Why is there a bump on my butthole or in my butt crack?

Most bumps in this area are common and treatable things like hemorrhoids, skin tags, folliculitis (an irritated hair follicle), or a pilonidal cyst near the tailbone. The research on this exact question is very limited — mostly single-patient case reports — but it also shows that occasionally a similar-looking bump turns out to be something more serious, like an infection or a growth that needs different treatment. A doctor can usually tell these apart with an exam.

What does it mean if you have a small bump at the top of your butt crack?

A bump right at the top of the buttock crease, near the tailbone, is a classic location for a pilonidal cyst — a small pocket that can form around a hair follicle and sometimes becomes infected. Case reports also describe rarer look-alikes in this exact spot, so a bump that keeps coming back or becomes painful is worth having looked at rather than assumed.

Why do I keep getting bumps on my butt?

Recurring bumps are often described in case reports as pilonidal disease, hidradenitis suppurativa (a condition causing recurring boil-like lumps), or folliculitis. No study in this review measured how often each cause leads to repeat bumps, so there's no reliable number to give you — but a pattern of repeat bumps in the same spot is a good reason to get a diagnosis rather than keep treating each one as new.

Why do I have bumps on my inner butt cheeks?

Bumps on the buttock skin itself, rather than right at the anus, are more often related to irritated hair follicles, skin infections, or cysts than to anal conditions like hemorrhoids. This review didn't find a study that sorted out causes specifically by location on the buttock, so this answer is based on how these conditions are generally described rather than a dedicated study.

How do I get rid of a bump on my butt — and when should I see a doctor instead of waiting?

What gets rid of a bump depends entirely on what's causing it, and no study has tested one treatment against another for an undiagnosed bump — so there's no single answer here. Given that case reports in this review describe serious conditions (including cancer and severe infection) that were first mistaken for an ordinary bump, see a doctor rather than self-treat if yours is new, growing, bleeding, very painful, or hasn't improved after a couple of weeks.

Why is there a bump on my butt or anus?

Name: Why is there a bump on my butt or anus?
Published: 2026-10-13
Keywords: why is there a bump on my butthole, why do i have a bump on my butt crack, why is there a bump at the top of my bum crack, why do i have a bump on my butt hole, why do i keep getting bumps on my butt, why do i have bumps on my inner butt cheeks, what does it mean if you have a small bump at the top of your butt crack, how to get rid of bump on butt

In people who notice a new lump near the anus, in the gluteal cleft, or on the buttocks, what are the common underlying causes (hemorrhoid, perianal skin tag, pilonidal cyst, anal wart, perianal abscess, folliculitis) and what features (location, pain, size, bleeding, duration) distinguish them?

How people search for this, in their own words

“why is there a bump on my butthole”
“why do i have a bump on my butt crack”
“why is there a bump at the top of my bum crack”
“why do i have a bump on my butt hole”
“why do i keep getting bumps on my butt”
“why do i have bumps on my inner butt cheeks”
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“how to get rid of bump on butt”

Evidence review in plain language · compiled 2026-10-13 · checked 2026-10-13 · next 2026-11-13 · automated review, how it works

Bottom line

A bump near your anus or in your butt crease usually has a simple, treatable cause — but the only evidence available is case reports, and some of those describe serious conditions that were first mistaken for an ordinary bump.

No clinical trials have studied why these bumps happen or compared treatments — the evidence is almost entirely single-patient case reports and small retrospective studies, and they often disagree with each other, so confidence in any conclusion here is very low. Several case reports describe bumps assumed to be hemorrhoids, cysts, or abscesses that turned out, on biopsy or further testing, to be cancer, a severe infection, or other serious disease. That doesn't mean a bump is usually serious — it means a lump that is new, growing, bleeding, or not improving should be examined rather than assumed.

How certain

Very low

Only observational evidence addresses this question (5 studies). The studies disagree with one another, so the overall certainty is lower than any single one of them.

What it shows

Signal of harm

6 studies reported harm or tissue damage, including laboratory evidence.

studies found: 133studies found
randomised trials: 0randomised trials
people studied: 7,367people studied
reviews of trials: 3reviews of trials
years covered: 2012–2026years covered

Read this first

Case reports describe anal cancer, melanoma, sarcoma, and other serious growths that were initially diagnosed as hemorrhoids, a cyst, or an abscess, sometimes delaying the correct treatment.
A few case reports describe serious infections — including tuberculosis and a rapidly spreading infection called Fournier's gangrene — presenting as a swelling or abscess near the anus or buttock.
One case report describes a death from surgical complications after an operation for a rare cancer that had been growing, undetected, inside a long-standing fistula.
In these case reports, surgery or drainage to find and treat the cause of a lump usually worked, but sometimes the true cause was only discovered during the operation itself despite earlier imaging, and one patient needed several previous surgeries before a hidden cyst behind the rectum was finally found and removed; beyond this diagnostic delay, the reports did not describe other complications from the procedures.

What the research shows

Which condition is actually causing the bump
Only one small study tried to measure how often each cause explains a bump — in 59 people with perianal itching, fistula was most common, then abscess, pilonidal sinus, and hemorrhoids. Everything else in this review is single-patient reports of rare causes, so there's no reliable overall breakdown for the general population.[1]
Insufficient evidence
Whether pain or tenderness tells you the cause
No study systematically compared pain across causes. Case reports describe both painful and painless bumps for almost every diagnosis, including cancer, so pain alone does not reliably point to one cause over another.[1,2,3]
Not studied
Whether bleeding tells you the cause
Bleeding was reported with both harmless and serious causes in these case reports, including anal cancers that were first mistaken for hemorrhoids. On its own, bleeding does not reliably separate a minor cause from a serious one.[1,2,3,4]
Insufficient evidence
Whether the bump shrinks or goes away by itself
No study followed people with a new, untreated bump to see how often it resolves on its own without any treatment.
Not studied
Recurrence after the bump is treated or removed
Single case reports describe no recurrence after surgery for specific conditions like a fistula or a growth, sometimes followed for months or a couple of years, but no study compared recurrence rates across different causes or treatments.[1,2,3,4,5]
Insufficient evidence
Whether drainage or surgery is needed
No trial compared surgery or drainage against simply watching a bump. In the case reports, treatment was chosen to match whatever the final diagnosis turned out to be, not tested against an alternative.
Not studied
Risk that the bump is something more serious than it looks
Multiple case reports describe bumps first assumed to be hemorrhoids, an abscess, or a cyst that were later found to be cancer, a dangerous infection, or a malignant change in long-standing tissue, sometimes after a diagnostic delay.[1,2,3,4,5,6,7,8,9,10,11,12]
Possible harm

