Anal Bumps: Hemorrhoids or Fissures?

A small lump has developed at the anal opening?

Hello, doctor.
I noticed a small raised bump near my anus while taking a shower.
It was fine the first day, but over the next few days, I experienced a slight stinging pain when I touched it or when it was pressed against (for example, while walking, sitting, or lifting my legs).
I'm not sure if it's hemorrhoids or an anal fissure.
I often have difficulty with bowel movements, resulting in very soft and crumbly stools.
Even though they are soft, they still cause pain when they rub against the anus.
I remember one day when I had very hard stools, and I had to strain a lot to pass them, which caused a tearing sensation in my anus, almost like being pricked by a needle or cut by a knife.
There was a little blood when I wiped, but none in the toilet; the amount of bleeding was minimal, but it was extremely painful afterward.
A few days later, the bump appeared.
Because of this, I've been having daily bowel movements, and my stools have become softer, but the bump still causes stinging pain.
I looked in the mirror and saw that it is located above the anus, near the vagina, and occasionally I notice some moistness and an unusual odor.
I'm uncertain whether I have external hemorrhoids or an anal fissure.
Now, I have difficulty even taking a shower because of the pain.
I don't know what to do; I have panic disorder and hyperventilation syndrome, and I'm afraid of surgery.
Is surgery the only option, or can I improve my diet and lifestyle to help it resolve on its own?

DITH, 20~29 year old female. Ask Date: 2021/08/15

Dr. Cai Dongqi reply Family Medicine

Hello DITH! Please visit the colorectal surgery clinic.

Reply Date: 2021/08/15

More Info

When it comes to anal bumps, particularly in the context of your symptoms, it is crucial to differentiate between hemorrhoids and anal fissures, as both conditions can present with similar discomfort but require different management strategies.

Understanding Hemorrhoids and Anal Fissures:
1. Hemorrhoids are swollen veins in the lower rectum or anus. They can be classified as either internal or external. Internal hemorrhoids are located inside the rectum and usually do not cause pain, but they can bleed. External hemorrhoids, on the other hand, are located under the skin around the anus and can cause pain, especially when sitting or during bowel movements. Symptoms may include itching, discomfort, and a lump near the anus.

2. Anal fissures are small tears in the lining of the anus, often caused by passing hard or large stools. They can be extremely painful, especially during and after bowel movements, and may cause bleeding. The pain is typically sharp and can feel like a stabbing sensation. Fissures are often accompanied by a spasm of the anal sphincter, which can make bowel movements even more painful.

Given your description of a small bump near the anus that causes pain, especially after bowel movements, and the history of hard stools leading to a tearing sensation, it is possible that you may be experiencing either an external hemorrhoid or an anal fissure. The presence of a small bump could indicate an external hemorrhoid, especially if it is tender to touch and associated with your bowel habits.

Management Options:
1. Dietary Changes: Improving your diet can significantly help manage both conditions. Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools and reduce straining during bowel movements. Staying well-hydrated is also essential.

2. Topical Treatments: Over-the-counter creams or ointments containing hydrocortisone can help reduce inflammation and discomfort associated with hemorrhoids. For fissures, topical anesthetics may provide temporary relief.

3. Warm Sitz Baths: Soaking the anal area in warm water for 10-15 minutes several times a day can help relieve pain and promote healing.

4. Avoid Straining: It is crucial to avoid straining during bowel movements. If you feel the urge to go, try to respond promptly rather than holding it in, which can lead to harder stools.

5. Pain Management: If pain is significant, over-the-counter pain relievers like ibuprofen or acetaminophen can help manage discomfort.

6. Consultation with a Healthcare Provider: Given your symptoms and the presence of a bump, it is advisable to consult with a healthcare provider for a thorough examination. They can provide a definitive diagnosis and recommend appropriate treatment. If conservative measures do not improve your condition, further interventions may be necessary.

7. Surgical Options: While surgery is not the first line of treatment for hemorrhoids or fissures, it may be considered in cases where conservative management fails. Surgical options can include hemorrhoidectomy for severe hemorrhoids or lateral internal sphincterotomy for chronic anal fissures.

Conclusion:
It is understandable to feel anxious about potential surgical interventions, especially with a history of panic disorder. However, many cases of hemorrhoids and fissures can be effectively managed with lifestyle changes and conservative treatments. It is essential to address your symptoms early to prevent complications and improve your quality of life. Please consider scheduling an appointment with a healthcare professional who can provide personalized advice and support based on your specific situation.

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