Anal Lumps: Symptoms, Diagnosis, and Treatment Options

Anal mass

Hello Dr.
Chang, I would like to describe my condition in detail to help you make a better assessment.
I hope you don't mind: About a month ago, after using the restroom, I noticed a protrusion on the left side of my anus that feels like a soft, elastic mass, measuring less than 1 cm in diameter.
There was no bleeding during bowel movements, and I couldn't feel it when I touched it lightly, but I could feel it when I pinched it.
After researching online, I found that I have several habits that could lead to hemorrhoids, so I suspected it might be hemorrhoids.
I made an appointment with the colorectal surgery department at a nearby hospital, but since I didn't get checked immediately after using the restroom, the doctor didn't find anything.
I later realized that I couldn't feel it most of the time, but I could feel it on the left side of the anal opening when I inserted my finger.
After explaining my symptoms on the day of the appointment, the doctor performed a digital examination but reported that he couldn't feel anything.
To be thorough, he also used an anoscope and indicated that I had only mild internal hemorrhoids.
He advised me to be mindful in my daily life and prescribed a hemorrhoid cream for discomfort.
I initially thought that since the doctor said there was no problem, there should be no issue.
I also tried to avoid sitting for long periods and drank more water.
However, last week, after using the restroom, I noticed that the protrusion seemed to have increased in size.
Even though there were no significant symptoms, I felt anxious and applied some medication.
The next day, I experienced slight pain in the area of the protrusion on the left side of my anus, so I applied more medication, and everything seemed fine until the night before last when I suddenly felt a foreign sensation in my anus, as if I hadn't wiped properly.
I tend to have difficulty sleeping, so for peace of mind, I applied some ointment, and yesterday I experienced slight pain again, prompting me to apply more medication.
After reading some questions and answers from doctors online, I still have several concerns, so I would like to ask Dr.
Chang a few questions:
1.
During the anoscopy, I had some urgency to defecate due to increased bowel motility in the days prior.
To avoid the embarrassment of passing gas while the doctor was focused on the examination, I tightly clenched my anus.
Could this have caused any discrepancies in the results of the digital examination and anoscopy? I can feel the protrusion quite distinctly, but the doctor said he couldn't feel anything...
2.
The doctor who performed the anoscopy confirmed mild internal hemorrhoids, and my protrusion only appears after bowel movements.
Should I consider this a grade II internal hemorrhoid? However, internal hemorrhoids typically do not cause pain.
Since I am easily influenced by psychological factors, could the pain I feel be purely psychological, or could it be a side effect of the hemorrhoid ointment (the one prescribed)? Or could the doctor have misdiagnosed it, and it might actually be a mixed hemorrhoid, which could explain the sensation?
3.
If this is indeed a mixed hemorrhoid, what treatment would be necessary? If it is an internal hemorrhoid, can hemorrhoids resolve with improved habits? Even without symptoms, I feel uncomfortable knowing that it is there every time I wipe.
4.
If this is not a hemorrhoid, what other possible conditions do you think it could be, based on your expertise? Thank you, doctor, for your hard work.

Nìmíng, 20~29 year old female. Ask Date: 2022/02/13

Dr. Zhang Shuhao reply Surgery

1.
Based on the description, the likelihood of internal hemorrhoids is high.
They may become more swollen due to straining during bowel movements, staying up late, or drinking alcohol, but may not be noticeable during regular activities.
In the clinic, their appearance can vary depending on the patient's position or the type of endoscope used.
2.
Enlarged internal hemorrhoids typically do not cause any specific sensations, but during flare-ups, they can create a feeling of fullness due to swelling.
If bleeding occurs within the hemorrhoids and a thrombus forms near the dentate line, it can cause pain, which is similar to the symptoms of mixed hemorrhoids.
3.
For simple internal hemorrhoids or mixed hemorrhoids during flare-ups, warm sitz baths can be performed to promote blood circulation, help reduce swelling, and alleviate pain.
When applying ointment, avoid using hard tubes to prevent injury.
It is also important to stay well-hydrated and consume dietary fiber, and to avoid excessive straining during bowel movements.
If symptoms gradually improve, there is no need for concern.
4.
The likelihood of hemorrhoids is high, and the chance of malignant lesions in young individuals is relatively low.
If there are any concerns, it is advisable to consult a colorectal surgeon for further evaluation.
If hemorrhoids do not frequently flare up and do not affect quality of life, surgery is not necessary.

Reply Date: 2022/02/13

More Info

Understanding anal lumps can be a source of anxiety for many individuals, especially when symptoms such as discomfort or changes in appearance arise. Based on your detailed description, it seems you are experiencing a lump near the anal area, which you suspect may be related to hemorrhoids. Let's address your concerns systematically.

1. Potential for Misdiagnosis During Examination
It is possible that the tension you felt during the examination could have affected the findings. When you consciously tighten the anal sphincter, it can make it more difficult for a physician to palpate any abnormalities. However, if the physician performed a thorough examination, including a digital rectal exam and anoscopy, they would likely have been able to identify any significant issues. If the lump is only present after bowel movements, it may indicate a condition that is not always palpable during a routine examination.

2. Understanding Internal Hemorrhoids and Pain
Internal hemorrhoids typically do not cause pain unless they become thrombosed or prolapsed. The fact that you are experiencing discomfort could suggest that there is more than just a mild internal hemorrhoid. Psychological factors can indeed influence the perception of pain, and it’s also possible that the topical medication you are using could cause irritation. If the lump is indeed a hemorrhoid, it may not necessarily resolve on its own, but lifestyle changes such as increased fiber intake, hydration, and avoiding prolonged sitting can help alleviate symptoms.

3. Management of Hemorrhoids
If your lump is confirmed to be an internal hemorrhoid, treatment options include lifestyle modifications, topical treatments, and in some cases, procedures such as rubber band ligation or sclerotherapy. Hemorrhoids can improve with proper care, but they may not completely disappear without intervention. If you are experiencing ongoing discomfort, it may be worthwhile to revisit your healthcare provider for further evaluation and potential treatment options.

4. Other Possible Conditions
If the lump is not a hemorrhoid, other possibilities include anal warts, skin tags, or even more serious conditions such as anal fissures or tumors. It is essential to have a thorough examination to rule out these conditions. If the lump persists or worsens, or if you experience additional symptoms such as bleeding or significant pain, further diagnostic procedures may be warranted.

Recommendations
1. Follow-Up Appointment: It would be prudent to schedule a follow-up appointment with a colorectal specialist. They can perform a more comprehensive examination and possibly recommend imaging studies if necessary.

2. Symptom Diary: Keep a diary of your symptoms, noting when the lump appears, any associated pain, and the effectiveness of treatments. This information can be invaluable for your healthcare provider.

3. Lifestyle Modifications: Continue to implement lifestyle changes that promote bowel health, such as a high-fiber diet, adequate hydration, and regular exercise.

4. Avoid Self-Diagnosis: While it’s tempting to research symptoms online, it’s important to rely on professional medical advice for diagnosis and treatment.

In conclusion, while your symptoms may suggest a benign condition such as hemorrhoids, it is crucial to have a thorough evaluation to rule out other potential issues. Open communication with your healthcare provider about your concerns and symptoms will facilitate a more accurate diagnosis and effective treatment plan.

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