What it may help with

In small studies, imaging such as MRI or ultrasound correctly told apart specific causes when the diagnosis was unclear from examination alone — for example, separating a pus-filled abscess from simple inflammation, or identifying a pilonidal or presacral cyst that had been mistaken for something else.[1,2,3,4,5,6]
Case reports describe several infections that cause a perianal or gluteal lump — including tuberculosis, histoplasmosis, a pinworm (Enterobius) infection, and Listeria — that resolved fully once treated with the right antibiotic, antifungal, or antiparasitic medicine.[1,2,3,4]
A careful history and physical exam were described as able to distinguish common conditions like hemorrhoids, abscess, fistula, fissure, and genital warts in most cases, without needing imaging.[1,2,3]

Important limitations

Almost every study here is a single-patient case report of low or very low quality — useful for showing what is possible, but not for saying how common any cause is in someone like you.[1,2,3,4,5,6,7,8,9,10]
The one study that counted causes in real patients only looked at 59 people with itching (not bumps generally) at a single clinic over six months, so its breakdown of causes may not apply to you.[1]
Studies that looked at which fistula features point to Crohn's disease versus an ordinary (cryptoglandular) fistula did not fully agree: one study found complex or high fistulas were far more common in Crohn's disease (40.4% vs 4.8%), and another found intramural abscesses and complex tracts were strong predictors of Crohn's disease, while a third study found rectal inflammation was more common in Crohn's disease (29.2% vs 6.7%) but fistula type and abscess rates were similar between Crohn's and non-Crohn's groups.[1,2,3]

What the studies found

Found a benefit36 · 27%
Mixed or unclear91 · 68%
Found possible harm6 · 5%

What kind of studies

Case series72 · 54%
Narrative review33 · 25%
Retrospective18 · 14%
Prospective cohort5 · 4%
Systematic review2 · 2%
Meta-analysis1 · 1%
Case-control1 · 1%
Registry1 · 1%

