Perineal Swelling: When to See a Gastroenterologist

Perineal mass

I am a junior in college, and about two weeks ago, due to irregular eating and sleeping patterns along with high stress, my bowel movements changed from once every three days to two to three times a day.
I often experience bloating, and my stools have become thinner and less frequent.
Sometimes I alternate between diarrhea and constipation.
I consulted a pharmacist who suggested that I might have irritable bowel syndrome and provided me with oral medication.
After taking it for three days, my bowel movements decreased, and the stools became slightly thicker, but they are still short and small.
I have since returned to regular meals and have been going to bed earlier.

Today, while showering, I noticed a swollen area near my anus close to the perineum.
It is slightly painful when pressed, but there is no bleeding.
I do feel a sense of pressure when standing up from a squatting position.
Should I go directly to a gastroenterologist, or could this be hemorrhoids?

Sabrina Dong, 20~29 year old female. Ask Date: 2021/11/11

Dr. Chen Ronghong reply Surgery

Hello, if the swollen area is at the anal opening, the likelihood of hemorrhoids is higher.
Typically, increasing water intake and fiber consumption, while avoiding constipation and spicy foods, can alleviate symptoms.
If the lump is not at the anal opening, it may be an anal abscess, and it would be advisable to seek medical evaluation.
You can schedule an appointment with a colorectal surgeon.

Reply Date: 2021/11/11

More Info

It sounds like you are experiencing a combination of gastrointestinal symptoms and perineal swelling, which can be concerning. Based on your description, it is important to address both the changes in your bowel habits and the swelling you have noticed.

Firstly, the changes in your bowel habits, such as increased frequency of bowel movements, bloating, and variations between diarrhea and constipation, could indeed suggest a condition like Irritable Bowel Syndrome (IBS). Stress, irregular eating patterns, and sleep disturbances can exacerbate IBS symptoms. The fact that you have seen some improvement with medication from the pharmacy is a positive sign, but it is essential to continue monitoring your symptoms.

Regarding the perineal swelling you mentioned, it is crucial to consider a few possibilities. The swelling near the perineum could be related to several conditions, including hemorrhoids (commonly known as piles), which can cause discomfort and swelling in that area. Hemorrhoids can be internal or external and may not always present with bleeding. They can be aggravated by straining during bowel movements, which might explain the discomfort you are feeling.

However, other conditions could also cause perineal swelling, such as an abscess, which is a localized infection that can lead to swelling and pain. In rare cases, more serious conditions could be involved, so it is essential not to ignore these symptoms.

Given your situation, it would be advisable to see a gastroenterologist. They can provide a thorough evaluation of your gastrointestinal symptoms and the perineal swelling. During your visit, the doctor may perform a physical examination and possibly recommend further tests, such as imaging studies or a colonoscopy, to rule out any underlying conditions.

In the meantime, here are some general recommendations:
1. Dietary Adjustments: Focus on a balanced diet rich in fiber, which can help regulate bowel movements. Avoiding trigger foods that may exacerbate your symptoms (such as high-fat foods, caffeine, and alcohol) can also be beneficial.

2. Hydration: Ensure you are drinking enough water throughout the day, as proper hydration can help with digestion and bowel regularity.

3. Stress Management: Since you mentioned high stress levels, consider incorporating stress-reducing activities into your routine, such as exercise, meditation, or yoga.

4. Monitor Symptoms: Keep a diary of your symptoms, including bowel habits, dietary intake, and any other relevant factors. This information can be helpful for your healthcare provider.

5. Avoid Straining: If you are experiencing constipation, try to avoid straining during bowel movements, as this can worsen perineal swelling and lead to hemorrhoids.

In conclusion, while it is possible that your symptoms could be related to IBS and hemorrhoids, it is essential to consult with a gastroenterologist to obtain an accurate diagnosis and appropriate treatment. Early intervention can help prevent complications and improve your quality of life.

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