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What is Perianal Hematoma & How is it Treated? | Causes & Symptoms of Perianal Hematoma

What is Perianal Hematoma?

Perianal Hematoma which is also termed as Perianal Thrombosis is the name given to a hematoma formed around the anal region.  Hematoma is a condition in which there is a localized collection of blood under the skin outside of the blood vessels.  Some people mistake this condition as external hemorrhoids.  Perianal Hematoma causes severe pain.  These hematomas vary in size and may remain for approximately two to three months before they go away completely.  Excess pressure on the back or an abrupt rupture of a vein normally caused due to straining to pass bowels is believed to be the primary cause of Perianal Hematoma.[1,2]

Forceful coughing is also one of the reasons for rupture of a vein causing a hematoma.  Perianal Hematomas are extremely sensitive to pressure and the size of the hematoma is directly proportion to the symptoms that the person will experience.  The symptoms also start worsening once the blood within the sore starts to clot.  The size of a Perianal Hematoma can vary from the size of a golf ball to a few centimeters.  The larger the size the more painful the hematoma will be.[1,2]

What is Perianal Hematoma?

What Causes Perianal Hematoma?

As to the cause of Perianal Hematoma, the blood vessels around the anus are hypersensitive, especially to pressure.  Thus it is quite easy for the vessels to rupture with slight forceful activity.  Some of the activities that can cause Perianal Hematoma include heavy weightlifting, forceful coughing or sneezing, chronic constipation as it causes the person to strain for passing bowels and cause a vein to rupture.[2]

Some females develop Perianal Hematoma due to pregnancy and delivery of a child.  People who spend a lot of time sitting especially those who do a desk job are at an increased risk for developing Perianal Hematoma.  Use of birth control pills also is a known risk for developing Perianal Hematoma.  People who indulge in anal intercourse are also vulnerable to developing Perianal Hematoma.  Any type of medical procedure involving the anus can also be one of the causes for Perianal Hematoma.[2]

What are the Symptoms of Perianal Hematoma?

The primary symptoms of Perianal Hematoma include intense pain in and around the anus where the hematoma is located. The lump or the hematoma is purple in color and is located mostly at the edge of the anus.  Some people may also notice swelling around the hematoma. The anal region becomes extremely sensitive and even slightest pressure may cause severe pain. The affected individual will find it extremely difficult to sit even for a short period of time.[2]

Some people also experience bleeding from the hematoma site but it only occurs after a few weeks of the formation of the lump.  A mention should be made here of some of the symptoms that do not form a part of Perianal Hematoma.  These symptoms should not be ignored and a physician consultation is recommended. These symptoms include bright red blood observed on the toilet paper, anal itching, and a change in the texture, frequency, and consistency of stools.[2]

How is Perianal Hematoma Treated?

In majority of the cases, mild to moderate sized Perianal Hematomas are treated with symptomatic care.  Medications are given for pain relief and the hematoma is allowed to heal on its own.  For large hematomas that are extremely painful, drainage may have to be done.  Once drained, a wound is left behind which will further require treatment.  This is the reason why this mode of treatment is only left as a last resort.[2]

If Perianal Hematoma is detected early, the physician may just open up the hematoma with a small nick and let the blood collected ooze out.  This results in immediate relief of symptoms.  The wound that results from this mode of treatment closes on its own within a few days and does not require any further treatment. 

Another way to treat Perianal Hematoma is by using a syringe and removing the accumulated blood from the lump.  This also brings instant relief from the symptoms.[2]

Perianal Hematoma can also be managed effective with self-care techniques.   These include abstaining from activities like weightlifting that can irritate the area and worsen the symptoms. A warm bath is also quite effective in calming down the symptoms of pain and discomfort. Cold compress around the area of the hematoma is also quite effective in calming down the symptoms of Perianal Hematoma.[2]

People who are chronically constipated should take medications for the condition and refrain from straining to pass bowel movements.  Diet also plays a key role in treatment of Perianal Hematoma.  Being on a diet which is easy to digest helps with constipation.  Additionally, keeping the body hydrated with regular intake of fluids is also effective.  High fiber foods loosens stool and allows is to pass easily which is way these foods are encouraged for people with Perianal Hematoma.  Surgery is recommended for people who develop Perianal Hematoma in the same area repeatedly.[2]

In summary, Perianal Hematoma is an extremely painful condition that results due to a ruptured vein or a blood vessel and there is formation of a lump filled with blood.  The location of the hematoma is around the anus.  Perianal Hematoma is mostly caused by activities such as weightlifting, forceful coughing, or straining during bowel movements.[1,2]

Affected individuals will find it extremely difficult to sit due to discomfort and other activities also become a problem due to Perianal Hematoma.  The size of a Perianal Hematoma is variable and range from a few centimeters to that of a size of a golf ball.  The larger the size of the hematoma the worse the symptoms will be.[1,2]

For small to moderate sized hematoma only symptomatic treatment is given and the hematoma is allowed to heal on its own.  However for large hematoma draining is used to treat the condition.  In majority of cases, it normally takes quite a few months to get complete relief from Perianal Hematoma.[1,2]


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Sheetal DeCaria, M.D.
Sheetal DeCaria, M.D.
Written, Edited or Reviewed By: Sheetal DeCaria, M.D. This article does not provide medical advice. See disclaimer
Last Modified On:August 25, 2022

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