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All of a sudden I developed a small marble-sized lump in the lower wall of the rectal canal. It happened virtually overnight. It seems kind of hard and doesn't really hurt. I've been exceptionally fortunate ever since I had the original j-pouch surgeries. I have had an incisional hernia repair, but this is the first real concern I've had in a long time. Obviously any kind of lump gets my attention. Any ideas?

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The description sounds like a rectal abscess, except that you say it does not hurt. By the time an abscess gets hard, it is quite painful. so, my other thought would be an internal hemorrhoid. Could also be a fissure, but again, you should be having some serious pain with that. You can take a wait-and-see approach or put a call to your GI or surgeon, depending on how concerned you are.

The main guide for your urgency for treatment is how it feels or affects you. With a hemorrhoid is is OK to wait and see if things get worse or it resolves on its own. In the meantime, if you are straining at stool, it is time to rethink your toilet habits and you need to fix problems of too loose or too thick stool.

Jan Smiler
Jan Dollar
Alas, I've been doing some reading and tend to think that it's likely a perianal abscess. Whether that's right or not, I guess it's time for the doctor. Only problem is that I recently retired and moved to Phoenix. While I do have a primary care doc, I don't have a colo-rectal surgeon down here yet. Looks like that needs to change pretty quickly. With type II diabetes, one doesn't want to mess with infections.
D
Deathstalker, you are right. Abscesses can be painless in the earlier stages and they can go from barely noticeable to very painful practically overnight. Plus, it could be quietly causing a fistula without symptoms. It all depends on where it is located and if there are pain sensors in that area. Once you get above the dentate line (where the anal ends), there are no pain sensors. That's why internal hemorrhoids don't hurt like externals.

And yes! Being a diabetic, you don't want to mess around with wondering what this is. You can have your primary put in an urgent referral to a GI, which probably will get you an earlier appointment than a colorectal surgeon. The GI can refer you to the surgeon if necessary.

Jan Smiler
Jan Dollar
Well thank God, my little lump just disappeared. Went as quickly as it came on. Never did hurt, and I just procrastinated about getting a referral to a colo-rectal surgeon. In the meantime it just went away and hasn't returned. I think Jan was right from the outset: some kind of hemorrhoid. It's been almost a month and all is quiet on the southern front (or back, that is).
D

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