What Is a Perianal Hematoma and How Is It Treated?

What is a perianal hematoma?

A perianal hematoma is an accumulation of blood within the tissues surrounding the anus, typically resulting from a burst or bleeding vein. Not every perianal hematoma needs medical intervention, but some require evacuation during a straightforward in-office procedure. If a clot has developed, a clinician will need to extract it.

Perianal hematomas are often confused with prolapsed hemorrhoids because their signs overlap. A prolapsed hemorrhoid is a blood-filled swelling originating inside the anus that can protrude outside and then retract. Perianal hematomas are always external and do not occur internally.

What are the symptoms?

Visually, a perianal hematoma appears as a bluish bruise beneath the skin or a dark purple buildup of blood near the anus. You may also notice a palpable lump, varying in size from roughly a raisin to a tennis ball.

Additional symptoms may include:

• bulging or tense skin adjacent to the anus
• pain ranging from mild to severe, depending on how large it is
• blood on or in the stool

What causes them?

Perianal hematomas and hemorrhoids share many of the same triggers, in addition to overlapping symptoms.

Anything that increases pressure on the anal veins can cause a perianal hematoma, such as:

• Severe coughing. Intense or prolonged coughing can raise pressure on the veins around the anus and cause them to break.
• Constipation. Passing hard stools and straining during bowel movements increases stress on anal veins, which can lead to rupture.
• Medical procedures. Endoscopic exams that involve the anal canal—like colonoscopy, sigmoidoscopy, or anoscopy—can raise the risk of anal bleeding.
• Pregnancy. Expectant mothers are at higher risk for perianal hematomas and hemorrhoids. The growing uterus adds pressure to the pelvic area, and pushing during labor can further stress the anal veins.
• Sedentary habits. Prolonged sitting increases pressure on the anal area. Jobs that require long hours seated—at a desk or in a vehicle—raise the likelihood of developing a perianal hematoma.
• Heavy lifting. Lifting weight, particularly heavier loads than you usually handle, elevates body pressure and can affect the anal veins.

How is it diagnosed?

Diagnosis of a perianal hematoma is made through a physical examination. Identifying a perianal hematoma is generally simpler and less invasive than diagnosing hemorrhoids because the lesion is external—no colonoscopy or other advanced diagnostic tests are typically needed.

How is it treated?

Most perianal hematomas resolve spontaneously within five to seven days, though they can be painful while healing.

To manage discomfort during recovery, you can try:

• applying a cool compress to the area
• taking sitz baths twice daily
• sitting on a donut pillow to reduce pressure
• increasing fiber intake
• avoiding strenuous exertion

For larger hematomas, a healthcare provider may advise drainage. This minor procedure involves numbing the skin and making a small cut to release the collected blood. If a clot is present, it can be removed during the same procedure. The incision is usually left open and should seal on its own within a day or two. Keep the site clean and dry as it heals.

What’s the outlook?

Although perianal hematomas can be uncomfortable and painful at times, they typically improve without intervention within about a week. In more significant cases, a small incision to drain the blood or extract a clot may be necessary. Whether treated or not, most people notice marked improvement within a few days.