Perianal Hematoma: Causes, Symptoms, and Treatment Options

What is a Perianal Hematoma?

A perianal hematoma occurs when a small blood vessel near the anus bursts, causing blood to pool under the skin. This results in a painful, dark blue or purplish lump near the anus. 

While often mistaken for hemorrhoids, a perianal hematoma differs as it forms just beneath the skin, not involving the anal canal. Although generally not dangerous, larger or more painful hematomas may require treatment, such as drainage, to relieve discomfort.

Symptoms of a Perianal Hematoma

Perianal hematomas are characterized by several key symptoms that can vary in intensity depending on the size of the hematoma and whether a blood clot is present. The primary symptoms include:

• Painful lump: A sudden, painful lump appears near the anus. This lump is often dark blue or purplish due to blood pooling beneath the skin.
• Swelling: The area around the lump may swell, making it more prominent and uncomfortable.
• Sensitivity to pressure: The lump and surrounding area can be tender to the touch, causing discomfort when sitting or moving.
• Varying pain levels: Pain can range from mild discomfort to severe, depending on the size of the hematoma and the presence of a clot.
• Minor bleeding: In rare cases, if the skin over the hematoma breaks, there might be slight bleeding.

These symptoms are not only painful but can also interfere with daily activities, especially if sitting becomes difficult due to the discomfort.

If you're experiencing any of these symptoms and are unsure about the cause, using a Symptom Checker can help you identify possible conditions based on your symptoms. However, it’s always recommended to consult with a healthcare professional for an accurate diagnosis and appropriate treatment.

Causes of Perianal Hematoma

Perianal hematomas can develop due to various factors that put excessive pressure on the small blood vessels around the anus. Some common causes include:

• Straining during bowel movements: The World Journal of Gastroenterology noted that increased abdominal pressure during straining may be a significant factor in the formation of hematomas. Chronic constipation, which often leads to straining, is a significant risk factor for perianal hematomas. 
• Lifting heavy objects: Engaging in heavy lifting, especially without proper technique, can cause sudden pressure spikes in the veins around the anus.
• Severe coughing: Persistent or forceful coughing can strain the blood vessels, increasing the risk of a hematoma.
• Pregnancy and labor: The increased pressure on the pelvic area during pregnancy and the intense strain during labor can lead to the formation of a perianal hematoma.
• Medical procedures involving the anus: Procedures like colonoscopies or anoscopies can sometimes cause trauma to the blood vessels, resulting in a hematoma.
• Sexual activity: Engaging in anal sex can put pressure on the blood vessels around the anus, potentially leading to a perianal hematoma.

How is a Perianal Hematoma Diagnosed?

Diagnosing a perianal hematoma is straightforward and non-invasive. A doctor typically begins by asking about your symptoms and medical history. During the physical exam, they will visually inspect the area around your anus for a dark blue or purplish lump, which is characteristic of a perianal hematoma. Since this condition involves blood pooling just under the skin, it’s usually easy to identify without the need for further tests.

To differentiate a perianal hematoma from hemorrhoids or an anal fissure, the doctor will note that hemorrhoids often present as red or swollen bumps that may bleed, especially during bowel movements, while anal fissures are small tears in the skin of the anus, causing sharp pain and visible bleeding. Perianal hematomas, in contrast, cause a more localized and intense pain with a visible lump just outside the anus. 

Accurate diagnosis is essential for effective treatment and to prevent unnecessary complications.

Treatment Options for Perianal Hematoma

Treating a perianal hematoma depends on the size of the hematoma and the severity of the symptoms. Many small hematomas resolve on their own without the need for medical intervention. VeryWellHealth states that minor hematomas typically heal within approximately 5 days.

However, various treatment options are available to alleviate discomfort and speed up healing.

Home Remedies

For smaller perianal hematomas that are not too painful, several home remedies can help manage symptoms and promote healing:

• Cold compresses: Applying a cold compress to the affected area can help reduce swelling and numb the pain. Use the compress for 10-15 minutes several times a day for best results.
• Sitz baths: Soaking in a warm sitz bath for 15-20 minutes can help soothe the area, reduce discomfort, and promote circulation, which aids in the healing process.
• Pain relief medications: Over-the-counter pain relievers can help manage the pain associated with a perianal hematoma. Be sure to follow the dosage instructions carefully.
• Diet adjustments: Increasing your fiber intake and staying hydrated can make bowel movements easier, reducing the strain on the affected area and preventing further aggravation of the hematoma.

Medical Procedures

When a perianal hematoma is large, extremely painful, or not improving with home remedies, a doctor may recommend a minor surgical procedure to drain it. The procedure is typically performed in a doctor's office and involves the following steps:

1. Local anesthesia: The area around the hematoma is numbed to prevent discomfort during the procedure.
2. Incision: The doctor makes a small incision in the skin over the hematoma to allow the pooled blood to drain out.
3. Drainage: Once the blood is drained, the doctor may leave the incision open to allow any remaining blood to escape, which helps prevent the hematoma from reforming.

This procedure provides almost immediate relief from the pain and pressure caused by the hematoma. It is a simple and quick process, with most patients experiencing significant improvement shortly afterward.

Post-Treatment Care

After undergoing drainage or even following home treatment, proper care of the area is crucial to prevent infection and ensure a smooth recovery:

• Hygiene: Keep the area clean by washing it gently with mild soap and water. Pat the area dry afterward; avoid rubbing.
• Wound care: If an incision was made, follow your doctor's instructions for wound care. This may include applying an antiseptic ointment and covering the area with a clean bandage.
• Avoid strain: Refrain from activities that could strain the area, such as heavy lifting or prolonged sitting, until fully healed.

By following these treatment and care guidelines, most perianal hematomas heal without complications. However, if symptoms persist or worsen, it’s important to consult your doctor for further evaluation and management.

When to Contact a Doctor

While many perianal hematomas heal on their own, certain symptoms require immediate medical attention. 

If you experience severe pain, persistent or worsening symptoms, or signs of infection such as redness, warmth, or pus, it's important to see a doctor. These could indicate a larger hematoma or an infection that needs prompt treatment.

For those with recurrent hematomas or other concerning symptoms, routine check-ups are advisable. Regular consultation with a healthcare provider can help manage symptoms and prevent future issues.