The studies that decided it

Davra et al. 2026
Unraveling the Causes of Perianal Itching: Magnetic Resonance Imaging as a Diagnostic Tool for Perianal Fistulas and Its Mimics
Fistula or abscess most common causes.Prospective cohortLow quality
59 people2026
Perianal fistula was the most common cause (57.6%), followed by abscess (33.9%), pilonidal sinus (5.1%) and hemorrhoids (3.4%); MRI findings matched clinical and surgical findings well
Who was studied
adults aged 18 and older with perianal itching
What they received
MRI scan to diagnose cause of perianal itching
Compared with
clinical and surgical findings
Main outcome
identifying and classifying the underlying cause (fistula, abscess, pilonidal sinus, hemorrhoids)
Quality
This is a small observational study without a comparison group testing a treatment, so it shows what causes the bump but not whether any treatment works better than another.
Limitations
Small sample size of 59 patients from a single department over 6 months; no control group or treatment comparison.
Taken word for word from the abstract
- n included 59 patients aged ≥ 18 years with perianal itching
- population included 59 patients aged ≥ 18 years with perianal itching
- intervention MRI (1.5T) pelvis scans were obtained using T1, T2, short tau inversion recovery, diffusion-weighted imaging, apparent diffusion coefficient and postcontrast sequences
- comparator MRI findings showed high concordance with clinical and surgical data
- primaryOutcome evaluate the diagnostic utility of MRI in patients with perianal itching, focusing on the identification and classification of perianal fistulas and their mimics
- result Among 59 cases, perianal fistula was most common (57.6%), followed by abscess (33.9%), pilonidal sinus (5.1%) and hemorrhoids (3.4%).
- result MRI findings showed high concordance with clinical and surgical data.
Ann Afr Med · PMID 40952828 · Read it on PubMed ↗
Guo et al. 2021
Perianal and perineal rhabdomyosarcomas: a retrospective multicenter study of 35 cases
Rare cancerous lump, often misdiagnosed as abscess.RetrospectiveLow quality
35 people2021
Most patients presented with a perianal mass, often painful, and 16 of 20 painful cases were initially misdiagnosed as perianal abscess; overall survival was poor, with 32% alive at 2 years and 24% at 5 years
Who was studied
patients with a perianal or perineal mass later diagnosed with rhabdomyosarcoma (a rare soft tissue cancer)
What they received
no single intervention tested; study described diagnosis and various treatments (surgery, chemo/radiotherapy) used in these patients
Compared with
none (descriptive case series, no comparison group)
Main outcome
diagnostic accuracy (misdiagnosis rate) and survival outcomes
Quality
This is a small retrospective collection of 35 cases (partly from literature review) without a comparison group, so it can only describe patterns, not prove cause or treatment effect.
Limitations
Retrospective design, small number of cases pooled from a single center and prior literature, no control group, risk of selection and reporting bias.
Taken word for word from the abstract
- n A total of 35 patients were included in this study
- population 34 presented with perianal masses and the remaining one manifested as an inguinal mass
- intervention Multidisciplinary management is recommended in the treatment of PRMS.
- comparator The Chi-square test was used to evaluate the differences between each group.
- primaryOutcome to analyze the clinical, diagnostic, pathological and prognostic features of PRMS
- result 16 of them were misdiagnosed as perianal abscesses, in which the presence of pain contributed to the misdiagnosis (p < 0.05)
- result The overall 2 years and 5 years survival rates were 32% and 24%, respectively.
BMC Surg · PMID 33516222 · Read it on PubMed ↗
Samarska et al. 2019
Condyloma Acuminatum of Urinary Bladder: Relation to Squamous Cell Carcinoma
Bladder (not anal) wart linked to bladder cancerCase seriesVery low qualityRelated question
38 people6 y
condyloma of the bladder was strongly linked to squamous cell carcinoma of the bladder, found in 44.7% of patients
Who was studied
patients with condyloma acuminatum (wart-like growths) found in the urinary bladder
What they received
none (observational study of bladder condyloma lesions, not a treatment)
Main outcome
association between bladder condyloma and squamous cell carcinoma of the bladder
Quality
this is a small retrospective review of specialist consult cases with no comparison group, so it can only suggest an association, not prove risk.
Limitations
Retrospective, selected from consult files (likely unusual/referred cases), no control group, and condyloma location studied is inside the bladder, not the skin around the anus.
Taken word for word from the abstract
- population We studied 51 cases of condyloma acuminatum of the urinary bladder from transurethral resections of the urinary bladder of 38 patients
- n from transurethral resections of the urinary bladder of 38 patients
- primaryOutcome is considered to be a risk factor for squamous cell carcinoma
- result In total, 17 patients (17/38; 44.7%) had squamous cell carcinoma of the bladder, either invasive or in situ.
- result condyloma acuminatum of the urinary bladder shows a strong association with squamous cell carcinoma of the bladder
- followUp The follow-up period ranged from 15 months to 20 years (median: 6 y).
- intervention Transurethral resections of the urinary bladder were obtained from 25 males with a median age of 73 years (range: 41 to 87 y) and 13 females with a median age of 68 years (range: 30 to 86 y).
Am J Surg Pathol · PMID 31368913 · Read it on PubMed ↗
Val-Bernal et al. 2016
Incidental Melanocytic Nevi in Hemorrhoidectomy Specimens
Rare benign mole found in hemorrhoid tissue.RetrospectiveLow qualityRelated question
1,918 people2016
benign moles were found in 4 out of 1918 patients (about 1 in 480 specimens), all benign with no signs of cancer
Who was studied
adults who had surgery to remove hemorrhoids
What they received
routine microscopic examination of removed hemorrhoid tissue
Compared with
none
Main outcome
how often benign moles (melanocytic nevi) are found incidentally in hemorrhoid tissue
Quality
this is a retrospective review of pathology specimens from one center, not a treatment study, so it only shows how often a finding occurs rather than comparing outcomes.
Limitations
retrospective, single-institution review of surgical specimens; does not address why a lump might form in the first place, only an incidental finding during pathology review.
Taken word for word from the abstract
- n a series of 1918 consecutive hemorrhoidectomies performed between January 2004 and November 2012
- population hemorrhoidal tissue obtained in a series of 1918 consecutive hemorrhoidectomies
- intervention retrospective histologic study of the hemorrhoidal tissue
- comparator RESULTS: Incidental hemorrhoidal MN were detected in 4 (0.21%) patients.
- primaryOutcome There are no data on incidence of these lesions.
- result Incidental hemorrhoidal MN were detected in 4 (0.21%) patients. The ratio observed was 1 nevus in 480 specimens.
Am J Dermatopathol · PMID 26332535 · Read it on PubMed ↗
Marres et al. 2014
[Patients with a therapy-resistant anal fissure: beware of malignancies]
Fissure hid anal cancer.Case seriesVery low quality
3 people2014
all three patients turned out to have anal cancer
Who was studied
adults with anal fissures that did not respond to treatment, aged 53, 39 and 70
What they received
examination under anaesthesia with biopsy
Compared with
none
Main outcome
finding of cancer in the anal area
Quality
only three cases with no comparison group, so it cannot show how common this is
Limitations
Very small number of patients and no control group; abstract does not describe how patients were selected.
Taken word for word from the abstract
- n three patients aged 53, 39 and 70
- population three patients aged 53, 39 and 70 with a therapy-resistant anal fissure
- intervention Each patient was inspected under anaesthesia
- comparator In all three cases a suspicious lesion or swelling was observed and all biopsies taken showed anal malignancies.
- primaryOutcome all biopsies taken showed anal malignancies
- result all biopsies taken showed anal malignancies
Ned Tijdschr Geneeskd · PMID 25308220 · Read it on PubMed ↗
Abramowitz et al. 2014
The prevalence of proctological symptoms amongst patients who see general practitioners in France
Anal lumps often hidden, usually hemorrhoidsProspective cohortLow qualityRelated question
1,079 people2014
only 2% of patients came in mainly for anal symptoms, but questioning uncovered anal symptoms in 14%, most often bleeding, pain, itching, or swelling, with diagnoses including hemorrhoids and anal fissure
Who was studied
adult patients seen during general practice consultations in France
What they received
doctors specifically asking patients about anal symptoms during the visit
Compared with
patients who came in on their own without being asked about anal symptoms
Main outcome
how often anal/proctological symptoms were found, either spontaneously reported or only after questioning
Quality
this was a one-time questionnaire survey of GP visits with no comparison group or long-term follow-up, so it can only show how common symptoms are, not why a bump happens or what helps.
Limitations
Self-reported symptoms, short 2.5-day sampling window, single-country general practice setting, and diagnoses based partly on questioning alone rather than examination.
Taken word for word from the abstract
- n A total of 1079 questionnaires were completed
- population all patients seen prospectively over 2.5 days of consultations
- intervention Following questioning, an anal symptom was found in 153 patients (14%).
- comparator Twenty-two patients (2%) were seen primarily for anal symptoms.
- primaryOutcome assessing how many of these are spontaneously diagnosed and how many are diagnosed after questioning the patient
- result Symptoms reported were: bleeding (32%), pain (31%), pruritus ani (22%), swelling (22%), oozing (14%), and anal discharge (14%). Physicians' diagnoses were: haemorrhoids, anal fissure, anal discharge, dermatology disease, and functional disorder.
Eur J Gen Pract · PMID 24702041 · Read it on PubMed ↗
Dwarkasing et al. 2013
Chronic anal and perianal pain resolved with MRI
MRI found a cause in some casesRetrospectiveLow qualityRelated question
103 people2013
MRI showed abnormalities that were confirmed as the final diagnosis in 39% of patients, mostly abscess-type lesions or scarring
Who was studied
patients with chronic anal and perianal pain without a clear diagnosis after clinical work-up
What they received
MRI scan of the anus and rectum
Compared with
clinical follow-up and later diagnosis (no imaging-based comparison group)
Main outcome
whether MRI findings explained the cause of the pain, confirmed by follow-up
Quality
this is a single-center diagnostic study without a control group or randomization, so it shows MRI can sometimes find a cause but doesn't test whether any treatment works
Limitations
no comparison group, single tertiary referral center, and most patients still had no explanation found on MRI
Taken word for word from the abstract
- population Patients referred from a tertiary department of colorectal surgery to the MRI unit with clinically occult chronic anal and perianal pain were included.
- intervention MRI of the anorectum was performed with an endoanal or pelvic phased-array coil.
- comparator MRI findings were correlated with clinical follow-up data.
- primaryOutcome The purpose of this study was to assess the diagnostic value of anorectal MRI in the care of patients with chronic anal and perianal pain but without findings of abnormalities in the clinical workup.
- result MRI findings suggested the final diagnoses in 40 patients (39%).
- n The study group (103 patients) was stratified into patients with no history of anorectal disease (n = 60) and those who had a history of surgery for anorectal disease (n = 43).
AJR Am J Roentgenol · PMID 23617486 · Read it on PubMed ↗
Pandey et al. 2014
Squamous cell carcinoma arising from pilonidal sinus
Rare cancer from long-standing pilonidal sinus.Case seriesVery low quality
1 people2014
the chronic pilonidal sinus had turned into squamous cell carcinoma
Who was studied
person with long-standing pilonidal sinus (a chronic sinus near the tailbone)
What they received
none described (observation of disease course)
Compared with
none
Main outcome
development of squamous cell carcinoma (skin cancer) in a chronic pilonidal sinus
Quality
this is a single patient case report, so it cannot show how common or likely this outcome is for others.
Limitations
single case report with no comparison group or treatment outcome data
Taken word for word from the abstract
- n We report a case of chronic pilonidal sinus complicated with squamous cell carcinoma.
- population Pilonidal sinus is usually present in the sacrococcygeal region.
- intervention We report a case of chronic pilonidal sinus complicated with squamous cell carcinoma.
- comparator We report a case of chronic pilonidal sinus complicated with squamous cell carcinoma.
- primaryOutcome Rarely malignant change may be seen in chronic pilonidal sinus.
- result We report a case of chronic pilonidal sinus complicated with squamous cell carcinoma.
Int Wound J · PMID 23050944 · Read it on PubMed ↗

What actually helps, on this site

More about the condition:

All 133 studiesEvery study that answered the question, with its design, size and result.

