surrounding skin (no redness, white, or gray) and is not painful.
Subsequently, I began to experience blood in my stool.
At that time, following my boyfriend's suggestion, I visited a gynecologist, but the doctor did not provide any specific information, so I didn't pay much attention to it.
Later, based on my mother's experience with hemorrhoids, I assumed it was hemorrhoids and went to see a colorectal surgeon.
The doctor confirmed the presence of hemorrhoids but said it was not severe.
However, after looking at pictures of hemorrhoids online, I feel that my condition is different (hemorrhoids are typically round and localized, while mine is more elongated, flat, and wrinkled, extending along the entire perineal area).
A few days ago, I came across some discussions among pregnant women online, mentioning that during childbirth, the perineum may tear and heal, resulting in a growth that is not painful.
Although there were no pictures, the descriptions of the shape and location seem similar to mine.

1.
I would like to ask, what could be the reason for the growth in my perineal area? What possible conditions could it indicate? Is there a way to eliminate it?
Another small issue: after my visit to the colorectal surgeon, the doctor performed a rectal examination, and I noticed some bleeding afterward.
I initially thought it was due to the anal dilation, but when I used a rectal suppository at home, I discovered that the blood was coming from my vagina.
My next menstrual period is expected in two weeks, but I am unsure why I am experiencing vaginal bleeding.

2.
Is it normal to have vaginal bleeding after a rectal examination?

Ms. Chen, 20~29 year old female. Ask Date: 2021/05/14

Dr. Huang Yuande reply Obstetrics and Gynecology

1.
It would be helpful to have a photo for a more accurate diagnosis; it could be a polyp, wart, or tumor, and a physician's examination is necessary for proper assessment.
2.
Rectal bleeding is likely caused by different factors than vaginal bleeding, unless it is due to a fistula or cancer.
It is advisable to consult a gynecologist for an examination to alleviate any concerns.

Reply Date: 2021/05/14

More Info

Understanding perineal bumps and associated symptoms can be concerning, especially when they involve changes in your body that you may not fully understand. Based on your description, it seems you have a few interconnected issues that need to be addressed.

1. Perineal Bumps: The elongated, flat bump you described in the perineal area could be a variety of things. Given that it is flesh-colored, non-painful, and has been present for several years, it might be a benign condition such as a skin tag, a fibroma, or a wart. Skin tags are common and often appear in areas where skin rubs against skin, which could be exacerbated by factors like obesity, pregnancy, or friction from clothing. On the other hand, warts are caused by the human papillomavirus (HPV) and can also appear in the genital area.
However, the presence of blood in your stool and the changes in your bowel habits, such as constipation, are concerning. Blood in the stool can be caused by hemorrhoids (which you have been diagnosed with), but it can also indicate other conditions such as anal fissures, diverticular disease, or even more serious conditions like colorectal cancer. Given your history of constipation and prolonged sitting, it is possible that the pressure from straining during bowel movements could have contributed to the development of hemorrhoids or fissures.

To address the bump, it is essential to have a thorough examination by a healthcare professional, preferably a dermatologist or a colorectal surgeon, who can provide a definitive diagnosis and discuss treatment options. If it is a skin tag or wart, they can be removed through minor surgical procedures. If it is related to your hemorrhoids, managing your bowel habits through dietary changes, increased hydration, and possibly medications can help alleviate symptoms.

2. Vaginal Bleeding: The bleeding you experienced after the rectal examination is concerning, especially since it was unexpected and occurred from the vaginal area. It is not typical for a rectal examination to cause vaginal bleeding unless there was some trauma or if there is an underlying condition that needs to be addressed.
The bleeding could be due to several factors, including:
- Trauma: If the examination was particularly vigorous, it could have caused minor trauma to the vaginal walls.

- Hormonal Changes: If you are near your menstrual cycle, hormonal fluctuations can sometimes cause spotting or bleeding.

- Infection or Inflammation: Conditions such as vaginitis or cervicitis can lead to abnormal bleeding.

- Polyps or Other Growths: Benign growths in the vaginal or cervical area can also cause bleeding.

It is crucial to follow up with your healthcare provider regarding this bleeding, especially since it is not typical and could indicate an underlying issue that needs to be addressed. They may recommend a pelvic examination or ultrasound to rule out any significant concerns.

In summary, the bump in your perineal area could be benign, but the combination of symptoms, including blood in your stool and unexpected vaginal bleeding, necessitates further evaluation. It is essential to communicate openly with your healthcare provider about all your symptoms, as this will help them provide you with the best care and treatment options. Regular follow-ups and monitoring your symptoms will be key in managing your health effectively.

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