What could be the grape-size swelling in the anal opening causing terrible pain?

Q. I have terrible pain due to a grape-sized swelling in the opening of my anal area. What could it be?

Answered by
Dr. Lalit Kumar Bansal
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jul 07, 2020 and last reviewed on: Jul 29, 2020

Hello doctor,

Since yesterday, I have been having terrible pain from my perianal area. On self examination, I noticed there was a grape-sized swelling covering nearly half of the upper portion of my anal opening. It is slightly tender on palpation. I never had anything like this before. Prior to noticing the swelling, that same morning, I had diarrhea episodes (up to four or five times of loose stools). Hours later once diarrhea settled, the perianal pain started and I noticed the swelling.

I have no other past medical or surgical history. I have otherwise been well in myself. I am concerned that it may be an external hemorrhoid but would be very grateful for your kind advice on how to manage this.



Welcome to icliniq.com.

I have seen the pictures (attachment removed to protect patient identity). Yes, this is hemorrhoid with a mixed internal and external patterns. It usually occurs when there is a long history of constipation and strain during stool. It is also common in a chronic smoker and alcoholic patients. It may be internal or external hemorrhoids. It may have a mixed variety also. Internal hemorrhoids usually causes bleeding more but usually not protruding outside the anal canal and nonpainful. External hemorrhoid are bulging outside and extremely painful. So in your case, it is a mixed variety of hemorrhoids.

I will advise you on some preventive measures and treatment. Avoid spicy and fatty foods. Intake plenty of water. Sitz bath with Povidone iodine solution two times for 15 minutes. Apply Lignocaine ointment three times locally. Take syrup Lactulose 30 ml HS, and tablet Esomeprazole once a day before breakfast.

I hope this helps.

Thank you doctor,

I am concerned with the cosmetic appearance of hemorrhoid and I want to know how long it will take to start to see a reduction in its size and appearance, if I follow the regime you advised? Could surgery be an option here?



Welcome back to icliniq.com.

Usually, surgery is not required in these kinds of hemorrhoids. It will start decreasing in size in about one week. Most important thing is, avoid straining and constipation with a proper sitz bath. Once the tone of sphincter of the anal canal decreases, swelling will go up in the anal canal and slowly it will disappear.

Eat a high fiber diet with plenty of water. Do regular exercise. Keep in touch and update me about the progress.

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