A perianal hematoma is a collection of blood under the surface of the skin at the edge of the anal opening. Perianal hematomas are caused by a traumatic rupture of a small blood vessel in this area due to high pressures resulting from straining. Many people with a perianal hematoma can recall lifting something heavy, moving house, carrying suitcases or children, severe coughing or straining with constipation shortly before they notice that there is something wrong in their anal area. Similarly, perianal hematomas are commonly seen in people working out at gyms, lifting weights, etc.
The perianal hematoma presents as a painful lump at the edge of the anal opening (anal verge). They can vary in size from a centimeter to the size of a golf ball, and are usually quite painful. The pain will last a week to ten days. Patients take all sorts of over the counter medications for these but there is not much good evidence that anything helps. A perianal hematoma has a natural course that will follow pretty much regardless of what the patient does. Eventually, the pain will lessen and stop, and the patient will be left with firm lump which will gradually shrink and disappear over the course of 3 months or so.
Perianal hematomas are often misdiagnosed as hemorrhoids or external hemorrhoids. 'External hemorrhoids' is a poor term that should probably be abandoned. It is pretty meaningless and usually refers to skin tags and such that do not develop bruises. Internal hemorrhoids can thrombose (clot), but when they do not have a blown out vessel, but more likely to vessel within the hemorrhoid that clots. Thrombosed internal hemorrhoids are a much bigger deal than a perianal hematoma. In a thrombosed internal hemorrhoid, the thrombosis may extend right up into the anal canal and low rectum. Any doctor foolishly trying to excise this under local anesthetic will quickly end up with a bloody mess and start wondering why he or she got out of bed that morning. Such cases are usually referred to as a surgeon who will generally leave them alone to resolve on their own.
Perianal hematomas should be distinguished from true hemorrhoids, abscesses, and anal cancer, including the rare malignant melanoma that can Occasionally start in this area and appear as a dark bluish lump or lumps.
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