Perianal thrombosis or anal thrombosis refers to the formation of very painful lumps in the area of the anal outlet. It is uncomfortable, but usually resolves itself within a few weeks, although a fold of skin may remain.
What is perianal thrombosis?
Perianal thrombosis refers to blood clots in the area of the anus that appear in nodules and can vary in size depending on the severity of the thrombosis. Mild nodules only reach about the size of a grape, while severe cases have been reported to have nodules that reach the size of plums or pigeon eggs. In some cases, multiple nodules form, or one nodule contains multiple thrombi. The nodules are reddened or appear bluish. Often, the nodule formation is accompanied by painful water retention, which causes additional feelings of tightness, adding to the pain that perianal thrombosis causes. Because of their similarity to hemorrhoids, perianal thrombosis is also known as “fake hemorrhoids.”
Causes
Perianal thrombosis is caused by the formation of blood clots in the veins around the anal outlet. What causes these blood clots, however, is the subject of controversy. In the past, the most common doctrine was that prolonged sitting (especially on cold surfaces), high body pressure (for example, when coughing, pressing or lifting heavy weights, in women during childbirth or during menstruation), and the consumption of alcohol and highly spiced foods favor the development of perianal thrombosis. In addition, the presence of larger hemorrhoids may play a role in the formation of the blood clots. Recent studies suggest that intensive wet cleaning of the anal region and vigorous physical activity may also carry some risk for the development of perianal thrombosis.
Symptoms, complaints, and signs
Perianal vein thrombosis is associated with severe pain and usually occurs without warning signs. Unlike hemorrhoids, they are not fine and blood-filled tissue protrusions. Anal vein thromboses have a highly indurated structure. Their dimensions vary from pea- to plum-sized nodules. The appearance is usually characterized by a dark red to bluish coloration. Initially, they are noticed by a discreet stinging sensation in the anal area. After a short course, this sensation intensifies and the pain intensity increases. Since the direct area of the anal outlet is affected, the sphincter muscle subsequently maltreats the already affected area. Patients complain of permanently oozing itching in addition to the actual pain. Due to the blockage position, the anus does not close flush and secretion escapes from the rectum. Those affected often confuse anal venous thrombosis with prolapsing hemorrhoids. These do not cause significant pain in the early stages and remain mobile to some degree. Moreover, they do not arise spontaneously in just a few minutes, but gain size slowly and over time. In contrast, the hardened nodule of a perianal vein thrombosis is firmly attached and cannot be pushed back. In addition, this does not tend to bleed. Strong pressure occasionally leads to partial evacuation without the nodule receding. Affected persons report sometimes considerable agony during defecation. Passage of hard stool past the pressure-sensitive swelling is considered extremely uncomfortable. Walking as well as simply sitting on unpadded seating also causes patients severe discomfort due to the constant friction of the lump.
Diagnosis and course
Perianal thrombosis develops within a very short period of time, and those affected are often unaware of the cause themselves. The lumps are noticeable by severe pain and sometimes burning and itching, but they are actually harmless and in many cases heal on their own, which takes several days or even weeks. Anyone who is uncertain about the diagnosis should consult their family doctor or a specialized physician (proctologist or dermatologist). This is particularly indicated if the pain caused by the perianal thrombosis is so severe that the affected person is massively restricted.Also, after healing of particularly pronounced thrombi, an unsightly skin fold (called a mariske) may form in the affected area, which can be surgically removed at the patient’s request.
Complications
In most cases, perianal thrombosis does not result in any particular complications or life-threatening symptoms. In such cases, the lumps in the anus regress relatively quickly on their own. However, scars or wrinkles may remain on the skin itself. Patients suffer from very severe pain due to perianal thrombosis. This pain is particularly unpleasant, as it is usually no longer possible to sit normally. Bowel movements are also associated with severe pain. The permanent pain not infrequently has a negative effect on the patient’s psyche, so that depression or other psychological complaints may result. Blood clots form in the anus itself and anal itching occurs. As a rule, no direct treatment is necessary for perianal thrombosis. The discomfort disappears relatively quickly and no further complications occur. The pain can be well relieved with the help of painkillers. Laxatives can also soften the stool and thus reduce the pain. Perianal thrombosis does not affect the life expectancy of the affected person.
When should you go to the doctor?
Although perianal thrombosis normally heals on its own within a few weeks and leads to freedom from symptoms, to be on the safe side, a visit to the doctor should be made at the first irregularities. It is important to exclude serious diseases of the affected person as well as to create an optimal treatment plan to alleviate the symptoms. In case of pain in the anus area, a doctor should be consulted. Pain medication should not be taken until the medical professional has been consulted, as complications and side effects may occur. If there is itching, bleeding or changes in the appearance of the skin, a doctor should be consulted. A stinging sensation at the anus, bleeding, and palpable lumps at the exit of the anus should be examined and treated. If there is an inner restlessness, disturbances in locomotion as well as discomfort when sitting, a doctor should be consulted. A decrease in well-being, swellings as well as ulcers should be treated by a doctor. If open wounds or the formation of pus occur, special care should be taken. If sterile wound care cannot be provided, the assistance of a physician should be sought. The affected person is at risk of sepsis in severe cases. Blood poisoning can have a fatal course without timely treatment. A feeling of pressure at the anus, changes in libido or sexual dysfunction should be discussed with a physician.
