SymptomDigestive system
Mass or Swelling Around the Anus
A lump or swelling around the anus is most often a hemorrhoid, especially a painful clotted (thrombosed) external hemorrhoid, a perianal abscess, a skin tag, or anal warts. Less common causes include a prolapsed rectum, a pilonidal cyst and, rarely, anal cancer. A painful, tense lump that came on suddenly is usually a thrombosed hemorrhoid or abscess. A lump with fever needs prompt drainage, and any lump that persists, bleeds or grows should be examined.
Also called: Anal lump, perianal mass, anal swelling, lump near the anus, bump on the anus
At a glance
- What it is
- Any bump, lump or swelling on or near the anal opening.
- Most common causes
- Hemorrhoids, perianal abscess, skin tags, anal warts.
- Painful and sudden
- Usually a thrombosed hemorrhoid or abscess.
- Painless and persistent
- Skin tag, warts, or rarely anal cancer.
- Diagnosis
- Visual and finger exam, and anoscopy or colonoscopy if needed.
When to get help
Call 911 or go to the ER
- A painful, swollen anal lump with high fever above 38.5 °C (101.3 °F), chills, spreading redness or feeling very unwell, especially with diabetes or a weak immune system
- Rapidly spreading pain, dark skin or crackling under the skin around the anus or genitals (possible necrotizing infection)
- Heavy rectal bleeding, or bleeding with dizziness or fainting
See a doctor within a day or two
- A tender, warm, red swelling beside the anus that is getting bigger (likely abscess, needs drainage within a day or so)
- A very painful purple-blue lump that appeared suddenly, within the first 3 days (a thrombosed hemorrhoid can be removed for faster relief)
- A rectal prolapse that will not go back in
Book a routine appointment
- A lump that has not gone away after 2 to 3 weeks
- A hard, irregular or growing lump, or one that bleeds without a bowel movement
- Wart-like growths around the anus
- A recurring boil or a hole near the anus that keeps draining pus or fluid (possible fistula)
Usually safe to manage at home
- Soft, painless swellings that appear with straining and go back afterward, with occasional bright red blood on the paper
- A small, soft, painless skin tag that has been unchanged for years
Common causes of anal lumps
| Cause | Feels like | Pain | Other clues |
|---|---|---|---|
| Thrombosed external hemorrhoid | Firm, purple-blue, pea to grape size at the edge | Severe, worst in first 48 to 72 hours | Sudden onset, often after straining or heavy lifting |
| Prolapsed internal hemorrhoid | Soft, moist, pink lumps from inside | Mild unless stuck | Bright red bleeding with bowel movements |
| Perianal abscess | Hot, red, tender swelling beside the anus | Throbbing, constant, worse sitting | Fever, may burst and drain pus |
| Skin tag | Soft, flesh-colored flap | None | Often left after an old hemorrhoid or fissure |
| Anal warts | Small, cauliflower-like bumps, sometimes clusters | Usually none, may itch | HPV infection, can spread |
| Rectal prolapse | Red, ringed tissue sticking out after a bowel movement | Discomfort | Older women, chronic straining, leakage |
| Pilonidal cyst | Swelling higher up, at the top of the buttock crease | Painful if infected | Young men, hairy skin |
| Anal cancer | Hard, irregular lump or ulcer | Often mild or none at first | Bleeding, itching, persistent change |
Hemorrhoids
Hemorrhoids are swollen cushions of blood vessels in and around the anus. External hemorrhoids lie under the skin at the anal edge. When a clot forms inside one, it becomes a thrombosed hemorrhoid: a sudden, firm, bluish, very painful lump. The pain usually peaks in 2 to 3 days and settles over 1 to 2 weeks as the clot is absorbed, often leaving a skin tag. Internal hemorrhoids can bulge out (prolapse) during bowel movements and usually go back by themselves.
Perianal abscess
A perianal abscess is a pocket of pus, usually starting in a small gland inside the anal canal. It causes constant throbbing pain, a red, warm, tender swelling and often fever. Antibiotics alone do not cure it: it needs to be drained. About 1 in 3 abscesses lead to an anal fistula, a tunnel between the anal canal and skin that keeps draining.
Skin tags
Anal skin tags are harmless folds of skin, often the remains of a healed thrombosed hemorrhoid or fissure. Large or multiple tags, especially with fissures, can be a sign of Crohn's disease.
