perianal hematoma

Perianal hematoma: Causes, symptoms, and treatment of perianal thrombosis

A perianal hematoma, also known as perianal thrombosis, is a hematoma located around the border of the anus. A hematoma is a localized collection of blood outside of blood vessels under the skin. Perianal hematomas are sometimes inappropriately referred to as external hemorrhoids.

Perianal hematomas can present over a short period of time and be extremely painful. They can be small or large in size, taking about three months to fully resolve. They may be caused by back pressure or the sudden rupture of veins, that can occur when you are straining during stool defecation or even during times of forceful coughing.

What causes perianal hematoma?

The overarching cause of perianal hematoma is trauma and injury. The rupture of small veins that line the anus leads to the development of a hematoma, which causes pain. The following are some of the most common perianal hematoma causes:

  • Constipation: Leads to excessive straining when trying to pass hard stools. The back pressure that straining too hard causes may lead to blood vessel rupture in the perianal region.
  • Lifting weights: Especially very heavy weights, as they often have to bear down when lifting a barbell over their heads.
  • Forceful coughing: Can cause excessive force on the perianal region, leading to hematoma development.
  • Surgery: Occurs due to direct trauma to the area.
  • Invasive medical procedures: Medical equipment such as a proctoscopy, which is used to examine the anus and lower part of the rectum and can damage blood vessels lining the perianal area.
  • Pregnancy
  • Extending sitting periods

Symptoms of perianal hematoma

The main symptom is pain and the sensation that there is something lumpy around the anus. Pain can range from mild to severe, usually in proportion to the amount of swelling present.

It has an unsightly appearance—a perianal hematoma looks like a small purple swelling on the edge of the anus, typically situated in the lateral region of the anal margin. Swelling may be as small as a fingernail or as large as a baseball.

Perianal hematoma or external hemorrhoid: Understanding the difference

Hemorrhoids are vascular structures in the anal canal that can get swollen and inflamed. They can be treated by several in-office procedures.

The common name for enlarged or swollen hemorrhoids is “piles,” which act as cushions that help stool control. Hemorrhoids can be internal or external, with the internal variant not causing too much pain but having a tendency to bleed. External hemorrhoids appear on the top of the anus and are famously known for causing excruciating pain and discomfort.

Hemorrhoids are not particularly dangerous on their own but can be a sign of more serious medical conditions. Hemorrhoids can be caused by a variety of things, ranging from genetic factors and obesity to pregnancy. Simply straining excessively during a bowel movement can also be a causative factor.

It may be difficult for you to differentiate between external hemorrhoid and a perianal hematoma, which is why a consultation with an experienced doctor is recommended when in doubt. This is extremely important, as some cases of perianal hematomas may result in blood clotting.

Related: Benefits of using essential oils for hemorrhoids

Treating perianal hematoma

Depending on the severity of your perianal hematoma, treatment will differ. In less severe cases, only conservative management will take place that comes in the form medication and procedures to help relieve pain.

However, severe cases of perianal hematoma will require incision and evacuation, generally within the first seven days of its presentation. This often involves numbing the area with local anesthesia and cutting open the hematoma and evacuating the clot. The procedure can provide instantaneous relief, with the wound spontaneously closing after a day or two. Patients are instructed to keep the area clean with soap and water during the healing period.

If left alone, a perianal hematoma will usually heal and resolve on its own, generally over a couple of weeks.

How to get rid of perianal hematoma naturally?

While the majority of cases are not worrisome, serious cases left untreated can lead to the development of a lump that may take up to two months to heal. This prolongs the pain and discomfort.

Providing treatment as early as possible can help mitigate some of the pain that may develop if not otherwise treated. The following are some of the best options for perianal hematoma home treatment.

  • Cold compresses: Help to reduce pain.
  • Sitz bath: For best results, it is recommended to bath twice a day to ease pain and swelling. A Sitz bath is a warm, shallow bath mixed with soothing additives that cleanse the anal area.
  • Doughnut-shaped pillow: A circularly shaped pillow that reduces pressure and pain while sitting.
  • Eat fiber: Helps reduce constipation and the resulting strain during defecation. Fruits and vegetables are great sources of fiber. However, it is recommended to consume fiber after the first few days of perianal hematoma to not elicit as much pain.
  • Avoid certain activities: This includes running, jogging, and weightlifting.

Considering your stools are directly related to the food you eat, consuming a diet specifically tailored for perianal hematoma pain can be a great help. It includes:

  • Increased protein intake, as it facilitates faster wound healing
  • Fruits and vegetables to improve blood components and their properties
  • Vitamin C to boost the immune system
  • Consuming mostly a liquid diet to help ease the defecation process
  • Avoid high fiber foods early on in the condition

Care to be taken after removal of perianal thrombosis

The following are some of the most common things that can occur following a perianal hematoma incision and evacuation procedure:

  • Discomfort: A feature of almost all invasive procedures. It is recommended to take some Panadol or Nurofen on a regular basis as recommended by your doctor. Discomfort should be more tolerable after 48 hours, with medication only being used on an “as needed” basis.
  • Bowel activity: Normal bowel activity after surgery is important, with it expected to take about two to three days for this to occur. Going to the bathroom may cause some discomfort at first, possibly leading you to avoid going to the bathroom as much as possible. This is not recommended as it can lead to constipation.
  • Bleeding: A small amount of bleeding is expected during the first two or three days after the procedure. It may be more pronounced when going to the bathroom. If you experience excessive bleeding, simply apply some pressure with serial gauze for 15 to 20 mins until the bleeding stops.
  • Swelling: A common occurrence in the perianal region following surgery and typically lasts for a few days.
  • Wound care: Cleaning the wound with soap and water while in the shower and after defecation will keep the area free of bacteria. Bathing the area in a sitz bath may also help provide some relief
  • Physical activity: While minor activity such as walking and doing house chores is acceptable, more strenuous exercise is not recommended. It will take a couple of days until you are able to resume your normal day to day level of activity. However, going the gym or playing sports is recommended to be put off for at least three weeks.

Related: What causes anal leakage?


Author Bio

Emily Lunardo studied medical sociology at York University with a strong focus on the social determinants of health and mental illness. She is a registered Zumba instructor, as well as a Canfit Pro trainer, who teaches fitness classes on a weekly basis. Emily practices healthy habits in her own life as well as helps others with their own personal health goals. Emily joined Bel Marra Health as a health writer in 2013.

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