When it comes to unpleasant and embarrassing sources of pain, hemorrhoids are right at the top of the list. Though many people experience them, it is not something you ever want to go through. 

Some people may be surprised to learn that the discomfort from swollen blood vessels in and around your anus is not the only thing that can go wrong at your rear end. Though it is often mistaken for its more common cousin, a condition called a perianal hematoma is a unique and uncomfortable problem all its own. What may be even more surprising to some people is that, unlike many other diseases or conditions that have external causes, simply pushing too hard when you are going to the bathroom can be enough to cause a hematoma.

What is Perianal Hematoma?

A perianal hematoma (sometimes spelled “perianal haematoma”) is a concentrated pooling of blood caused by a blood clot near your anus. Though sometimes incorrectly referred to as external hemorrhoids (or haemorrhoids) that occur inside or very near the end of the rectum, a perianal hematoma is a collection of blood from burst blood vessels in the area around the anus. 

As blood pools, it naturally begins to clot. This process, known as thrombosis, can increase the amount of discomfort you experience as it becomes harder for your body to clear the clot and begin reabsorbing blood. In some cases, it may be necessary for a doctor to cut open the hematoma and remove the clot. 

A perianal haematoma is recognized by a bulgy or bubbling appearance to the area around the anus. You may be able to feel a lump in the region even with small hematomas; larger ones are much more difficult to miss, as they can become quite large, even reaching the size of a tennis ball. Depending on the size, mild to severe pain may be experienced. It is also not uncommon to have bloody stools for a period of time after a perianal hematoma forms. With these symptoms being close to those associated with hemorrhoids, it is easy to see why there can be confusion between the two. 

What Causes Perianal Hematoma?

Unlike hemorrhoids, which can be caused by genetic predisposition, obesity, or pregnancy, perianal hematomas are typically caused by physical trauma to the vessels around your rectum. This can be caused by a variety of reasons, including:

  • violent coughing
  • extended periods of sitting
  • pregnancy
  • surgery
  • lifting weights
  • constipation

Damage to blood vessels in the anal verge can also come from physical trauma during a proctoscopy or pushing too hard while trying to defecate. Constipation, and the consequent stress placed on the anal canal while straining to complete a bowel movement, can put high stress on the blood vessels in the anal area, sometimes causing them to rupture. Similarly, the extra pressure on blood vessels near your anus when lifting heavy weights can be extreme. This is particularly true if you are performing exercises that involve lifting large amounts of weight over your head.

How Long Does Perianal Hematoma Last?

Perianal hematomas can take time to resolve, especially if they are larger. Left alone, these hematomas can often heal themselves within a couple of weeks. If you are suffering from thrombosis, healing completely may take a matter of a few months.

If, on the other hand, your hematoma is drained by a doctor, relief from pain is almost immediate, and full healing can occur in a matter of a few days. In these cases, you need to take special care to keep the area around the incision clean, as infection can easily set in. Due to the risk of infection, unless your hematoma is causing you a significant amount of pain, your doctor may recommend conservative treatment with over-the-counter solutions rather than opting for an office procedure. 

How Do You Treat a Hematoma?

It is sometimes possible to address a perianal hematoma with conservative, at-home treatment using over-the-counter methods. Relieving pressure on the rectal area by sitting on a doughnut-shaped pillow, cleaning the area with a regular Sitz bath, and taking fiber to help avoid hard stools can all help alleviate your discomfort. You will likely also want to avoid strenuous activity, particularly working out with heavy weights for a period of time.

Where diet is concerned, it is important to remember that you may not want to increase your fiber intake immediately after developing a perianal hematoma. A high-fiber diet will help to soften your stool, but too much fiber too soon can cause an increase in bowel movements that may put stress on your body as it is trying to heal. 

At-home treatment is sometimes not enough, especially if a clot has formed or the size of the hematoma has gotten quite large. In these cases, your doctor may need to perform a simple office procedure under local anesthetic to drain the hematoma. These are different from the procedures used to help get rid of hemorrhoids in that an incision is made to drain the pooled blood rather than letting the body process out excess blood on its own.  

Getting the Care You Need

It is always important to see your physician when worrying symptoms arise. With a perianal hematoma, there is even more incentive to seek treatment early. Properly diagnosed and treated, a perianal hematoma can resolve in a matter of days. Going without treatment, however, can dramatically prolong the time it takes for your hematoma to heal. This can result in discomfort that lasts for two months or more. 

At Cary Gastro, we specialize in treating conditions that occur throughout your digestive tract, and beyond it. More than just a colonoscopy every few years, comprehensive gastrointestinal health takes commitment and having the right people behind you. If it is time to start taking your digestive health more seriously, request an appointment with Cary Gastroenterology today.