Anal Foreign Body Sensation: Causes and Management During Pregnancy

Anorectal foreign body sensation

Hello, Dr.
Ko.
I previously underwent ligation for internal hemorrhoids, and during my follow-up visit, the doctor mentioned that there is a small internal hemorrhoid located at the 12 o'clock position, close to the dentate line.
The doctor suggested monitoring it without treatment.
There is also a small lump of tissue near the anal area, but I have not experienced any discomfort.
Recently, I noticed that this small lump often shrinks significantly, almost disappearing when I wake up, but it enlarges again by the afternoon or evening (I'm not sure if it gets bigger due to bowel movements, as sometimes it does not change size after defecation).
However, it is not painful.
When I touch it, it feels very soft, and I experience a sensation of a foreign body at the anal opening, along with a slight tightness.
I would like to ask what this could be.
Is it a prolapsed internal hemorrhoid at the 12 o'clock position? Is it swollen external hemorrhoids (but without pain)? Or is it what is referred to as external hemorrhoidal skin tags? What would be the best way to manage this? Additionally, I am currently newly pregnant; can I use rectal suppositories or other hemorrhoid medications?

gāngmén yìwù gǎn, 30~39 year old female. Ask Date: 2015/09/15

Dr. Ke Fangxu reply Surgery

In simple terms, external hemorrhoids are those that are always outside, while internal hemorrhoids are those that protrude during bowel movements.
If internal hemorrhoids are not too large, they can be treated with rubber band ligation.
External hemorrhoids, on the other hand, can only be removed through surgery.
If you have just become pregnant, it is recommended to take warm sitz baths and avoid prolonged sitting and constipation, as there is no bleeding or pain, so special medication treatment is not necessary.

Reply Date: 2015/09/15

More Info

Understanding anal foreign body sensation during pregnancy can be quite complex, especially when considering the physiological changes that occur in a woman's body during this time. The sensation of an anal foreign body can arise from various causes, including hemorrhoids, anal fissures, or even benign growths such as skin tags. Given your history of internal hemorrhoids and the presence of a small mass near the anal area, it is essential to differentiate between these possibilities.

Causes of Anal Foreign Body Sensation
1. Hemorrhoids: Internal hemorrhoids can cause a sensation of fullness or pressure in the anal area. They may become more prominent due to increased blood flow and pressure in the pelvic region during pregnancy. The fact that you have a small mass at the 12 o'clock position suggests that it could be an internal hemorrhoid that is either thrombosed or prolapsed.

2. Skin Tags: These are benign growths that can develop around the anal area, often as a result of previous hemorrhoids. They can fluctuate in size based on factors such as hydration, bowel movements, and muscle tone.

3. Anal Fissures: Although you mentioned that there is no pain, fissures can sometimes present with a sensation of tightness or discomfort, especially during bowel movements.

4. Other Benign Growths: Occasionally, other benign lesions can develop in the anal region, which may not cause pain but can lead to a sensation of something being present.

Management During Pregnancy
1. Observation: Since your doctor has recommended observation, it is essential to monitor the mass for any changes in size, color, or associated symptoms such as pain or bleeding. If it remains asymptomatic, conservative management is often appropriate.

2. Dietary Modifications: To prevent constipation and reduce straining during bowel movements, it is crucial to maintain a high-fiber diet and stay well-hydrated. This can help minimize the risk of exacerbating hemorrhoids or causing new ones.

3. Topical Treatments: While some over-the-counter hemorrhoid treatments may be safe during pregnancy, it is vital to consult your healthcare provider before using any medications, including suppositories or topical creams. They can recommend suitable options that are safe for use during pregnancy.

4. Warm Sitz Baths: Taking warm sitz baths can help alleviate discomfort and promote relaxation of the anal area. This can be particularly soothing if you experience any tightness or discomfort.

5. Pelvic Floor Exercises: Engaging in pelvic floor exercises can help improve circulation and reduce pressure in the pelvic region, which may alleviate some of the sensations you are experiencing.

6. Consultation with a Specialist: If the sensation persists or worsens, or if you develop new symptoms such as pain or bleeding, it may be beneficial to consult a gastroenterologist or a colorectal surgeon. They can perform a thorough examination and provide tailored recommendations based on your specific situation.

Conclusion
The sensation of an anal foreign body during pregnancy can be attributed to various benign causes, including hemorrhoids and skin tags. Given your history and the current symptoms, it is advisable to continue monitoring the situation while implementing dietary and lifestyle modifications to prevent exacerbation. Always consult your healthcare provider before using any medications or treatments during pregnancy to ensure safety for both you and your baby. If symptoms change or worsen, seeking further evaluation will be essential for appropriate management.

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