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Forum Name: Gastroenterology Topics

Question: Possible thrombosed hemorrhoids?


 mmews - Sun Jun 06, 2010 10:01 pm

I am a 38 year old male in good health. I have a peanut sized lump between my scrotum and anus. It has been there for several months and is only painful when pressure is applied. It constantly oozed out a puss like liquid, sometimes blood, and sometimes what looks like clotted blood. When I apply pressure to it, I can feel pressure near my anus as well. Is this a thrombosed hemorrhoid and if so, what is the necessary treatment.

Thanks.
 Dr.M.Aroon kamath - Sun Jul 04, 2010 10:07 pm

User avatar Hi,
You have not mentioned as to exactly how far from the anus this swelling is located.

If it is too close to, or at the anal verge, it could be
- a peri-anal hematoma (presumably organized by now) or
- a per-anal abscess (a variety of ano-rectal abscesses), which has turned hard following antibiotic therapy(an antibioma).

If it is much farther in front, and roughly in the midline, a periurethral abscess needs to be considered strongly.

Periurethral abscesses usually develop secondary to the following risk factors:
- a past history of gonococcal urethritis,
- urethral strictures (post-gonococcal, Post-chlamydial, post-traumatic, post-operative).
- urethral calculi.

Primarily, these are due to infections arising in the periurethral glands and spreading outwards. They will be generally be accompanied by local pain, & fever. They commonly arise in the region of the bulbar or penile urethra.

Although, historically, this was associated with Neisseria gonorrhoea infections, later on, Chlamydia trachomatis also was implicated in the aetiology of periurethral abscess. The prevalence of HIV infection in these patients has also been noted high & as well as other STDs.

Treatment of an early periurethral abscess is by aspiration of pus and antimicrobial therapy(covering both N gonorrhoeae and C trachomatis). Incision and drainage may become necessary in some cases.

The underlying cause (ex; urethral strictures) must be dealt with, once the abscess is cured, to prevent recurrences.

An infected sebaceous cyst is also one of the differential diagnoses.

You should have yourself examined by your family doctor who will then be able to refer you to the appropriate specialty.
Best wishes!

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