Persistent Anal Swelling: Causes and Treatment Options Explained

From mid-December last year to mid-March this year, there has been a sensation of swelling around the anus?

Hello Doctor, I work in an office, but I make sure to get up and walk around for five minutes every half hour on average.
I have been doing this for years.
In April of the year before last, I underwent laparoscopic surgery for a hernia in my right lower abdomen.
I do not have any issues in my left lower abdomen, but I often experience a feeling of heaviness there, although there is no visible bulge.
After an ultrasound, the doctor said everything was fine, so I didn't pay much attention to it.
In July of last year, I had my gallbladder removed due to cholecystitis, which has resulted in chronic diarrhea (once a day, always after meals).
In mid-December, I felt a heaviness in my buttocks (the heaviness is located at the 2 o'clock position relative to the anus when lying on my left side, and at the 5 o'clock position when viewed from behind while standing).
I went to a medical center's colorectal department for a consultation.
During the first examination with a digital rectal exam and anoscopy, the doctor noted some internal hemorrhoids but said they were not severe.
The anoscopy revealed two red spots, but the doctor did not explain the situation and prescribed a rectal suppository and hemorrhoid ointment.
A month later, the symptoms persisted, but there was no pain, fever, or skin lesions.
Initially, I thought it might be an anal abscess (due to my frequent diarrhea), but I did not experience any typical symptoms.
I then visited a urologist to check my prostate and took a week of antibiotics; blood tests also came back normal.
Suspecting it was not a urological issue, I did not return.
In mid-February, I went back to a different medical center for a consultation.
After a digital rectal exam, the doctor again noted the presence of internal hemorrhoids and prescribed the same suppository and ointment.
However, the condition did not improve, so I returned for another consultation a week later.
After the digital rectal exam, the doctor prescribed two weeks of antibiotics (a large white pill taken twice a day), suspecting an anal abscess.
Two weeks later, during the follow-up, the doctor palpated the swollen area and said it felt empty inside but should be fine, and sent me home, advising me to take sitz baths regularly.
However, to this day, I still feel a sense of swelling, but there is no discharge, and it is not painful.
I would like to ask the doctor if it is normal for internal hemorrhoids to remain swollen for three months without subsiding.
Additionally, could you help clarify whether this could be rectal inflammation or possibly something neurological? I would appreciate your guidance on whether I should seek further examination at a medical center.
I apologize for the lengthy message and thank you for your assistance.

Liu Xiansheng, 30~39 year old female. Ask Date: 2024/03/17

Dr. Zhang Shuhao reply Surgery

The swelling sensation caused by internal hemorrhoids may recur and can persist for several months.
Most rectal and anal-related issues can be diagnosed through a clinical examination.
If further evaluation is needed, options may include colonoscopy, rectal ultrasound, or pelvic CT scan.
It is advisable to discuss your current symptoms with your doctor during your follow-up visit to determine whether further testing or definitive treatment for hemorrhoids is necessary.

Reply Date: 2024/03/17

More Info

Persistent anal swelling can be a concerning symptom, especially when it lasts for an extended period, as you've described. Given your medical history and the various evaluations you've undergone, let's explore the potential causes and treatment options for your condition.

Possible Causes of Persistent Anal Swelling
1. Internal Hemorrhoids: Internal hemorrhoids can cause swelling and a feeling of fullness in the anal area. They may not always be painful, and symptoms can persist for weeks or months. The fact that your doctor noted the presence of internal hemorrhoids suggests this could be a contributing factor.

2. Anal Abscess: Although you mentioned that typical symptoms of an anal abscess (such as pain, fever, or drainage) have not occurred, it's still possible for a chronic abscess to develop without classic symptoms. The swelling you feel could be related to a low-grade infection or inflammation.

3. Rectal Prolapse: In some cases, rectal prolapse can cause a sensation of swelling or fullness. This condition occurs when part of the rectum protrudes through the anus. It is more common in older adults but can occur in younger individuals as well.

4. Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can lead to inflammation in the rectal area, potentially causing swelling. Given your history of chronic diarrhea, this could be a consideration.

5. Neurological Issues: Sometimes, nerve damage or dysfunction in the pelvic area can lead to abnormal sensations, including swelling or fullness. This is less common but could be a factor if other causes are ruled out.

6. Skin Conditions: Conditions such as dermatitis or infections of the skin around the anus can also cause localized swelling.

Treatment Options
1. Conservative Management: For internal hemorrhoids, conservative treatments such as dietary changes (increasing fiber intake), hydration, and over-the-counter topical treatments (like creams or suppositories) can help reduce symptoms. Sitz baths may also provide relief.

2. Medications: If inflammation or infection is suspected, your doctor may prescribe anti-inflammatory medications or antibiotics. Since you've already been on antibiotics, it would be essential to follow up with your doctor to assess their effectiveness.

3. Surgical Options: If conservative treatments fail and the swelling persists, surgical options may be considered. For hemorrhoids, procedures like rubber band ligation or hemorrhoidectomy may be necessary. If an abscess is present, surgical drainage might be required.

4. Further Evaluation: Given the duration of your symptoms, it would be prudent to undergo further evaluation. This could include imaging studies (like an MRI or ultrasound) to assess for any underlying issues that may not have been identified during previous examinations.

5. Referral to a Specialist: If your symptoms continue without improvement, consider seeking a referral to a colorectal surgeon or a gastroenterologist. They can provide a more in-depth evaluation and tailored treatment plan.

Conclusion
Persistent anal swelling can arise from various causes, including hemorrhoids, abscesses, or inflammatory conditions. Given your ongoing symptoms, it is crucial to maintain open communication with your healthcare provider and consider further evaluations to rule out more serious conditions. If you experience any new symptoms, such as increased pain, fever, or changes in bowel habits, seek medical attention promptly. Your health and well-being are paramount, and addressing these symptoms is essential for your quality of life.

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