A perianal hematoma is a collection of blood that has leaked from a burst blood vessel in the area around the anus. As well as being uncomfortable, the appearance of a painful, bruised-looking bump near the anus can cause alarm.

People may confuse these swellings with external hemorrhoids because both conditions cause sore lumps around the rectum. However, even though hemorrhoids are the most common cause of anal problems, they do not cause a perianal hematoma, and there are important differences between the two conditions.

Keep reading to learn more about perianal hematomas, including the causes and treatment options.

Person in bath reading about perianal hematomas. Share on Pinterest
Image credit: Getty Images

A perianal hematoma is a collection of blood that has leaked from a burst blood vessel in the area around the anus. This blood pools up outside the blood vessel below the surface of the skin, although it is possible to see the characteristic dark-blue discoloration with the naked eye.

Also known as anal thrombosis, a perianal hematoma can be small or large. Perianal hematomas are sensitive to pressure, and the larger they are, the more sore they can become. A perianal hematoma can also become more painful as the blood that shaped it starts to clot.

A perianal hematoma can range in size from a centimeter to a golf ball, with the larger ones being more painful. In terms of their duration, the pain typically lasts from 1 week to 10 days, and it can take up to 3 months for the lump itself to go away completely.

Perianal hematomas are effectively swollen bruises under the surface of the skin near the opening of the anus. They are the result of a burst blood vessel in that area.

The blood vessels around the anus are small and sensitive to pressure, so numerous factors and activities can cause them to burst, or rupture. These include

  • lifting heavy weights
  • coughing
  • sneezing
  • chronic constipation
  • difficult bowel movements
  • pregnancy and labor
  • spending a lot of time sitting
  • cardiovascular problems
  • taking birth control pills
  • having anal intercourse
  • injury
  • surgery that damages the area
  • an invasive medical procedure, such as proctoscopy

The main symptoms of a perianal hematoma are:

  • pain
  • a purplish lump near the edge of the anus
  • swelling
  • sensitivity to pressure
  • difficulty sitting

Bleeding can sometimes be a sign of a perianal hematoma, but it only occurs about 1–3 weeks after the lump first develops.

It is important to be aware of some common symptoms of anal problems that are not signs of a perianal hematoma. Individuals who have any of the symptoms below should see a doctor to find out what may be causing these problems:

  • itching
  • bright red blood in the stool or on toilet paper after wiping
  • changes in stool frequency and consistency

In most cases, treatment for a small-to-mid-sized perianal hematoma focuses on reducing pain and discomfort and letting the swelling heal on its own.

Larger hematomas, which can be extremely painful, may require draining. However, this procedure results in a wound that then needs treatment. Due to this, doctors reserve the procedure for hematomas that cause significant pain.

If treatment starts soon after the perianal hematoma forms, a doctor can administer a local anesthetic, make a small cut, and let the clotted blood escape, which brings quick relief of symptoms. While it is important to keep this area clean, the wound from this procedure typically closes on its own within a few days.

Other practices that doctors may use to treat a perianal hematoma include:

Most people who are dealing with a perianal hematoma can manage it with self-care practices, which include:

  • refraining from activities such as running and weightlifting, which increase irritation and make the pain worse
  • soaking in a warm shallow bath twice a day to promote the reabsorption of the blood clot and reduce discomfort
  • applying cold compresses to the anal area for pain relief
  • using a donut-shaped pillow to take pressure off the anal area, if sitting is difficult
  • avoiding straining during bowel movements

Adapting the diet can be very helpful for people healing from a perianal hematoma. Drinking a lot of fluids and limiting high fiber foods right after the perianal hematoma develops can help make bowel movements easier. It can also reduce the pressure on the anal area, which will support healing.

If a person repeatedly develops perianal hematomas in the same area, a doctor may recommend surgery, particularly if the area in question seems to be scarred. If there is damage to the region, treating the underlying problem could prevent recurrences.

Individuals who notice painful bumps around their anus should consider seeing a doctor for a diagnosis. The doctor will be able to determine whether a sore is a perianal hematoma, a hemorrhoid, or anal cancer.

Carrying out a physical exam and asking the person about typical symptoms, such as discomfort, are usually enough for a doctor to diagnose a perianal hematoma.

A perianal hematoma is a pool of blood from a ruptured blood vessel that has collected near the anus.

They usually occur due to pressure from activities such as weightlifting, coughing, labor, medical procedures, and straining during bowel movements.

The main symptoms are pain, swelling, and a purplish lump that is sensitive to pressure.

For the most part, perianal hematoma symptoms go away in 7–10 days with minor medical treatment, although they can cause significant discomfort during that period.

It can, however, take months for the lump to disappear.