I have lump in the perineum with tenderness and constipation. What should I do?

Hello,

Welcome to icliniq.com.

Well, I can very well understand your problem, but I must admit that my assessment might be incomplete unless I have the test results which I suggest to you.

Secondly, I want to see the notes which your gynecologist and gastroenterologist have written in the prescription you receive. Or preferably a summary of your overall assessment and findings of digital rectal examination if they did while examining you.

Your history of feeling lump in the perineum plus constipation and pain with tenderness in the area over background of the obesity suggest descending perineum syndrome a condition where the pelvic floor muscles are tender and leading to inordinate pooping mechanism resulting in constipation as well.

I would like to ask you for some investigations, that will help us to establish the diagnosis and later can suggest you treatment for it. The test is called a rectal balloon expulsion test. In this, a rectal catheter is placed inside the rectum and the balloon inside the catheter is filled with 50 cc of water, and examiner ask you to expel it. Failing to expel within 2 minutes suggest descending perineal syndrome or pelvic dyssynergia. The other test is barium defecography, which is a radiology based tests requiring you to visit to a radiologist and get an appointment.

Let me know your thoughts on this, particularly your feasibility is important. Also, let me know how severe you feel the constipation? Is the pain a predominant feature or the constipation? And did you ever use finger to evacuate the stools? Are you sitting long time in the restroom before you pass the stools? Have you ever noticed blood in the stools?

Share with me all the blood investigations you had in the past, that will help to exclude any other accompanying problem namely diabetes, cholesterol, and liver dysfunction secondary to obesity.