Anal warts
Anal warts are caused by human papillomavirus (HPV), usually spread by sexual contact, though not only through anal sex. They can be single or clustered and may grow inside the anal canal.
Rectal prolapse
In rectal prolapse, the lining or full thickness of the rectum slides out through the anus. It looks like a red, ringed lump and is more common in older women and people with long-term constipation.
Anal cancer
Anal cancer is uncommon. It can cause a lump, bleeding, pain, itching, discharge or a change in bowel habits. Risk is higher with HPV infection, HIV, a history of cervical, vulvar or vaginal precancer, smoking and organ transplant. Because early symptoms mimic hemorrhoids, any lump that does not settle should be examined.
Other causes
- Crohn's disease: skin tags, abscesses and fistulas around the anus, sometimes before bowel symptoms appear
- Molluscum contagiosum: small, pearly, dimpled bumps
- Sebaceous or epidermoid cysts
- Hematoma after injury
How doctors examine an anal lump
A doctor will ask about pain, bleeding, bowel habits, fever, sexual history and how long the lump has been there. The exam usually includes:
- looking at the area while you lie on your side
- a gentle finger exam (digital rectal exam), unless it is too painful
- anoscopy, a short tube with a light to view the anal canal
Further tests depend on the findings: colonoscopy for bleeding (especially over 45 or with a family history), MRI or ultrasound for complex abscesses and fistulas, and biopsy of any suspicious lump.
Treatment
Home care for hemorrhoids
- Sitz baths: sit in a few inches of warm water for 10 to 15 minutes, 2 to 3 times a day and after bowel movements.
- Soften stools: 25 to 35 g of fiber a day, plenty of fluid, and a fiber supplement such as psyllium.
- Avoid straining and do not sit on the toilet for long.
- Over-the-counter creams with a local anesthetic, witch hazel or hydrocortisone for up to a week.
- Pain relief: acetaminophen (paracetamol) or ibuprofen, following the label dose. Avoid codeine, which causes constipation.
Medical treatments
- Thrombosed hemorrhoid: if seen within about 72 hours, a doctor can remove the clot under local anesthetic for faster relief. After that, home care is usually best.
- Internal hemorrhoids: rubber band ligation, injection, or surgery for large or persistent ones.
- Abscess: incision and drainage, usually in the clinic or ER. Antibiotics are added for spreading infection, diabetes or a weak immune system.
- Fistula: surgery.
- Warts: creams, freezing, or surgical removal. HPV vaccination protects against new infections.
- Rectal prolapse: surgery for full-thickness prolapse.
- Anal cancer: usually chemotherapy with radiation, which cures most early cancers.
Frequently asked questions
What is the lump around my anus?
Most anal lumps are hemorrhoids, skin tags, abscesses or warts. A sudden, painful, bluish lump is usually a thrombosed hemorrhoid. A hot, red, tender swelling with fever is usually an abscess. A doctor can tell them apart with a quick exam.
Is a lump near the anus serious?
Usually not. Most are hemorrhoids or skin tags. An abscess needs prompt drainage, and a lump that persists, grows, bleeds without bowel movements or feels hard should be examined to rule out cancer.
How long does a thrombosed hemorrhoid last?
Pain is worst for the first 2 to 3 days and improves over 1 to 2 weeks as the clot is absorbed. A skin tag may remain. If seen within about 3 days, a doctor can remove the clot to speed recovery.
Can a perianal abscess go away on its own?
Sometimes it bursts and drains, easing pain, but it often comes back or forms a fistula. Most perianal abscesses need to be drained by a doctor. Antibiotics alone are rarely enough.
What does anal cancer look like?
Anal cancer may look like a firm lump, a sore that does not heal, or a thickened area at the anal edge. It can bleed, itch or cause pain and discharge. Because it can mimic hemorrhoids, any persistent lump should be checked.
Sources
This guide was written from current patient and clinical guidance, including:
- American Society of Colon and Rectal Surgeons: Hemorrhoids; Abscess and fistula expanded information
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): Hemorrhoids
- NHS: Lumps around the anus; Anal abscess
- American Cancer Society: Signs and symptoms of anal cancer
- MedlinePlus (US National Library of Medicine): Rectal problems