What causes a painful and irritated bump in the anus?

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Posted on Wed, 12 Jul 2017 in Digestion and Bowels
Question: Hello, I have a question regarding my anus region. Over the past couple of weeks I have had blood on the toilet paper when that is bright red (on and off not consistently). I thought it was just a cut so ignored it. However after having a lot of blood today & feeling more irritated, I had my partner have a look and there seems to be a purple colour around my anus hole & a pea size bulge or lump with a cut on it (where I guess the blood came from). Around the rest of the area (bottom crack) seems to be red. It is a little itchy or burny but not overly irritating or painful. What could this be? I have a picture to help with diagnosis. Thanks!
doctor
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Most likely hemorrhoid send photo with follow up.

Detailed Answer:
Hello,
Thanks for choosing HealthcareMagic for your query.
I am a Gastroenterologist and would be answering your query.

As per the history given by you most likely cause of your problem is Hemorrhoids. Hemorrhoids are swollen veins in the lowest part of your rectum and anus. Sometimes the walls of these blood vessels stretch so thin that the veins bulge and get irritated, especially when you pass stools.
.Sometimes hemorrhoids prolapse(as in your case), or get bigger and bulge outside the anal sphincter(as seen by your partner). Then you may be able to see them as bumps that are purple pink as compared to the surrounding area.


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 2 hemorrhoid most likely.

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.It was demonstrated that calcium dobesilate decreased capillary permeability, inhibited platelet aggregation and improved blood viscosity; thus resulting in reduction of tissue edema.

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.

-A probiotic like VSL#3 should also be taken regularly with these medicines. Probiotic improves overall digestion and help in formation of smooth stools easier to pass.

Oral flavonoids: These venotonic agents were first described in the treatment of chronic venous insufficiency and edema. They appeared to be capable of increasing vascular tone, reducing venous capacity, decreasing capillary permeability, and facilitating lymphatic drainage as well as having anti-inflammatory effects
However, if not relieved even after 3 months of aggressive therapy proceed for Rubber bands ligation- inexpensive and are easy to deploy. It's a day care procedure usually done under local anesthesia. The success rate varies from about 70-80%.

Strict lifestyle modification should be followed along with medications-

Take simple organic and vegetarian home cooked low-fat food for few days.
Avoid alcohol, smoking aerated beverages, junk food like pizza burger etc.

Take lots of probiotic rich food like yogurt.
Increase your fiber intake take oats, wheat, barley, vegetable and fruit like Pear, apple, and oranges.

No aerated beverages.
Take fiber containing easily digestible food.
Avoid red meat.
Drink a glass of lukewarm water before going to the washroom in morning.
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 proctoscopic 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.


Thank you.
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Ramesh Kumar 17 minutes later
Thank you for your reaponse. I think thats what it might be by the sounds of it. I have attached a picture for your review.
I hope surgery is not required, im quite young and Im unsure of how this came about. Im thin, healthy (have allergies) and a faily balanced diet (not often constipated). Hope the picture sheds some extra light. You might need to zoom in to see the cut .
doctor
Answered by Dr. Ramesh Kumar 6 minutes later
Brief Answer:
Hemorrhoids.

Detailed Answer:
Hey there,
This is a hemorrhoid.However a in person examination by a general surgeon shouldbe done intially.

Don't worry i have mentioned all treatments that are possible.
As of now you have to go for conservative therapy and life style modification only.
Please discuss that with your Gastroenterologist or Surgeon and revert back to me.

Hope i was helpful dear.
In case you need any other details feel free to follow up.
Thanks.
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Ramesh Kumar 14 minutes later
Thank you, I will get this investigated further. Thanks for your help!
doctor
Answered by Dr. Ramesh Kumar 2 minutes later
Brief Answer:
Folow up advice.

Detailed Answer:
Your most welcome XXXXXXX
Wish you Healthy life ahead.
Thanks.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
Answered by
Dr.
Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2405 Questions

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