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Q. I have a painful pulp outside the ass crack. What is that?

Answered by
Dr. Aditya Jalan
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on May 12, 2020

Hello doctor,

I have a pulp just outside the ass crack which just originated today and it is painful.



Welcome to

I went through your question. It seems from the picture that you should be having severe pain (attachment removed to protect identity).

This can be the result of thrombosed hemorrhoids, perianal fistula, or a pilonidal sinus. Still, to guide you better I need a few more details.

What is the exact site? Is it the anal orifice or around the anal orifice? Is there any discharge serous or purulent? Is there any kind of bleeding? Do you have a fever? Do you have to complain of constipation or straining in the past?

At present to relieve your symptoms please take tablet Aceclofenac 100 mg per orally twice daily for two days.

After you provide me details, I will add further specific advice.

Thank you doctor,

It is around the anal orifice, having no discharge or bleeding. I am not having a fever but in the past, I had the problem of internal piles and had IRC done last year.



Welcome back to

Just to reconfirm and let you know in simple terms. If you having swelling at the border of the anus, it most likely to be thrombosed piles (hemorrhoids). And also since you had a history of IRC (infrared coagulation), it is more likely. And if the swelling is slightly away from the margin of the anus it is more likely to be a perianal fistula.

Treatment plan:

I would recommend you to take these medications. Your symptoms should reduce. Tablet Ciprofloxacin 500 mg twice daily for one week after food, Ornidazole 500 mg twice daily for one week after food, Pantoprazole 20 mg once daily before food for one week, Aceclofenac 100 mg twice daily for three days after food. Surgical intervention may be required later once the infection subsides.

Preventive measures:

Take sitz bath thrice daily for 20 minutes in lukewarm water for seven days.

Regarding follow up:

These medications will reduce your symptoms and relieve the infection. Let me know if you have a fever, or any discharge.

Thank you doctor,

Should I sit on an ice bag or warm water bag to reduce the swelling as I have started the sitz bath already?



Welcome back to

Only a sitz bath should be enough for a few days. If you are also having constipation or you are reluctant to pass stool due to pain please take laxatives and syrup Lactulose 10 ml at night after food for seven days.

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