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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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I am male, 38 years old, I have a lump

Answered by
Dr.
Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2349 Questions

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Posted on Thu, 21 Mar 2019 in Digestion and Bowels
Question: I am male, 38 years old, I have a lump just outside my anus, about size of a pea, skin colored, no brusing, hard ish but not solid, gotten a little bigger, using anusol as figure its haemerroids but to be honest I am massively worried I have cancer. Not register with GP as moved and forgot to register.
doctor
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Attach a photo with follow up.

Detailed Answer:
Hi,
Thanks for asking query on this forum,
1)As per your query regarding the lump being cancerous kindly attach a photo of it with follow up.As very likely it's a hemorrhoid.Initially a MD should do a examination of lump physcially.
2)As per the history given by you most likely it's a Hemorrhoids.
According to standard texts Hemorrhoids are classified as-
Grade 1:hemorrhoid bulges into the canal but does not prolapse or fall completely into it. These may bleed.
Grade 2: hemorrhoid protrudes past the anal verge with straining for a bowel movement or passage of flatus, but spontaneously return to their original internal position once the straining has subsided.
Grade 3: the hemorrhoid may protrude past the anal verge without any straining and requires the patient to push them inside manually.
Grade 4: the internal hemorrhoid always stays protruded or prolapsed and is at risk for thrombosis or strangulation should the anal muscles go into spasm.
Your case is grade 3 or 4 hemorrhoid.

Three types of managements are there
1)Conservative
2)Non invasive
3)Invasive surgical

Initially we start with conservative management for at least 3 months-
Suggestion for conservative management are-

Start taking Syp. Lactulose 10-15ml once daily before going to bed. It is one of the most frequently used laxatives, tolerated very well by patients in long terms with minimal side effects. Using laxative would prevent straining while defecating.

-Secondly, start using Prepration H (a combination containing contains Calcium Dobesilate, Hydrocortisone, Lignocaine, and Zinc.) locally over the prolapsed hemorrhoids.

Thirdly, request your gastroenterologist to prescribe you with oral Calcium Dobesilate-Doxium therapy for 3 months. Initially twice daily for 21 days followed by once daily for 10 weeks. Trials have shown that 3-month therapy can cause shrinkage of Hemorrhoids in almost 60% cases.

Add Metamucil/Fybrogel to your regimen. It's a natural laxative containing husk. It absorbs water from the intestine and swells up making passage of stool easy and add bulk to stool.Take it 2 tsf twice daily with half cup of XXXXXXX warm milk.
Taking Sitz bath will help.

If not relieved by it in 3 months then Noninvasive methods are tried like-

1)Sclerotherapy: This is currently recommended as a treatment option for first- and second-degree hemorrhoids. The rationale of injecting chemical agents is to create a fixation of mucosa to the underlying muscle by fibrosis.

2)Rubber band ligation: Rubber band ligation (RBL) is a simple, quick, and effective means of treating first- and second-degree hemorrhoids and selected patients with third-degree hemorrhoids. Ligation of the hemorrhoidal tissue with a rubber band causes ischemic necrosis and scarring, leading to fixation of the connective tissue to the rectal wall.

3)Cryotherapy: Cryotherapy ablates the hemorrhoidal tissue with a freezing cryoprobe. It has been claimed to cause less pain because sensory nerve endings are destroyed at very low temperature.

In case if this is not successful then we have invasive surgical procedures like-

1)Hemorrhoidectomy: Excisional hemorrhoidectomy is the most effective treatment for hemorrhoids with the lowest rate of recurrence compared to other modalities.Success rate is more then 90%.

2)Stapled hemorrhoidopexy-A circular stapling device is used to excise a ring of redundant rectal mucosa proximal to hemorrhoids and resuspend the hemorrhoids back within the anal canal. Apart from lifting the prolapsing hemorrhoids, blood supply to hemorrhoidal tissue is also interrupted.
Initially go for digital and physical examination by a general surgeon and see what he says.
Hope I provided you with the information you wanted.
In case you need further advice feel free to ask.

Regards

Above answer was peer-reviewed by : Dr. Nagamani Ng
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