Hello, Thank you for your query at DoctorSpring.com. 

I understand your concern.

From your history and pictures, the spherical excrescence seems more likely a skin tag and the other lesions seem to be hemorrhoids. There is also a surrounding mild redness due to inflammation. A physical inspection and per rectal examination is required for confirmation.

Hemorrhoids occur in certain individuals due to straining at stool and in those with chronic constipation. Anal skin tags are usually seen associated with anal fissures, but since you do not have any pain during defecation, fissure is unlikely. Tag can be left alone or if  required excised surgically.

I have the following suggestions for you.

1. Please increase intake of fiber in your diet. Additionally you can take an OTC like Metamucil, 1 teaspoon in 1 glass of water, 3 times a day. This will soften stool and prevent constipation.

2. Please consume plenty of fluids.

3. You can continue the proctosedyl cream as local application.

4. Sitz bath(sitting in a tub of warm water) can be taken, after every bowel movement, to relieve any anal discomfort.

5. You can visit a general surgeon for examination and confirmation.

I hope this was helpful.

Feel free to ask queries.

Thank you.

Hello.

You have understood me right. If the excresence has appeared all of a sudden, then it is unlikely to be a skin tag. If it is an occluded hemorrhoid, like you have been told, it would have been excruciatingly painful, at least in the initial few days.

Although chronic constipation is most commonly associated with hemorrhoids, other factors such as chronic diarrhea, prolonged sitting etc can also lead to their development.

You can send another picture with a a closer view of the anal orfice. However, I need to add that a picture will not be as helpful as a physical examination.

Please upload the picture in the follow up.

Thank you.

Hello Mr. Luke.

Thank you for the additional picture and additional history. It is definitely much clearer. 

The dark blueish coloured spherical lump could be an external thrombosed(clotted) hemorrhoid? from the appearance. The only reason why I cannot be definitive about it is because a thrombosed external hemorrhoid will be very painful when it develops. The dark blue colour can indicate venous blood.

Initial management of a thrombosed hemorrhoid is surgical evacuation of the hemorrhoid with excision of the skin overlying the thrombosed hemorrhoid which produces immediate relief. This is usually done within 72 hours when the patient presents with acute pain. After 72 hours, evacuation is generally not required.

You should use stool softeners, and sitz baths, as mentioned earlier, which provide adequate relief until spontaneous resolution occurs.

Some surgeons advocate that patients with thrombosed external hemorrhoids should undergo excision of the hemorrhoids to prevent recurrent thrombosis. However whether it is required in your case can be decided based on the status of your hemorrhoids. This will require a per rectal examination. So I suggest you consult a general surgeon in this regard and discuss whether surgical intervention is required or not.

I hope this was helpful.

Thank you.