Perianal pain is a common problem that has both serious and benign causes. As it sounds like this problem is really bothering you, you should talk with a physician about this pain. When you talk to a doctor, be prepared to discuss the following possibilities.
The pain you are experiencing may likely be a perianal or perirectal abscess, which is a localized infection in this area. A pocket of pus forms either just underneath the skin, between the sphincter muscles, or in the fat surrounding the anus and rectum. These infections original in small glands around the anus, and progress to form a painful swelling that may be red, painful, or warm to the touch. The more superficial the abscess, the easier it is to feel. Perianal abscess may be accompanied by systemic symptoms such as fevers or chills. Treatment may include surgical drainage or antibiotics, so you should have a physician examine you to determine if these things are necessary.
Another possibility is that the pain and lump are a fistula. A fistula is a connection underneath the skin between a pocket of pus (abscess) or an area higher up in the anal canal or rectum, with the skin near the anus. Fistulas often need surgical procedures to help them close, and evaluation by a surgeon
would be necessary in this case.
A third disease process that can be responsible for perianal pain is anal warts, often caused by Human Papilloma Virus (HPV), which is a sexually transmitted infection. Warts are not typically painful, as you are describing, but would cause a pea-sized hard spot under the skin. Warts can be spread by sexual contact, and tend to progress if left untreated. An experienced physician can diagnose anal warts by physical exam, accompanied by a test in which vinegar is applied to the area to make the warts have a characteristic appearance. Warts are generally treated by topical medications or removal through freezing them off (cryotherapy) or burning them off (laser therapy or electrocautery). Because anal warts can lead to cancer, you must have a doctor examine this area to determine if this is the cause of your symptoms.
It is not possible to diagnose the cause of your anal warts without an office visit with a physician. You should make an appointment to see either your PCP, and emergency medicine physician
, or a colorectal surgeon
. As some of these causes discussed above are serious, I suggest you make the appointment in a timely manner.