A perianal hematoma is a common condition characterized by a collection of blood under the skin at the edge of the anal opening when a small blood vessel in this area ruptures. While often confused with hemorrhoids, a perianal hematoma is distinct as it involves a burst blood vessel just beneath the skin, rather than swollen veins within the anal canal.
Understanding the Condition
A perianal hematoma develops when a blood vessel near the anus breaks, causing blood to pool and clot. This creates a lump that can range in size from a centimeter to that of a golf ball. The sudden increase in pressure from straining is a common cause, often linked to activities like heavy lifting, intense coughing, or constipation.
The lump often appears dark blue or purplish due to the pooled blood and is painful and sensitive to pressure. The pain can vary from mild to severe, often intensifying as the blood clots. While small hematomas may resolve on their own, the discomfort can last for several days to a week.
Deciding When to See a Doctor
While many perianal hematomas resolve with self-care, professional medical attention is sometimes needed. Consult a doctor if the pain is severe or worsening, especially if it significantly interferes with daily activities or sleep. A medical professional can accurately diagnose the condition and rule out other issues like hemorrhoids or abscesses, which may present with similar symptoms.
Signs of infection, such as fever, increasing redness, warmth around the lump, or pus discharge, warrant immediate medical evaluation. If the hematoma is particularly large, continues to grow, or if home remedies do not provide relief after a few days, seek a doctor’s assessment. Any new or unusual skin bumps or growths near the anus, especially if accompanied by bleeding, itching, or changes in bowel movements, should also be reviewed by a healthcare provider.
Managing at Home
For smaller perianal hematomas, several home strategies can help alleviate discomfort and support healing. Warm sitz baths, where you sit in a few inches of warm water for 15-20 minutes, can soothe the area and reduce pain and itching. Perform this two to three times daily, especially after bowel movements. Applying a cold compress or ice pack wrapped in a cloth to the affected area for 10-15 minutes at a time, several times a day, can help reduce swelling and numb the pain.
Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can help manage discomfort. Using stool softeners can prevent straining during bowel movements, reducing pressure on the area and preventing further irritation. Maintain good anal hygiene by gently cleaning the area with water and fragrance-free soap after bowel movements.
Professional Treatment Options
When a perianal hematoma is large, very painful, or does not improve with conservative measures, a healthcare professional may recommend intervention. The most common medical procedure is incision and drainage, also known as excision. This is an in-office procedure where a local anesthetic is injected to numb the area around the hematoma.
A small incision is then made over the hematoma to allow the pooled blood and clot to drain. This procedure provides rapid relief from pain by releasing the pressure. The incision is usually left open to facilitate continued drainage and prevent the hematoma from reforming, and it heals on its own within a few days to a week. Post-procedure care involves keeping the area clean with regular hygiene and managing any mild discomfort with over-the-counter pain medication.
Preventing Future Occurrences
Preventing perianal hematomas involves lifestyle and dietary adjustments to promote regular, soft bowel movements and reduce straining. Increasing dietary fiber intake is recommended, as fiber adds bulk to stool and helps it pass more easily. Incorporate fiber-rich foods such as whole grains, fruits, vegetables, beans, and nuts into your daily diet.
Drinking plenty of fluids, especially water, helps the fiber work effectively and keeps stools soft. Aim for at least six to eight glasses of water daily. Avoiding prolonged sitting and engaging in regular physical activity helps promote healthy bowel function and reduce pressure in the anal area. Addressing constipation promptly through diet and hydration prevents the straining that leads to hematoma formation.