External Anal Masses: Thrombosed Hemorrhoids or Fistula?

Is the external anal mass an anal fistula or a thrombosed external hemorrhoid?

1.
Symptoms: For about 2-3 weeks, there has been a hard lump outside the anus with no redness or swelling.
Pressing on it causes a sharp pain, but if left alone, there is no discomfort.
It has been observed to fluctuate in size.
Currently, warm sitz baths have been taken four times.

2.
Medical records: - In the second week, a visit was made to the colorectal surgery department at Mackay Memorial Hospital in Taipei, where the physician indicated the presence of hemorrhoids, but they were not severe and did not require a follow-up appointment.
Treatment included topical medication and oral medication, along with dietary advice.
- In the third week, a follow-up visit was made to the outpatient clinic in Taipei, where the physician noted some minor anal fissures.
Treatment included warm sitz baths, oral antibiotics, and topical antibiotic ointment, with continued observation.
3.
Wound photos: [Link to photos]
4.
Inquiry points: 1.
After extensive research, it seems that if there are no other abnormal discharges, it should be a thrombosed external hemorrhoid, but I still want to confirm for accuracy.
2.
I would like to inquire if this is indeed hemorrhoids or another issue.
3.
If it is a thrombosed hemorrhoid, what is the expected absorption time? I have read that it typically takes 2-4 weeks, but it has already been 3 weeks.

Mas, 20~29 year old female. Ask Date: 2024/02/06

Dr. Chen Jiaming reply Surgery

After all, you have already received treatment in a colorectal surgery outpatient clinic, and both diagnosis and treatment should be based on the recommendations of a specialist.
Relying on images found online for diagnostic purposes can lead to inaccuracies; a physical examination is still more reliable.
Additionally, the absorption of thrombosed hemorrhoids varies from person to person and is not consistent.
Moreover, did your physician mention that you have this diagnosis?

Reply Date: 2024/02/06

More Info

Based on your description, it seems that you are experiencing a condition that may be related to thrombosed hemorrhoids, which is a common issue that can occur in the anal region. Let's break down your symptoms and the medical advice you've received to provide a clearer understanding of your situation.

Symptoms and Observations
1. External Hard Mass: You mentioned a hard mass near the anus that has been present for about 2-3 weeks. This is a typical presentation of thrombosed hemorrhoids, which occur when a blood clot forms in the external hemorrhoidal tissue. The mass can feel firm and may cause discomfort, especially when pressure is applied.

2. Pain and Sensation: The sharp pain you experience when pressing on the mass, along with the fact that it does not cause discomfort when left alone, aligns with thrombosed hemorrhoids. These can fluctuate in size due to changes in swelling or the resolution of the clot.

3. Medical Consultations: You have consulted with healthcare professionals who have diagnosed you with hemorrhoids and noted some anal fissures. The treatment plan involving warm sitz baths, topical medications, and oral antibiotics is standard for managing these conditions.

Diagnosis Considerations
1. Thrombosed Hemorrhoids vs. Fistula: The absence of redness and swelling suggests that it is less likely to be an anal fistula, which typically presents with more significant inflammation and possibly drainage of pus or other fluids. Fistulas are abnormal connections between the anal canal and the skin, often resulting from previous infections or abscesses. Your symptoms are more consistent with thrombosed hemorrhoids, especially given the lack of other systemic symptoms.

2. Healing Time: Thrombosed hemorrhoids can take anywhere from 2 to 4 weeks to resolve, depending on the size of the clot and individual healing factors. Since you are approaching the three-week mark, it is reasonable to expect that you may see improvement soon. However, if the mass does not decrease in size or if you experience increased pain, it would be prudent to follow up with your healthcare provider.

Recommendations
1. Continued Care: Continue with the warm sitz baths, as they can help alleviate discomfort and promote healing. Maintaining a high-fiber diet and staying hydrated can also help prevent straining during bowel movements, which can exacerbate hemorrhoidal symptoms.

2. Monitoring Symptoms: Keep an eye on the mass. If it becomes increasingly painful, changes in color, or if you notice any discharge, it would be advisable to seek further medical evaluation.
3. Follow-Up: If your symptoms persist beyond the expected healing time or worsen, consider scheduling a follow-up appointment with a colorectal specialist. They may perform a more thorough examination and possibly imaging studies if needed.

In conclusion, while your symptoms are suggestive of thrombosed hemorrhoids, the best course of action is to continue monitoring your condition and adhere to the treatment plan provided by your healthcare professionals. If you have any concerns or if your symptoms change, do not hesitate to seek further medical advice.

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