The other 125 studiesEverything else the search returned, including anything retracted.

Yang et al. 2026
Langerhans cell histiocytosis in the adult lower gastrointestinal tract
Rare disease, cleared with chemotherapy.Case seriesVery low quality
1 people2026
complete remission of the disease after cladribine treatment
Who was studied
an older woman (early 80s) with a persistent anal fissure
What they received
chemotherapy with cladribine for Langerhans cell histiocytosis affecting the colon and anus
Compared with
none (no comparison treatment)
Main outcome
resolution of the Langerhans cell histiocytosis symptoms and lesions
Quality
It is a single patient case report, so it cannot show how the treatment works in general.
Limitations
Only one patient was described, so the findings cannot be generalized.
Taken word for word from the abstract
- population A female in her early 80s presented with chronic anal fissures
- intervention The patient was treated with cladribine as systemic chemotherapy
- comparator The patient was treated with cladribine as systemic chemotherapy, resulting in complete remission of LCH symptoms and lesions.
- primaryOutcome resulting in complete remission of LCH symptoms and lesions
- result resulting in complete remission of LCH symptoms and lesions
- n A female in her early 80s presented with chronic anal fissures
BMJ Case Rep · PMID 42481139 · Read it on PubMed ↗
Wang et al. 2026
Giant condyloma acuminatum in a patient with HIV infection: a case report
HPV-related growth, cleared by surgery.Case seriesVery low quality
1 people3-month follow-up
wound fully healed and no recurrence at 3 months after surgery
Who was studied
a 24-year-old man with HIV infection and poor adherence to HIV medication, with a growing lump near the anus
What they received
surgical removal of the mass plus improved HIV treatment and antibiotics
Compared with
no comparison group (single patient case report)
Main outcome
healing of the wound and whether the lump came back
Quality
This is a single patient's case report, so it cannot show whether this treatment works in general.
Limitations
Only one patient, short follow-up of 3 months, no comparison group
Taken word for word from the abstract
- n a 24-year-old man with a 7-year history of HIV infection
- population a 24-year-old man with a 7-year history of HIV infection who had suboptimal adherence to antiretroviral therapy (ART)
- intervention He underwent wide local excision of the mass and received optimized antiretroviral therapy, culture-guided antimicrobial therapy, and supportive care.
- comparator We describe a 24-year-old man
- primaryOutcome At 3-month follow-up, the wound had completely healed, anal sphincter function was preserved, and there was no evidence of recurrence.
- result At 3-month follow-up, the wound had completely healed, anal sphincter function was preserved, and there was no evidence of recurrence.
- followUp At 3-month follow-up
AIDS Res Ther · PMID 42231443 · Read it on PubMed ↗
Maconi et al. 2026
Transperineal contrast-enhanced ultrasound: a rapid and reliable tool for differentiating abscesses from inflammatory masses in perianal Crohn's disease
better scan tells abscess from inflamed lumpRetrospectiveLow qualityRelated question
37 people2026
the contrast ultrasound reclassified many lumps compared with standard ultrasound and doctors agreed with each other and with themselves much more often using it
Who was studied
adults with Crohn's disease who had painful bumps or swelling near the anus and possible infection
What they received
contrast-enhanced ultrasound scan done through the skin near the anus
Compared with
standard ultrasound without contrast
Main outcome
how well the scan told apart a pus-filled abscess from a non-pus inflamed lump
Quality
this was a small retrospective review of ultrasound recordings in Crohn's patients, not a trial testing whether treatment or outcomes improved
Limitations
retrospective design, small number of patients, only examined selected lesions over 10mm, excluded simple fistulas and large obvious abscesses
Taken word for word from the abstract
- n 52 examinations of 37 adult CD patients
- population CD patients with perianal symptoms and suspected septic complications
- intervention transperineal CEUS
- comparator conventional B-mode TPUS
- primaryOutcome Lesions were classified as abscesses, inflammatory masses, or phlegmons.
- result Of the 17 abscesses diagnosed on B-mode, only 4 were also classified as abscesses on CEUS, while 13 were reclassified; conversely, 11 inflammatory masses were reclassified as abscesses.
Inflamm Bowel Dis · PMID 42191223 · Read it on PubMed ↗
Stoker et al. 2026
How I Do It: MRI Approach to Perianal Fistulas
Bump may be an anal fistula from infection.Narrative reviewLow quality
size not given2026
MRI with described imaging technique helps classify fistula type/extent and assess healing, and radiologists should distinguish it from mimics like pilonidal sinus or hidradenitis suppurativa
Who was studied
people with a perianal fistula, including those with Crohn disease
What they received
pelvic MRI to examine the fistula
Main outcome
accurate classification, extent, and treatment response/healing of the fistula
Quality
This is an expert narrative review describing an imaging technique, not a study comparing outcomes with numbers of patients.
Limitations
No patient numbers, no comparative data, and no outcome statistics are reported; it is a descriptive 'how I do it' guide rather than a research study.
Taken word for word from the abstract
- population Most cases result from chronic infection of the anal glands (cryptoglandular), leading to an internal opening in the anal canal and an external opening that discharges fluid.
- intervention Pelvic MRI has become essential for its management because it helps accurately classify the type and extent of the fistula, enabling optimized preoperative planning before surgery.
- primaryOutcome Easy-to-use imaging criteria have been proposed to assess treatment response and healing in daily practice
- result It is particularly useful for perianal fistulas in patients with Crohn disease, in whom infections are often extensive.
- result Radiologists should be aware of mimics, such as pilonidal sinus and hidradenitis suppurativa, and recognize that cancers can rarely develop in fistulas.
Radiology · PMID 42117990 · Read it on PubMed ↗
Fornell-Perez 2026
Perianal pathology beyond fistulizing disease: spectrum of MRI findings and diagnostic pitfalls
Describes imaging look of bumps, no outcomes.Narrative reviewVery low qualityRelated question
size not given2026
This review describes imaging features of many non-fistula-related perianal conditions to help tell them apart, without reporting outcome data or accuracy figures
Who was studied
people with lumps or abnormalities near the anus
What they received
MRI imaging to identify the cause
Compared with
none
Main outcome
ability to correctly identify and distinguish types of perianal conditions on imaging
Quality
This is a narrative review of case examples and imaging teaching points, not a study measuring outcomes in patients.
Limitations
No patient numbers, no outcome data, no comparison of methods — it is a descriptive/teaching review based on selected cases.
Taken word for word from the abstract
- population perianal abnormalities may also be incidentally detected on pelvic MRI studies performed for unrelated indications
