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Irregular stool, got a extra skin in anus, no bleeding or itching. Hemorrhoids?

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Gastroenterologist, Surgical
Practicing since : 1989
Answered : 883 Questions
About a month ago, I noticed that my stools were no longer circular but rectangular in cross section. A little later I then noticed that my anus seemed to be extruding something, that then retracted after the movement. Looking in the mirror, the extrusion is on 2 sides of my anus, but is NOT red, or bleeding or itching. In the past, I have had a smaller prolapsing hemmerhoid, e.g., pea-sized, that went away in a week or two.
I am a bit worried. What is the likelihood that this is not a prolapsing hemmerhoids, but rather a mucosal prolapsis or worse. Am I in immediate danger and in need of surgery? I am in MA USA, and my health insurance does not activate until April 1st; however, in the interim, which specialist should I see in the which I could pay for myself to provide a prognosis. I am a physicist, so feel free to be a technical as needed. Thanks! XXXXXXX
Posted Tue, 2 Apr 2013 in Digestion and Bowels
Answered by Dr. Ketan Vagholkar 10 days later
Thanks for writing in.
I can understand that the condition is not only worrisome but quite distressful as well.
There are two possibilities
1. a rectal mucosal prolapse wherein the the protrusion is circumferential that is all around the anal opening. It comes out on straining and goes in spontaneously which is suggestive of aonly mucosal prolapse or a grade I prolapse. It may not be assocaited with many complications. However if untreated or rather if the precipitating factor is un identifiable then it can progress to higher grades thus increasing the complication rate. The comdition requires confirmation of diagnosis, identification and remedy for the precipitating cause and surgical treatment thereafter.
2. a prolapsed hemorrhoid is a second possibility. the appearance is of a bunch of grapes protruding out accomapanied with symptoms of pain while defecation and bleeding. The color is dark towards a purplish hue. In prolapsed piles the patient in most of the times needs to reposit them back inside. These have a very complication rate namely of thrombosis which is a XXXXXXX condition requiring emergency intervention.
If you could sent a photo of the lesion I would have been in a somewhat better position to provide a provisional diagnosis.
As the symptoms as per your description are tolerable and as you have a few insurance cover issues I would suggest the following to carry on till your insurance cover commences
1. Plenty of water at least 2 litres per day.
2. Avoid red meat or any other constipating foods.
3. Stool softners at night. (liquid paraffin would be the best)
4. Avoid straining at stools at any cost. Just allow effortless passage of stools. Do not make aconscious effort to evacuate.
5. Plenty of XXXXXXX leafy vegetables.

With this protocol I am sure you will be able to pull on till april.
The specialist whom you need to consult would be a General Surgeon . You can go on the American College of Surgeons website and see who is the general surgeon in you regional health area or hospital.
I hope this answers your doubts. Kindly let me know if you have any further doubts.
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