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Swelling on anus, pain during bowels, perineal hernia, pilonidal cyst

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Internal Medicine Specialist
Practicing since : 1998
Answered : 1579 Questions
I am 32 6ft tall 180lbs. I have swollen area on the bottom quarter of my butt crack on the right side. it runs vertically and is below the skin and other than a slight bulge there isn't a cut or any irritation to the skin that is visible. i think it may be some kind of hernia, as i had one on my lower abdomen 10 years ago and it feels like it could be a swollen section of intestine that is out of place or something. It is about the size of the last two sections of my pinky and about the same length. If i lay on my stomach and rub the area it seems to for lack of a better word to, deflate. But becomes hard and protrudes again if put any pressure on the area For the past 2-3 months i have been lifting weights 3-4 times a week and taking creatine, protein powder, bcaa's, fish oil, vitamin D, and caffeine supplements. I also take saw palmetto to slow down my hair loss. I don't know if any of these could be a factor but it seems worth mentioning. I have recently started a new job and will have health insurance in two weeks, i'm hoping i can wait till then to see a physician? Thanks for your help.
Fri, 18 May 2012 in General Health
Answered by Dr. Jasvinder Singh 1 hour later

Thanks for your query. I would like to ask a few questions regarding this swelling in the butt crack before I come to any conclusion.

1)     Is the swelling painful?
2)     Is the swelling accompanied by any redness, discharge or warmth in the area?

Considering your symptoms and history of earlier lower abdominal hernia repair and lifting of weights since the last 3-4 weeks, perineal hernia is one possibility which needs to be ruled out. It is a hernia involving the perineum (pelvic floor), mostly found in men and often appears as a sudden swelling to one side (sometimes both sides) of the anus.

Second possibility which comes to my mind is of pilonidal cyst. It is a cyst that develops along the tailbone (coccyx) near the cleft of the buttocks, more frequently found in men and presents as localized swelling over the lower spine.

Third possibility is of any perianal abscess if there is any accompanying pain or redness over the area.

Mostly a physical exam and some tests are needed to confirm which of the above is the cause. But do write back to me describing any more symptoms that you have so that I can come to a closer diagnosis and suggest if you should wait couple of weeks before seeing a physician.

Hope this helps. Waiting for your follow up.

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Follow-up: Swelling on anus, pain during bowels, perineal hernia, pilonidal cyst 1 hour later
In answer to your questions. There is a slight discomfort if i push directly on the swelling and also during a bowel movement or when sitting for a prolonged amount of time, but it is only slightly painful at most. There is no redness, discharge, abnormal warmth or visual signs other than the bulge. The skin over the area can be moved independently from the swelled area. If it a perineal hernia or a perineal abscess, is there any chance that it will go away on it's own, or will i have to get surgery?

Thank you for your help
Answered by Dr. Jasvinder Singh 1 hour later

Thanks for writing back.

If there is no redness, warmth or visual signs, then chances of an abscess are less. It can be perineal hernia or a pilonidal cyst. A common cause of perineal hernia is surgery involving the perineum. Perineal hernia can be caused also by excessive straining to defecate.

Eat a diet XXXXXXX in fiber to avoid any constipation. You can also take swelling. Unfortunately it does not go away on its own and the permanent treatment for both these conditions is by surgery.

The right standard of care is feeling it and locating it with the neighboring structures by a primary physician / surgeon so that the treatment plan can be decided for you.

Wishing you good health.
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