Rectal Masses: Symptoms, Concerns, and Diagnosis

Anal mass

I have noticed that my stool consistently has grooves, and when I reach about one and a half fingers above my anus, I can feel a hard lump the size of a ten-dollar coin that can be pushed upwards.
It feels more like a hard mass pressing from outside the intestines rather than a foreign object inside the intestines.
Two weeks ago, I had a colonoscopy and a pelvic ultrasound, and the doctors said everything was fine.
However, my stool still has grooves or is flattened, making it difficult to pass.
I am very worried that there might be a tumor that was not detected!

Dai Xiaojie, 30~39 year old female. Ask Date: 2022/10/15

Dr. Zhang Shuhao reply Surgery

The structures located above the anus and below the coccyx are primarily composed of pelvic floor muscles and ligaments.
If a painless hard mass is palpated, it is most commonly the tip of the coccyx; however, in rare cases, it may be a presacral tumor of neurogenic or osseous origin.
A preliminary assessment can usually be made through a digital rectal examination, and if there is suspicion, a transrectal ultrasound or magnetic resonance imaging (MRI) can be performed for confirmation.

Reply Date: 2022/10/15

More Info

Understanding rectal masses and their implications can be a source of significant concern, especially when symptoms like changes in bowel habits and the presence of palpable masses are involved. Based on your description, it sounds like you are experiencing some distressing symptoms, including the sensation of a hard mass near the coccyx and changes in your stool shape.
Firstly, it’s important to note that the presence of a hard mass in the rectal area can be caused by various conditions, ranging from benign to malignant. The fact that you have undergone a colonoscopy and a pelvic ultrasound recently, and both tests returned normal results, is reassuring. Colonoscopies are particularly effective in visualizing the inner lining of the colon and rectum, and they can help identify polyps, tumors, and other abnormalities. If your doctor did not find any concerning lesions during the procedure, it is less likely that a significant tumor is present in the rectal area.

The symptoms you describe, such as the stool having grooves or being flattened, could be due to several factors. One possibility is that the hard mass you feel could be a benign condition, such as a rectal prolapse or a hemorrhoid, which can create pressure and affect the shape of the stool. Another possibility is that it could be related to muscle tension or spasm in the pelvic floor, which can lead to difficulties in bowel movements and changes in stool consistency.

It’s also worth considering that the sensation of a hard mass could be due to muscular or connective tissue changes rather than a tumor. Conditions like fibromas or other benign growths can occur in the pelvic area and may not be detected during a colonoscopy or ultrasound.
However, your concern about a potential tumor is valid, especially given the persistent nature of your symptoms. While the imaging studies you underwent are quite comprehensive, if your symptoms continue or worsen, it may be prudent to follow up with your healthcare provider. They might consider additional diagnostic tests, such as an MRI or a CT scan of the pelvis, which can provide more detailed images of the soft tissues and help identify any abnormalities that may not have been visible on the previous tests.

In summary, while your recent tests have not indicated any serious issues, it is essential to maintain open communication with your healthcare provider about your ongoing symptoms. They can help determine if further evaluation is necessary. Additionally, keeping track of your symptoms, including any changes in bowel habits, pain levels, or the characteristics of the mass, can provide valuable information for your healthcare team.
Remember, early detection and intervention are key in managing any potential health issues, so don’t hesitate to seek further evaluation if you feel it is warranted. Your health and peace of mind are paramount, and addressing your concerns with your doctor is the best course of action.

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