Hemorrhoids and Anal Abscess: Key Questions Answered

Inquiry Consultation

Dear Dr.
Ke,
Last Monday (July 18), I experienced diarrhea and poor sleep, and a semi-circular protrusion appeared near my anus, approximately 0.5 to 1 cm in size.
It feels slightly hard, and pressing on it or sitting causes pain.
I would like to ask you:
Q1.
Based on the description, do you think the semi-circular protrusion near my anus is a "thrombosed hemorrhoid" or an "anal abscess"? How can I differentiate between the two?
I have been trying to treat it with a topical medication (Hiyu Zhi) and warm baths.
By last Thursday (July 21), the semi-circular protrusion ruptured and bled due to friction from bowel movements, which reduced its size significantly to about 0.5 cm or less, and the pain has also decreased considerably.
Q2.
After the semi-circular protrusion ruptured and bled, although it has shrunk, it has not completely disappeared.
Will this semi-circular protrusion eventually be absorbed by the body and disappear? If so, how long might this take?
Q3.
Following up on the above, should I seek medical attention for a physician to surgically incise (or puncture) and drain this semi-circular protrusion? Is there a necessity for this?
Q4.
Does applying the "Hiyu Zhi" ointment promote the absorption of a thrombosed hemorrhoid by the body? Or would it be better to use the "Hiliu Yu" ointment instead?
Thank you, Dr.
Ke.

Axiang, 40~49 year old female. Ask Date: 2022/07/25

Dr. Ke Fangxu reply Surgery

1.
It is difficult to determine whether it is a thrombosed hemorrhoid or an anal abscess without a physician's personal examination.
Generally, abscesses tend to have a larger area of involvement and are associated with heat and pain, whereas hemorrhoids do not.
However, this principle may not apply in the case of early-stage small or deep abscesses.

2.
Typically, it takes about 2 to 4 weeks for recovery.

3.
If symptoms improve, further observation may be warranted.

4.
Both conditions are manageable.

Reply Date: 2022/07/25

More Info

Understanding hemorrhoids and anal abscesses is crucial for effective management and treatment. Based on your description, let’s address your questions one by one.

Q1: Is the protrusion near my anus a thrombosed hemorrhoid or an anal abscess? How can I differentiate between the two?
The protrusion you described, which is a firm, semi-circular mass near the anus, could potentially be either a thrombosed hemorrhoid or an anal abscess.
- Thrombosed Hemorrhoid: This occurs when a blood clot forms in a hemorrhoid, leading to swelling and pain. It typically presents as a hard, painful lump at the anal verge, especially after straining or during bowel movements. The pain is usually localized, and the lump may be bluish in color.

- Anal Abscess: This is a collection of pus that can occur due to an infection in the anal glands. It may present as a painful, swollen area that can feel warm to the touch. Abscesses can also cause systemic symptoms like fever and malaise, which are less common with thrombosed hemorrhoids.

In your case, the fact that the lump is painful and has reduced in size after a bowel movement suggests it may be a thrombosed hemorrhoid, especially since you mentioned it was exacerbated by straining.

Q2: Will the protrusion disappear after it has ruptured and bled? How long might this take?
After a thrombosed hemorrhoid ruptures, it can indeed shrink and may eventually be absorbed by the body. The healing process can vary from person to person, but typically, you might expect the lump to gradually diminish over a few days to weeks. If the bleeding has stopped and the pain is lessening, this is a positive sign. However, if the lump persists or worsens, it may require further evaluation.

Q3: Should I seek medical attention for incision and drainage of the protrusion?
If the protrusion continues to persist despite conservative treatment (like topical medications and warm baths), or if you experience increasing pain, fever, or any signs of infection (such as redness or swelling), it would be prudent to consult a healthcare provider. In cases of an anal abscess, incision and drainage may be necessary to relieve pain and prevent further complications. A healthcare professional can assess the situation and determine the best course of action.

Q4: Does the topical medication "Hiyu Zhi" help with the absorption of a thrombosed hemorrhoid? Would "Hiyu You" be better?
Topical treatments for hemorrhoids, such as "Hiyu Zhi," are designed to reduce inflammation, relieve pain, and promote healing. While these medications may provide symptomatic relief, they do not directly accelerate the absorption of a thrombosed hemorrhoid. The choice between "Hiyu Zhi" and "Hiyu You" would depend on their specific formulations and your individual response to them. It may be beneficial to consult with a healthcare provider or pharmacist to determine which product would be more effective for your specific situation.

Conclusion
In summary, based on your symptoms, it is likely that you are dealing with a thrombosed hemorrhoid. While it may resolve on its own, monitoring the situation is essential. If symptoms persist or worsen, seeking medical advice is recommended. Maintaining good bowel habits, using topical treatments as directed, and considering warm sitz baths can help alleviate discomfort. Always consult with a healthcare professional for personalized advice and treatment options tailored to your condition.

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