Treatment and therapy
In many cases, it is sufficient to treat perianal thrombosis oneself, for example, by applying creams and ointments containing anti-inflammatory ingredients (anti-inflammatory drugs). Oral intake of analgesic drugs such as ibuprofen, which also has an anti-inflammatory effect, can also relieve the pain. Most sufferers are helped by making sure that their stools are as soft as possible during this time (for example, by using mild laxatives or eating a diet with plenty of fluids, perhaps dried fruit on an empty stomach and flaxseed consumption). Sitz baths round out the therapy. For larger lumps or those that are extremely painful, the only choice is often to see a specialist and have the thrombi cut open under local anesthesia, at which point the thrombi are forced out. This procedure can be performed by some general practitioners, but also by dermatologists, surgeons and proctologists. As a rule, healing then occurs quickly and without complications. If mariscs have formed, it is possible to have them surgically removed.
Outlook and prognosis
Usually, there is healing without complications in perianal thrombosis. After a few days to weeks, the healing process is complete with conservative therapy. No damage usually remains and the tissue regresses completely. Possibly, a spontaneous departure of the thrombus can happen, which is accompanied by bleeding. This leads to an abrupt relief of symptoms. Sometimes perianal skin folds, so-called anal marisques, form during healing.Due to the thrombi, the skin tissue overstretches considerably and is subsequently no longer able to completely regress. The mariscs do not cause any discomfort, but may be perceived as a nuisance by the patient. The skin folds can be removed as a whole under local anesthesia. There are hardly any risks with this procedure, but under certain circumstances there may be a disturbance of wound healing. With surgical treatment, immediate pain relief is achieved by removing the thrombosis. Rarely, scarring may be seen or felt. Perianal thrombosis tends to recur. In patients treated conservatively, the rate is 15%. With surgical therapy, the likelihood decreases.
Prevention
Because it is not known exactly what causes nodule formation due to perianal thrombosis, it is also difficult to deliberately prevent this condition. Therefore, until further research is conducted, it is advisable to avoid prolonged sitting (on cold surfaces) or to interrupt sedentary activities repeatedly, to limit wet cleaning of the anal region or to change anal hygiene practices, and to reduce the consumption of highly spiced foods or alcohol. On the other hand, conscious de-stressing while coughing or lifting or pressing is hardly possible.
Follow-up
Perinatal thrombosis needs good aftercare, regardless of whether it has regressed spontaneously or has been surgically opened. On the one hand, this involves the healing of any small wound that may have developed in the anal canal. On the other hand, aftercare is synonymous with prevention in order to prevent the development of a new perianal thrombosis. Excessive hygiene in the anal area is strongly discouraged. Sharp cleaning and very rough toilet paper should be avoided. Normal washing with lukewarm water is sufficient, and the sensitive area should be carefully patted dry. Heavy pressing promotes the recurrence of perianal thrombosis and also has an unfavorable effect on any wound healing that may be necessary. Therefore, it is important to regulate bowel movements so that they are not too hard. For this it is significant to drink enough. Water and herbal teas are ideal. A high-fiber diet is also recommended. Fruits and vegetables are helpful, as are whole grain products. If this alone is not enough to regulate bowel movements, psyllium husks are a valuable aid. They are available in health food stores, among others, are simply stirred into water and drunk after a short phase of swelling. Sufficient drinking quantity is also important here. Exercise is also important in the aftercare of perinal anal thrombosis. It promotes digestion and the necessary intestinal movements and in this way can avoid pressing.
Here’s what you can do yourself
Perianal thrombosis is a symptom that the affected person can significantly positively influence in everyday life through consistent behavior. In the acute phase, the main thing in this context is not to expose the anal vein thrombosis, which is a bulging or opened by the medical professional, to further irritation. This applies to prolonged sitting as well as to wearing tight pants. When hygienizing after going to the toilet, avoid using rough paper and damp toilet paper. Strong rubbing is also better replaced by gentle dabbing of the affected areas around the anus. To promote rapid healing of perianal thrombosis and prevent further thromboses in this area, behavioral changes in the patient are helpful, which are closely related to diet. Often anal venous thrombosis, similar to hemorrhoids, results from pressure caused by forceful pressing during defecation. Therefore, in both the treatment and prevention of perineal thrombosis, it is important to avoid constipation. Patients achieve this by eating a high-fiber diet and drinking a sufficient amount. If this does not achieve the goal, loosening up the stool is possible with natural remedies such as psyllium husks or flaxseed, which are simply dissolved in water or stirred into yogurt and then ingested. Foods that cause flatulence are better replaced with alternatives in the acute phase.