- intervention Magnetic resonance imaging (MRI) of the perianal region is frequently performed
- comparator Selected complementary computed tomography findings are included when relevant.
- primaryOutcome emphasizing key imaging features that aid in differential diagnosis across a broad range of benign and malignant conditions
- result This review focuses on the MRI appearance of non-fistulizing perianal pathology, emphasizing key imaging features that aid in differential diagnosis across a broad range of benign and malignant conditions.
Abdom Radiol (NY) · PMID 41998420 · Read it on PubMed ↗
Akyel et al. 2026
Perianal and gluteal parasitic abscess of Enterobius vermicularis: case report and review of the literature
Pinworm infection caused the lump.Case seriesVery low quality
1 peopleone-month follow-up MRI
the lump nearly completely went away one month after drainage and treatment
Who was studied
a 17-year-old girl with abdominal pain during her period
What they received
surgical drainage followed by anti-parasite medication (pyrantel pamoate)
Compared with
none
Main outcome
resolution of the perianal/gluteal lump on follow-up MRI
Quality
this is a single patient case report, so it cannot show how often this treatment works for others.
Limitations
only one patient was described, and this is a rare presentation of a common infection.
Taken word for word from the abstract
- population A 17-year-old female presented with abdominal pain during menstruation.
- n A 17-year-old female presented
- intervention The patient was treated with surgical drainage followed by pyrantel pamoate
- primaryOutcome resulting in near-complete resolution of the lesion at the one-month follow-up MRI
- result resulting in near-complete resolution of the lesion at the one-month follow-up MRI
- comparator Surgical drainage revealed pus, and cytological analysis identified abundant parasitic oocytes consistent with E. vermicularis.
Turk J Pediatr · PMID 41871566 · Read it on PubMed ↗
Kupietzky et al. 2026
Benign Presacral Tumor Mimicking a Pilonidal Abscess: A Diagnostic Pitfall
Bump was a benign cyst, not an abscessCase seriesVery low qualityRelated question
1 people2026
the lump was not an infection but a benign cyst behind the rectum, successfully removed with no complications
Who was studied
a 43-year-old woman with a slowly growing lump near the tailbone
What they received
surgical removal of the mass via a Kraske approach
Compared with
none
Main outcome
final diagnosis and surgical outcome
Quality
this is a single patient case report, so it cannot show how common this is or what usually works best
Limitations
only one patient described, no comparison group, findings may not generalize
Taken word for word from the abstract
- n A 43-year-old woman presented with a gradually enlarging mass in the pilonidal region over the course of several months.
- population A 43-year-old woman presented with a gradually enlarging mass in the pilonidal region over the course of several months.
- intervention a Kraske approach was selected for surgical excision
- comparator Presacral tumors are rare and heterogeneous neoplasms
- primaryOutcome The specimen was sent for pathological evaluation, which revealed a retrorectal epidermal cyst.
- result revealed a retrorectal epidermal cyst. The patient's postoperative course was uneventful, and she was discharged on postoperative day one.
Isr Med Assoc J · PMID 41800580 · Read it on PubMed ↗
Kristjansdottir et al. 2026
[Perianal tuberculosis]
Rare TB cause, fully treatable.Case seriesVery low quality
1 peoplesix-month course of anti-tuberculosis medications
the perianal wound and underlying tuberculosis infection healed fully after treatment
Who was studied
a healthy 41-year-old man
What they received
surgical drainage followed by six months of anti-tuberculosis medication
Main outcome
wound healing and resolution of infection
Quality
this is a single patient case report, so it cannot show how often this happens or what works best in general
Limitations
single case report with no comparison group, so findings cannot be generalized
Taken word for word from the abstract
- population This report describes a healthy 41-year-old man diagnosed with a perianal abscess
- n a healthy 41-year-old man
- intervention required examination and surgical drainage under general anesthesia
- intervention The patient received a six-month course of anti-tuberculosis medications
- result The patient received a six-month course of anti-tuberculosis medications and recovered fully. The perianal wound healed well following treatment.
- primaryOutcome The wound healed poorly over the following months, prompting repeat cultures and tissue sampling.
Laeknabladid · PMID 41733318 · Read it on PubMed ↗
Kuru Öz et al. 2026
Atypical course of fistulas and intramural abscesses in patients with perianal fistula on magnetic resonance imaging: predictive signs for Crohn's disease?
MRI clues may signal Crohn's-related fistula.RetrospectiveLow qualityRelated question
624 people2026
Abscesses inside the bowel wall, complex fistula tracts, and certain opening locations were strongly linked to Crohn's disease, while fistulas passing through the anal sphincter muscle were usually not Crohn's-related
Who was studied
patients with perianal fistulas who had MRI scans
What they received
MRI features of the fistula (such as abscesses inside the bowel wall, complex fistula tracts, and opening location)
Compared with
fistulas not caused by Crohn's disease (cryptoglandular/idiopathic fistulas)
Main outcome
whether certain MRI features could identify Crohn's disease as the cause of the fistula
Quality
This was a retrospective look-back at scans rather than a forward-planned study, so it can show patterns but not prove cause and effect.
Limitations
Retrospective analysis; study looks at distinguishing disease causes rather than directly answering why a lump forms.
Taken word for word from the abstract
- n A retrospective analysis of 624 patients with perianal fistulas was conducted via magnetic resonance imaging (MRI).
- population 624 patients with perianal fistulas
- intervention Fistulas were classified by type, complexity, activity, course within the EAS, and presence of intramural abscesses.
- comparator primarily of cryptoglandular origin (87.3 %), with a minority associated with CD (7.9 %)
- primaryOutcome Logistic regression analyses identified factors differentiating CD-associated fistulas from idiopathic fistulas.
- result Intramural abscesses, which are significantly more prevalent in CD patients (P<.001), increased the likelihood of CD by 9.4-fold (95 % CI: 3.08-28.70, P<.001). Additionally, complex fistulas (OR = 2.46, P<.001) and internal orifice localisation in the proximal anal canal or distal rectum (OR = 2.26, P=.002) were identified as independent predictors of CD.
Clin Radiol · PMID 41455178 · Read it on PubMed ↗
Chatziisaak et al. 2025
The diagnostic value of faecal calprotectin levels in patients with perianal fistula: A systematic review
Stool test may help find cause.Systematic reviewLow qualityRelated question
3 people2025
stool calprotectin was higher in fistulas caused by inflammatory bowel disease, with moderate to high accuracy at distinguishing the two causes
Who was studied
people with a fistula (tunnel) near the anus
What they received
stool test for calprotectin (a marker of gut inflammation)
Compared with
no calprotectin testing / diagnosis based on other methods
Main outcome
