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Is small hard escrescence on my anus a HEMORROID?

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Hello. I am a 42 year old male and I recently noticed a 4-5mm small spherical escrescence on my anus. It is slightly out of the "rim" area so to speak. It is darker than the rest of the skin and rather hard at touch. It isn't painful but if I press it it hurts a bit. I've had it for about 10 days. I have uploaded a picture where you can see it on the left (I put some proctosyll cream ointment on it). Is it a hemorroid? I don't usually suffer from hemorroids but after some "hard" evacuations I do feel some slight protuberances though never painful or bleeding which usually go away by the next day. Thank you for any insight or suggestions.

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
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Hello, Thank you for your query at DoctorSpring.com. 

I understand your concern.

From your history and pictures, the spherical excrescence seems more likely a skin tag and the other lesions seem to be hemorrhoids. There is also a surrounding mild redness due to inflammation. A physical inspection and per rectal examination is required for confirmation.

Hemorrhoids occur in certain individuals due to straining at stool and in those with chronic constipation. Anal skin tags are usually seen associated with anal fissures, but since you do not have any pain during defecation, fissure is unlikely. Tag can be left alone or if  required excised surgically.

I have the following suggestions for you.

1. Please increase intake of fiber in your diet. Additionally you can take an OTC like Metamucil, 1 teaspoon in 1 glass of water, 3 times a day. This will soften stool and prevent constipation.

2. Please consume plenty of fluids.

3. You can continue the proctosedyl cream as local application.

4. Sitz bath(sitting in a tub of warm water) can be taken, after every bowel movement, to relieve any anal discomfort.

5. You can visit a general surgeon for examination and confirmation.



I hope this was helpful.



Feel free to ask queries.



Thank you.



Patient replied :

Thank you for your reply. So you are saying that the circular dark blue/violet coloured excrescence is a skin tag (maybe I got confused)? It suddenly appeared one day (I thought it was a hemorroid): I noticed it shortly after having defecated, without any problems or pain. It feels rather hard to the touch. Someone suggested it could also be some kind of occulsion around the hemorroid area not letting the vein blood flow leading to this formation. All the other areas are much softer to the touch respect to this "ball". I eat vegetables every day and whole grain bread and cerials, so I believe to be eating enough fiber. I usually am not constipated and my bowel movements are regular (daily). I usually don't feel discomfort after having evacuated. If you prefer I can attempt another picture. Thanks


Hello.



You have understood me right. If the excresence has appeared all of a sudden, then it is unlikely to be a skin tag. If it is an occluded hemorrhoid, like you have been told, it would have been excruciatingly painful, at least in the initial few days.



Although chronic constipation is most commonly associated with hemorrhoids, other factors such as chronic diarrhea, prolonged sitting etc can also lead to their development.



You can send another picture with a a closer view of the anal orfice. However, I need to add that a picture will not be as helpful as a physical examination.



Please upload the picture in the follow up.



Thank you.



Patient replied :

Dr. Deepu, I have uploaded another photo, I think this one is better (unfortunately the flash renders the picture very "cold" and white-ish). I am referring to the lower left side of the anus respect to the picture, where you see this dark blueish coloured spherical excresence: this is rather hard to the touch while the hemorroid just above is very soft. Is this also a hemorroid? As I said, it does not really hurt, I just feel it as a "presence". If I press on it with my finger, I feel it is rather hard/dense and doesn't hurt unless I insist with the pressure and make it move around a bit under my fingertip, but it never stings or really burns, it just feels uncomfortable. I hope I have been clear enough. Doesn't the dark blue colour indicate venous blood? Is there a way to deflate it (I guess with an incision)? Should I leave it be? Thanks, Luke


Hello Mr. Luke.



Thank you for the additional picture and additional history. It is definitely much clearer. 



The dark blueish coloured spherical lump could be an external thrombosed(clotted) hemorrhoid? from the appearance. The only reason why I cannot be definitive about it is because a thrombosed external hemorrhoid will be very painful when it develops. The dark blue colour can indicate venous blood.



Initial management of a thrombosed hemorrhoid is surgical evacuation of the hemorrhoid with excision of the skin overlying the thrombosed hemorrhoid which produces immediate relief. This is usually done within 72 hours when the patient presents with acute pain. After 72 hours, evacuation is generally not required.



You should use stool softeners, and sitz baths, as mentioned earlier, which provide adequate relief until spontaneous resolution occurs.



Some surgeons advocate that patients with thrombosed external hemorrhoids should undergo excision of the hemorrhoids to prevent recurrent thrombosis. However whether it is required in your case can be decided based on the status of your hemorrhoids. This will require a per rectal examination. So I suggest you consult a general surgeon in this regard and discuss whether surgical intervention is required or not.



I hope this was helpful.



Thank you.



Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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