A perianal hematocele is a condition where blood collects inside the abdominal cavity (peritoneum) due to scar tissue formation or injury. The condition may occur spontaneously without any cause. Some cases are hereditary, but most cases develop during childhood and adolescence when there is trauma such as surgery, severe burns, or other injuries to the abdomen. There are two types of perihepatomas: internal and external. Internal perihematoscopic hematomas are usually caused by trauma, infections, tumors, or bleeding disorders. External perihematoscopic hematomas are usually caused by diseases like cancer and diabetes. Perianal hematoceles are not uncommon. They affect up to 5% of children under the age of five years old and 10% of adults over the age of 50 years. About 1 out of every 200 children will have one at birth and about 1 in 1000 will develop it before the age of five years. Approximately 3 out of 100 boys and 2 out of 100 girls will get a perianal hematocele by the time they reach puberty. Around half of these cases resolve themselves naturally with no treatment required. However, around 20% continue to experience problems into adulthood. If that is the case, you may need surgery to correct the condition.
Perianal hematoma can be cured with treatment, but it may reoccur in the future. If you do not treat a perianal hematoma, your condition will continue to worsen and cause other serious complications. This article will explain everything you wanted to know about perianal hematoma from its causes and symptoms to treatment and prevention.
What Is a Perianal Hematoma?
A perianal hematoma is a localized collection of clotted blood that forms in the perianal region. The perianal region refers to the area outside the body around the rectum. Perianal hematomas often occur in children under the age of five and adults over the age of 50, but they can happen at any age. A perianal hematoma can be superficial or deep. A superficial perianal hematoma occurs only on the skin around the rectum. A deep perianal hematoma goes through the skin and into the tissue underneath it as well as into the perianal region. This article will deal with deep perianal hematomas as they are much more likely to cause long-term damage or complications than superficial ones. A deep perianal hematoma can cause rectal Prolapse and also damage the nerve that controls bowel movements (the inferior pelvic nerve). Both of these conditions can be very serious.
What Causes a Perianal Hematoma?
A perianal hematoma usually occurs from an injury in or around the perianal region. This can include trauma from a fall or even straining to have a bowel movement. In most cases, the exact cause of the injury is unknown. This is called a spontaneous perianal hematoma. In some cases, a perianal hematoma is caused by an injury during surgery or another trauma to the abdomen. This is called an iatrogenic perianal hematoma. The location of the hematoma is one way to tell the difference between a spontaneous and an iatrogenic one. In a spontaneous perianal hematoma, the blood is located only around the rectum. In an iatrogenic perianal hematoma, the blood can be found in the abdomen or pelvis as well. A perianal hematoma is not contagious and cannot be passed from one person to another like a sexually transmitted infection (STI) or a blood-borne virus. A perianal hematoma cannot develop into cancer.
What Are the Symptoms of a Perianal Hematoma?
The most common symptom of a perianal hematoma is bleeding from the rectum. The blood may appear as a single clot or as a thin red stream of fluid. This is usually intermittent and may come and go. The amount and appearance of the blood can vary from person to person. Some people have large amounts of bleeding from the rectum with only light bruising or no visible signs at all. Other symptoms of a perianal hematoma include: Pain or pressure around the rectum
Difficult or painful bowel movements
Feeling the need to have a bowel movement all the time, but only passing small amounts of bloody urine and stool
Feeling dizzy or faint
Anxiety and depression as a result of feeling unwell
Tiredness
Weight loss
Rectal prolapse (if left untreated) If you have any of these symptoms, seek medical attention right away as a serious condition may be the cause. Always inform your physician of any and all symptoms before they begin to treat you. This is very important as some symptoms such as rectal bleeding can be caused by serious conditions such as cancer.
How Is a Perianal Hematoma Diagnosed?
A perianal hematoma is usually diagnosed based on a person’s symptoms. A physical examination will also take place to look for any signs of visible blood or bruising. In some cases, an ultrasound or colonoscopy may be used to get a clear look inside the rectum and see if there are any signs of internal bleeding.
How Is a Perianal Hematoma Treated?
A perianal hematoma is usually treated by draining the blood from the area. This is done using a syringe without a needle or a special tool called a ‘lancet’ which is used to prick the area and allow the blood to come out. This is a very minor and simple procedure that can be done in a doctor’s office. A local anaesthetic and numbing medicine may or may not be used, depending on the physician’s preference. If there is a lot of bleeding, a small dose of a blood thinner may be required. This allows the blood to clot more easily and stops any further bleeding. Antibiotics may also be required if an infection is detected during the examination. How to Prevent a Perianal Hematoma There is no way to prevent a spontaneous perianal hematoma as the cause is not always known. However, there are ways to lower your risk of developing one due to an injury. If you are in a high-risk group such as elderly people or those who are bed-ridden, it is important to have daily inspections of your rear end. Look for any signs of bruising or blood clots around your rectum. If you spot any of these, contact your physician immediately as you may be at risk of a perianal hematoma.
Can a Perianal Hematoma Be Prevented?
While you cannot prevent a spontaneous perianal hematoma, you can take steps to prevent one caused by an injury. If you are at high risk of developing one due to an injury, it is best to have your physician insert a rubber tube called a ‘drain’ into your rear end within 24 hours of the injury. The drain sits inside your rectum and allows any blood clots or bleeding in the area to drain out. This prevents the blood from building up and causing a hematoma.
When Should I Call a Doctor?
You should seek immediate medical attention if you: Have signs of a perianal hematoma and feel faint or have a serious drop in blood pressure.
How to Beat a Perianal Hematoma Once you’ve had a perianal hematoma, it can be beaten! Here are some ways to help you overcome this condition:
Drink Plenty of Fluids The most important part of recovery is to drink plenty of fluids. This prevents your body from becoming dehydrated and helps you to recover faster.
Take Your Medication If Your Doctor Gave You Prescription Drugs If you were given any medication by your doctor, be sure to take it exactly how your doctor told you to. Most likely, this will involve taking the medication for a few weeks or months, depending on the drug. If you don’t, your condition might not get better or may even get worse.
Rest Up You’ll also want to make sure you rest. The more tired your body is, the slower its recovery process will be because it doesn’t have the energy to rebuild itself. Get as much sleep as you can and try to do nothing too strenuous, like working out at the gym.
Eat a Healthy Diet While you want to make sure you get enough calories, you don’t want to over-do it. Eating fatty or sugary foods may give you more energy and feel good in the moment, but will slow down your recovery. To prevent a relapse of excessive bleeding, eat plenty of vegetables, lean meats and whole grains.With these tips, you should have no problem beating your perianal hematoma.
Don’t forget to contact your doctor to make sure there are no lasting effects of the injury or the surgery.
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Sources & references used in this article:
Hemorrhoidal thrombosis and perianal hematoma: diagnosis and treatment by GG Delaini, L Bortolasi, G Falezza… – Annali Italiani di …, 1995 – europepmc.org
Perianal thrombosis by S Brearley, R Brearley – Diseases of the colon & rectum, 1988 – Springer
Core out fistulectomy, anal sphincter reconstruction and primary repair of internal opening in the treatment of complex anal fistula by P Jivapaisarnpong – J Med Assoc Thai, 2009 – thaiscience.info