ability of the stool test to tell apart fistulas caused by inflammatory bowel disease versus ordinary gland infection
Quality
Only three small studies were pooled without a meta-analysis, and cut-off values varied widely, so the evidence is not strong enough to be confident.
Limitations
Only three studies included, varying cut-off values, and sensitivities/specificities were inconsistent across studies.
Taken word for word from the abstract
- population Studies were included if they assessed FC levels in patients with PAF and provided diagnostic accuracy metrics.
- intervention Faecal calprotectin (FC) has emerged as a promising non-invasive biomarker for IBD
- comparator distinguishing IBD-related perianal disease from CGD
- primaryOutcome evaluate the diagnostic accuracy of FC in distinguishing IBD-related perianal disease from CGD
- result all reporting significantly higher FC levels in IBD-related PAF compared to CGD-related fistulas
- n Three studies met the inclusion criteria
Colorectal Dis · PMID 41345764 · Read it on PubMed ↗
Chen et al. 2025
Extrasphincteric anal fistula with gluteal extension: A case report and literature review
Fistula healed after surgery.Case seriesVery low quality
1 people18 months
After surgery the patient had no purulent discharge, swelling, or pain in the buttocks, and the wound healed well over 18 months of follow-up
Who was studied
27-year-old woman with 6 months of buttock pain, swelling and discharge
What they received
surgery to remove the fistula and infected tissue, with drainage
Compared with
none (single patient, before-and-after treatment)
Main outcome
resolution of discharge, swelling, pain and wound healing after surgery
Quality
This is a single patient case report, so it cannot show how typical or reliable this outcome would be for others.
Limitations
Only one patient was described, with no comparison group, so results may not generalize.
Taken word for word from the abstract
- n A 27-year-old female patient presented with pain, swelling, and purulent discharge in the buttocks persisting for 6 months
- population A 27-year-old female patient presented with pain, swelling, and purulent discharge in the buttocks persisting for 6 months, with a recent exacerbation over the last 2 days.
- intervention The surgical intervention involving complete fistula dissection, excision of the affected area's apex in the buttocks, removal of necrotic material, fibrous tissue debridement, and thread-draped drainage facilitated fistula tract healing
- comparator OUTCOMES: After treatment, the patient showed no purulent discharge, swelling, or pain in the buttocks
- primaryOutcome After treatment, the patient showed no purulent discharge, swelling, or pain in the buttocks, and there was no bleeding or fluid leakage.
- result The patient was followed up for 18 months after the treatment, and the wound healed well, with a satisfactory treatment outcome.
Medicine (Baltimore) · PMID 41239594 · Read it on PubMed ↗
de Bary et al. 2026
Perianal tuberculosis with active pulmonary tuberculosis - a case report and review of the literature
TB can cause anal lumps.Case seriesVery low quality
195 people2026
Perianal TB was found to cause abscess, fistula and ulcer-like lesions, often misdiagnosed for a long time, with pulmonary TB present in about a third of cases
Who was studied
Adults with perianal tuberculosis, including a 47-year-old man with perianal pain and discharge
What they received
Diagnosis and anti-tuberculosis treatment for perianal TB
Compared with
No comparator group
Main outcome
Cause of perianal lumps, abscesses or fistulas and time to diagnosis
Quality
This is a single case report combined with a review of past case reports, not a controlled study, so it can't prove how common or how treatable this cause is.
Limitations
Based on one patient plus pooled case reports from the literature, with no control group and reliance on prior published cases of varying quality.
Taken word for word from the abstract
- population A 47-year-old male presented with perianal pain and purulent discharge.
- intervention The patient was initiated on a 9-month anti-tuberculosis treatment.
- comparator Our literature search identified 59 relevant publications comprising 195 cases.
- primaryOutcome TB must be considered in the differential diagnosis of ulcerative, fistulous and abscess-forming lesions of the perianal area
- result Pulmonary tuberculosis was concurrently present in one third of the cases.
- n 195 cases
Infection · PMID 41201735 · Read it on PubMed ↗
Nouma et al. 2026
Differential diagnosis of perianal herpes: sexual abuse or autoinoculation?
Bump was herpes virus infection.Case seriesVery low quality
1 people2026
lesions were herpes simplex virus type 1, but sexual abuse could not be ruled out or confirmed
Who was studied
13-year-old boy with bumps near the anus
What they received
PCR testing and forensic/psychological evaluation for perianal lesions
Compared with
none
Main outcome
cause of perianal lesions (herpes vs sexual abuse)
Quality
This is a single patient case report, so it cannot show how common this cause is or what usually happens.
Limitations
Single case, diagnostic uncertainty, conflicting findings between PCR and serology, and inconclusive abuse investigation.
Taken word for word from the abstract
- population A 13-year-old boy was referred to the forensic department for suspicion of unreported sexual abuse due to the presence of perianal dermatologic lesions.
- intervention The forensic examination revealed perianal herpes simplex virus type 1 (HSV-1) lesions using nucleic acid amplification by polymerase chain reaction (PCR) outside of any traumatic or other dermatological lesions.
- comparator Both the examination of the alleged aggressor and the serological tests for HSV and STIs were negative.
- primaryOutcome This case presents a challenge in differential diagnosis and highlights the difficulty in interpreting medical findings in cases of suspected sexual abuse.
- result Repeated serological tests for sexually transmitted infections (STIs) were negative. However during the psychological interview, the child reported penile touching by a 15-year-old boy at least one week earlier.
- n A 13-year-old boy was referred to the forensic department
Forensic Sci Med Pathol · PMID 40932585 · Read it on PubMed ↗
Yamanaka-Takaichi et al. 2025
Magnetic Resonance Imaging for Distinguishing Perianal Hidradenitis Suppurativa from Fistulizing Crohn Disease
MRI can help tell apart two causes of anal bumps/tunnels.RetrospectiveLow qualityRelated question
123 people2025
MRI showed different patterns for each disease, and a scoring system built from these differences correctly told the two apart most of the time (sensitivity 0.77, specificity 0.80)
Who was studied
patients with hidradenitis suppurativa or Crohn disease who had bumps/lesions near the anus and underwent pelvic MRI
What they received
MRI scoring system looking at imaging features of the perianal area
Compared with
comparing MRI findings between hidradenitis suppurativa patients and Crohn disease patients
Main outcome
whether MRI features could tell apart hidradenitis suppurativa from Crohn disease as the cause of perianal tunnels/fistulas
Quality
This was a retrospective review of medical records at one hospital, so it shows an association but can't prove the scoring system works well everywhere.
Limitations
Retrospective design, single center (Mayo Clinic), and the scoring system still misclassified roughly 1 in 5 cases.
