Dr. Ajeet Kumar
Medical Gastroenterology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have developed a lump around the anus. It is extremely painful and spoils my day. I assume it is piles. I keep doing sitz bath twice a day and have been taking Dr. Reckeweg R 13 regularly. I do not sense any relief besides walking for long and during sitz bath. Please help. Would it go away on its own?
Hello,
Welcome to icliniq.com.
Well, the picture are a little blur (attachment removed to protect patient identity). As far as I can see, it seems external hemorrhoids are likely thrombosed. Thrombosed meaning clotting of blood within these veins of the anal canal. The other possibility is an anal fissure, which is again a painful disorder. I suggest you upload more pictures as I can be very sure about the diagnosis.
Meanwhile, considering that it is external hemorrhoids, you should continue sitz bath. This time more frequently, like every four hourly for at least 15 minutes in semi-warm water and add some Savlon or Dettol 5 ml. You should keep doing it for five to seven days until this swelling subsides.
Plus, take tablet Daflon 500 mg (diosmin and hesperidine) thrice daily for seven days. Apply Xylocaine gel 2% (lignocaine) six hourly for five to seven days, or until the pain settles, Glyceryl trinitrate GTN cream six hourly alternatives with the Xylocaine.
Are you constipated as well? If yes, then use Ispagol husk two tablespoons full daily with water. Do not strain while passing stools.
Patient's Query
Thank you doctor,
Please find another attachment. I have been patient with anal fissures for more than a year, but now it does not pain during defecation. I had begun to apply Levorag Emugel and changed my diet to a soft diet and salads. There is no bleeding involved this time, neither I feel the direct sensation on the anus but lumpy around it. Also, it pains me a lot when I move. I do not have constipation.
Hello,
Welcome back to icliniq.com.
I have seen the picture you attached (attachment removed to protect patient identity). It does not seem an anal fissure. It is highly likely an external hemorrhoids or hair folliculitis, which is inflammation of the hair follicle.
Besides the above medications, which I have suggested to you, you can take a small course of antibiotics or apply local cream in the form of Fusicidin. Apply three times daily for seven days. You can use Levorag emugel, it is a good medication, and there is no harm in combining it all together.
Patient's Query
Thank you doctor,
I also do not feel it an anal fissure. However, I shall apply the Emugel as suggested. Also, I have noticed that I am a bit constipated when I am expecting periods and feel pressure around my rectum until I get my periods. Could it be inter-related? When progesterone rises around periods, my body feels constipated and does not hold the water further. By that, I mean that even if I consume lots of water during the day, the lips remain dry, and I only end up urinating more frequently. I shall try to buy the medicines as you suggested, but I shall not consider the antibiotic course as of now.
Hello,
Welcome back to icliniq.com.
Well, menstruation itself is a huge subject. There are various hormonal changes within the body that anticipate the various features of menstruation, such as pain, bleeding, sleep disturbance, and skin changes. Dry lips may be one of those symptoms. Since I am not an expert in it, I could not tell you enough.
Some change in the bowel is expected at the time of menstruation since the muscles of the uterus, and the rectum and anal canal are supplied by the same nerves. Painful contraction of the uterine muscles can increase the spasm of the rectum muscles, causing constipation.
This is just a physiological change and not pathological. Hence, it does not need any specific treatment except advice to modify diet. Increase fiber intake and to take plenty of water, i.e. 2 to 3 liters a day. Fucidin cream is a local antibiotic and would not cause any side effects. So do not be worried about that.
Patient's Query
Thank you doctor,
I am a bit confused now. So should I buy medicine for external hemorrhoids or Fucidin or both?
Hello,
Welcome back to icliniq.com.
I suggest both. You will be fine.
Patient's Query
Hi doctor,
Thank you for your kind help.
Hello,
Welcome back to icliniq.com.
You are welcome. Keep in touch for furhter doubts.
Patient's Query
Thank you doctor,
Daflon 500 mg is not available here. The chemist suggests Venentabs by Ratiopharm. Should I take it? Does the dosage remain the same?
Hello,
Welcome back to icliniq.com.
Do not take that. You should check for tablet Diosmin. Let me know if this is available. Dose should be 500 mg Flavinoids twice daily or equivalent.
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Medical Gastroenterology
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