I have lump in the perineum with tenderness and constipation. What should I do?

Question

Hello doctor,

I am a 17-year-old female. I am 5 feet tall and I weigh about 216 lbs. Three months ago, I had severe constipation and hemorrhoids that lasted for about a month and a half. After that incident, I decided to change my diet high on fiber and cereals, and red meat up to this day. I have had maintained it. The diet has helped me and I pass stools on alternate days. The problem is that near my anus and vagina the part that is in between (pelvic floor) it is swollen at 60% of the time. It hurts to sit, after going to the bathroom, and the anus becomes very tight and swollen as well. I have noticed that my urine has had a strange smell, and I drink plenty of water. I went to the gynecologist and gastroenterologist, I have had several blood samples and radiography taken, and everything comes perfect. But there is no concise answer that may actually be causing this. It worries me, because this has never happened to me, and it is really frustrating not knowing what you have.

Answer 1

Hello,

Welcome to icliniq.com.

Well, I can very well understand your problem, but I must admit that my assessment might be incomplete unless I have the test results which I suggest to you.

Secondly, I want to see the notes which your gynecologist and gastroenterologist have written in the prescription you receive. Or preferably a summary of your overall assessment and findings of digital rectal examination if they did while examining you.

Your history of feeling lump in the perineum plus constipation and pain with tenderness in the area over background of the obesity suggest descending perineum syndrome a condition where the pelvic floor muscles are tender and leading to inordinate pooping mechanism resulting in constipation as well.

I would like to ask you for some investigations, that will help us to establish the diagnosis and later can suggest you treatment for it. The test is called a rectal balloon expulsion test. In this, a rectal catheter is placed inside the rectum and the balloon inside the catheter is filled with 50 cc of water, and examiner ask you to expel it. Failing to expel within 2 minutes suggest descending perineal syndrome or pelvic dyssynergia. The other test is barium defecography, which is a radiology based tests requiring you to visit to a radiologist and get an appointment.

Let me know your thoughts on this, particularly your feasibility is important. Also, let me know how severe you feel the constipation? Is the pain a predominant feature or the constipation? And did you ever use finger to evacuate the stools? Are you sitting long time in the restroom before you pass the stools? Have you ever noticed blood in the stools?

Share with me all the blood investigations you had in the past, that will help to exclude any other accompanying problem namely diabetes, cholesterol, and liver dysfunction secondary to obesity.