Taken word for word from the abstract
- n HS group (n = 49) than the CD group (n = 74)
- population This retrospective cohort study included patients diagnosed with CD, HS, or both diseases
- population We further selected patients who had documented perianal lesions and underwent pelvic MRI.
- intervention A radiomics-based MRI scoring system was constructed according to the odds ratios and was validated.
- comparator differences in characteristics of fistulizing perianal CD vs. perianal HS on magnetic resonance imaging (MRI)
- primaryOutcome We sought to determine the differences in characteristics of fistulizing perianal CD vs. perianal HS on magnetic resonance imaging (MRI).
- result The proposed MRI scoring system for distinguishing HS from CD had a sensitivity of 0.77, specificity of 0.80, and area under the curve of 0.84.
Dermatology · PMID 40716427 · Read it on PubMed ↗
Singh et al. 2026
Magnetic resonance imaging to differentiate between Crohn's disease-associated and cryptoglandular perianal fistula
MRI pattern can flag Crohn's-caused fistula.RetrospectiveLow quality
119 people2026
a combined MRI score (DMC index) correctly identified Crohn's-related fistulas with high specificity (94%) and moderate sensitivity (65%), with an area under curve of 0.88
Who was studied
patients with a perianal fistula who had pelvic MRI scans
What they received
MRI-based scoring system (the "DMC index") using features like number of internal openings, rectal thickening and distance of fistula origin from anal verge
Compared with
patients with cryptoglandular (non-Crohn's) perianal fistula
Main outcome
ability of MRI features to tell whether a perianal fistula is caused by Crohn's disease rather than ordinary gland infection
Quality
it is a single-center retrospective review of 119 patients without outside validation, so the scoring tool's accuracy may not hold up elsewhere.
Limitations
retrospective, single-center design; only 119 of 287 scanned patients were analyzed; no external validation of the index mentioned
Taken word for word from the abstract
- population we analyzed the pelvic MRI images of the patients with PAF
- n 119 cases, including 32 (26.89%) patients with an established clinical diagnosis of CD, were analyzed
- intervention The DMC index, with a threshold of ≥ 1.5, demonstrated strong discriminatory ability for CD-associated PAF
- comparator distinguishing them is crucial for treatment decisions
- primaryOutcome distinguishing them is crucial for treatment decisions
- result sensitivity 65%; specificity 94%; area under curve 0.88 [95% CI 0.81-0.95; p < 0.0001]
Indian J Gastroenterol · PMID 40682731 · Read it on PubMed ↗
Mascarenhas et al. 2025
Artificial intelligence and endoanal ultrasound: pioneering automated differentiation of benign anal and sphincter lesions
AI accurately sorted anal injury types.RetrospectiveLow qualityRelated question
238 people2025
AI correctly identified external lacerations 88.2% of the time, internal lacerations 88.2% of the time, and fissures 100% of the time
Who was studied
patients who had endoanal ultrasound exams for anal lacerations or fissures
What they received
AI (CNN) algorithm analyzing ultrasound images to classify anal lesions
Compared with
expert-validated classification of the same images
Main outcome
accuracy of AI in telling apart fissures, internal lacerations, and external lacerations
Quality
it was a small, single-center retrospective study using only 238 exams with no outside testing, so results may not hold up elsewhere
Limitations
small dataset and single-center scope
Taken word for word from the abstract
- population A single-center retrospective study analyzed 238 EUAS radial probe exams (April 2022-January 2024), categorizing 4528 frames into fissures (516), external lacerations (2174), and internal lacerations (1838)
- intervention a convolutional neural network (CNN)-based algorithm for automatic classification of fissures and anal lacerations (internal and external) on EUAS
- comparator following validation by three experts
- primaryOutcome Performance metrics included sensitivity, specificity, and accuracy.
- result For external lacerations, the CNN achieved 82.5% sensitivity, 93.5% specificity, and 88.2% accuracy. For internal lacerations, achieved 91.7% sensitivity, 85.9% specificity, and 88.2% accuracy. For anal fissures, achieved 100% sensitivity, specificity, and accuracy.
- n 238 EUAS radial probe exams
- limitations While currently limited by small dataset and single-center scope
Tech Coloproctol · PMID 40493115 · Read it on PubMed ↗
Hanna et al. 2025
Isolated perianal Crohn's disease: a systematic review and expert consensus proposing novel diagnostic criteria and management advice
New criteria found hidden Crohn's in some.Systematic reviewLow quality
50 people2025
6 of 50 patients (12%) met the new diagnostic criteria for isolated perianal Crohn's disease
Who was studied
people with perianal fistulae (tunnels near the anus) who were being treated as having idiopathic (non-Crohn's) fistulae
What they received
a newly proposed set of diagnostic criteria to identify isolated perianal Crohn's disease
Compared with
usual diagnosis of idiopathic perianal fistulae
Main outcome
whether patients met new diagnostic criteria for isolated perianal Crohn's disease
Quality
The abstract itself says evidence is scarce and the framework is opinion-based and still needs validation.
Limitations
The abstract states the framework is opinion-based, evidence is scarce, and the criteria 'require validation and refinement.'
Taken word for word from the abstract
- n a prospective cohort of 50 patients treated as having idiopathic perianal fistulae at a proctology referral centre
- population a prospective cohort of 50 patients treated as having idiopathic perianal fistulae at a proctology referral centre
- intervention diagnostic criteria and management recommendations for isolated perianal Crohn's disease
- comparator treated as having idiopathic perianal fistulae
- primaryOutcome identifying six (12%) individuals as meeting the diagnostic criteria
- result identifying six (12%) individuals as meeting the diagnostic criteria
Lancet Gastroenterol Hepatol · PMID 40315877 · Read it on PubMed ↗
Guo et al. 2025
Rare giant perianal smooth muscle tumor: A case report
Rare tumor, successfully removed surgically.Case seriesVery low quality
1 people2 years
anus functioned well with no recurrence after 2 years
Who was studied
a 48-year-old woman with perianal swelling and pain
What they received
surgical removal of the tumor
Compared with
none
Main outcome
anal function and recurrence after surgery
Quality
This is a single patient case report, so it cannot show how common this is or what usually happens.
Limitations
Single case report; no comparison group; findings cannot be generalized.
Taken word for word from the abstract
- n A 48-year-old woman presented with perianal swelling and pain
- population A 48-year-old woman presented with perianal swelling and pain and was misdiagnosed with a perianal abscess after examination at a foreign hospital.
- intervention We succeeded in surgically removing the tumor.
- comparator We succeeded in surgically removing the tumor.
- primaryOutcome The patient was followed up for 2 years after the operation, and her anus functioned well without recurrence.
- result her anus functioned well without recurrence
J Int Med Res · PMID 40275791 · Read it on PubMed ↗
