What is a perianal hematoma?

A perianal hematoma is a pool of blood that collects in the tissue surrounding the anus. It’s usually caused by a ruptured or bleeding vein. Not all perianal hematomas require treatment. However, some need to be drained during a simple in-office procedure. If a blood clot has formed, a doctor will need to remove it.

Many people mistake perianal hematomas for prolapsed hemorrhoids because they have very similar symptoms. However, a prolapsed hemorrhoid is a pooling of blood located inside the anus that sometimes appears outside the anus before moving back in again. Perianal hematomas only occur outside the anus. They’re never internal.

What are the symptoms?

A perianal hematoma looks like a blue bruise under the skin or a dark-purple collection of blood near the anus. You might also be able to feel a small lump, ranging in size from about a small raisin to a tennis ball.

Other symptoms of a perianal hematoma include:

  • bubbling or bulging skin near the anus
  • mild to severe pain, depending on the size
  • bloody stools

What causes them?

In addition to having similar symptoms, perianal hematomas and hemorrhoids also share many of the same causes.

Anything that puts pressure on your anal veins can lead to a perianal hematoma, including:

  • Forceful coughing. A severe cough or excessive coughing can put extra pressure on the veins surrounding your anus, making them rupture.
  • Constipation. If you’re constipated, you’re more likely to pass hard stools and strain during bowel movements. This combination of straining and hard stools can put too much stress on the veins in your anus, causing them to break.
  • Medical procedures. Medical procedures that involve a scope can increase your risk of anal bleeding. Examples include a colonoscopy, sigmoidoscopy, or anoscopy.
  • Pregnancy. Pregnant women have a higher risk of developing perianal hematomas and hemorrhoids. As the baby grows in the uterus, it puts extra pressure on the anus. During labor, increased pressure around the anus from pushing can also cause perianal hematomas and hemorrhoids.
  • Sedentary lifestyle. Sitting for long periods puts added pressure on your anus. People with jobs that require long periods of sitting at a desk or in a car have a high risk of developing a perianal hematoma.
  • Heavy lifting. Lifting something heavy, especially something that’s heavier than you’re used to lifting, puts pressure on your body, including your anus.

How is it diagnosed?

Your doctor will need to give you a physical exam to diagnose a perianal hematoma. Keep in mind that diagnosing a perianal hematoma is much easier and less invasive than diagnosing a hemorrhoid. They only appear around the outside of your anus, so you won’t need a colonoscopy or any other type of diagnostic procedure.

How is it treated?

Most perianal hematomas resolve on their own within five to seven days. In the meantime, however, they can still cause pain.

To reduce pain while you heal, try:

  • using a cool compress on the site
  • taking a sitz bath twice a day
  • sitting on a donut pillow to relieve pressure
  • adding more fiber to your diet
  • avoiding strenuous activity

Depending on the size of your hematoma, your doctor might recommend draining it. This is a simple procedure that involves numbing the area and making a small incision. If your hematoma has formed a blood clot, your doctor can use this same procedure to remove it. They’ll likely leave the incision open, but it should close on its own within a day or to. Make sure you keep the area as clean and dry as possible while it heals.

What’s the outlook?

While perianal hematomas can be quite uncomfortable and painful in some cases, they usually heal on their own within a week. In more severe cases, your doctor might make a small incision to drain the blood or remove a blood clot. Regardless of whether you need treatment, you should be feeling better within a matter of days.

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