Rubio-López et al. 2025
Pilonidal sinus of perianal location. Difficult differential diagnosis with perianal fistula
Bump was a pilonidal sinus, not fistula.Case seriesVery low quality
1 people2025
surgery revealed the lump was actually a pilonidal sinus (hair-containing cyst) in the perianal area, not a true anal fistula
Who was studied
a 39-year-old man with a lump near the anus initially thought to be an anal fistula
What they received
surgery to examine and treat the area
Compared with
none
Main outcome
correct diagnosis of the cause of the perianal lump/fistula
Quality
This is a single patient case report, so it cannot show how well any treatment works or how common this is.
Limitations
Only one patient described; no comparison group; diagnosis only confirmed during surgery despite prior imaging.
Taken word for word from the abstract
- n a 39-year-old male
- population a case of a 39-year-old male with an initial diagnosis of perianal fistula
- intervention only during surgery was revealed that the origin of the fistula was in perianal pilonidal disease
- comparator Despite clinical examination and pelvic magnetic resonance image
- primaryOutcome only during surgery was revealed that the origin of the fistula was in perianal pilonidal disease
- result only during surgery was revealed that the origin of the fistula was in perianal pilonidal disease
Cir Cir · PMID 40199281 · Read it on PubMed ↗
Perregaard et al. 2025
Faecal calprotectin as a non-invasive marker of Crohn's disease in anal fistulas
Blood/stool test can hint at Crohn's cause.RetrospectiveLow qualityRelated question
63 people2025
higher calprotectin levels were linked to Crohn's disease, correctly identifying it about 78% of the time
Who was studied
patients referred with an anal fistula
What they received
measuring faecal calprotectin level
Compared with
colonoscopy to diagnose Crohn's disease
Main outcome
how well faecal calprotectin level tells apart Crohn's-related fistulas from other anal fistulas
Quality
This was a small retrospective study of only 63 patients testing a diagnostic test, not a treatment, so it says little about why someone has a bump and can't prove how well it works in general.
Limitations
Small sample size; retrospective design; does not address lumps/bumps generally, only distinguishing fistula cause in referred patients.
Taken word for word from the abstract
- population Patients referred with anal fistula who had an FC measurement and either ileocolonoscopy or colonoscopy within 12 weeks were included.
- intervention Faecal calprotectin (FC) is a noninvasive marker that reflects intestinal inflammation with good sensitivity.
- comparator either ileocolonoscopy or colonoscopy within 12 weeks
- primaryOutcome The aim of the study was to determine the accuracy of FC in distinguishing between anal fistulas of cryptoglandular and CD origin
- result FC ≥110 μg/g was significantly associated with CD (OR 12.5; 95% CI: 3.77-41.4) p < 0.0001.
- n A total of 63 patients were included (CD n = 31, 49%).
Colorectal Dis · PMID 39952904 · Read it on PubMed ↗
Inggriani et al. 2025
A systematic review and meta-analysis of the diagnostic test accuracy of diffusion weighted imaging and apparent diffusion coefficient in differentiating active from inactive perianal fistula
Imaging can distinguish active fistulas, not a cause finder.Meta-analysisLow qualityRelated question
1,007 people2025
T2WI combined with DWI was highly accurate; ADC alone was not reliable enough
Who was studied
patients with perianal fistulas
What they received
MRI diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC)
Compared with
contrast-enhanced T1WI and other MRI sequences
Main outcome
accuracy in telling active from inactive fistula
Quality
The studies pooled had moderate to high risk of bias and were quite different from each other, so the results may not be fully trustworthy.
Limitations
moderate to high risk of bias and heterogeneity, may bias this conclusion
Taken word for word from the abstract
- population 1007 patients (77.5 % male) with 1092 fistulas and 321 abscesses
- intervention diagnostic accuracy of MRI-based apparent diffusion coefficient (ADC) and diffusion-weighted imaging (DWI)
- comparator surpassing contrast-enhanced T1WI
- primaryOutcome differentiating active from inactive perianal fistulas
- result ADC alone is inadequate for reliably distinguishing active from inactive fistulas. T2WI combined with DWI offers superior diagnostic performance
- n encompassing 1007 patients (77.5 % male) with 1092 fistulas and 321 abscesses
Radiography (Lond) · PMID 39946821 · Read it on PubMed ↗
Margulies et al. 2024
Diagnosis of perianal pyramidal protrusion in infants
Harmless skin bump, not warts.Case seriesVery low quality
1 people2024
the bump was identified as infantile perianal pyramidal protrusion rather than genital warts or molluscum
Who was studied
an infant with a bump near the anus
What they received
none (diagnostic evaluation and biopsy)
Compared with
none
Main outcome
correct diagnosis of the perianal bump
Quality
this is a single case report, so it cannot show how common or reliable this diagnosis is in general.
Limitations
only one case is described, biopsy findings are described as nonspecific, and the report does not test any treatment.
Taken word for word from the abstract
- population We report a case of perianal pyramidal protrusion that was originally biopsied owing to concern of condyloma acuminatum or molluscum.
- intervention Although biopsies are not routinely done, histopathology is relatively nonspecific and can appear similar to an acrochordon.
- comparator The differential diagnosis is broad and clinical misdiagnosis as condyloma can lead to unnecessary accusations of child abuse.
- primaryOutcome This case raises awareness of this diagnosis to help avoid unnecessary procedures and prevent emotional distress that could come for families with an inaccurate diagnosis of condyloma in young children.
- result We report a case of perianal pyramidal protrusion that was originally biopsied owing to concern of condyloma acuminatum or molluscum.
- n We report a case of perianal pyramidal protrusion
Dermatol Online J · PMID 39680974 · Read it on PubMed ↗
Becker et al. 2025
Clinical relevance of calprotectin in patients with perianal fistulas in Crohn's disease and cryptoglandular fistulas
Marker tells Crohn's fistulas from other fistulasProspective cohortModerate qualityRelated question
63 people2025
Stool calprotectin was significantly higher in Crohn's disease patients than in cryptoglandular fistula patients, and higher calprotectin levels taken directly from the fistula tract correlated with more severe fistula disease
Who was studied
patients with an active fistula near the anus undergoing surgery to examine it, some with Crohn's disease (45) and some without (18, cryptoglandular)
What they received
measuring calprotectin (an inflammation marker) in stool and in scrapings from the fistula tract
Compared with
Crohn's disease fistulas compared with non-Crohn's (cryptoglandular) fistulas
Main outcome
whether stool calprotectin levels can tell Crohn's disease fistulas apart from cryptoglandular fistulas
Quality
it was a real-time prospective study but included only 63 patients split unevenly between groups, and it tested a diagnostic marker rather than a treatment
Limitations
small, uneven group sizes (45 vs 18) and it studies a diagnostic marker, not the cause of the bump or a treatment
Taken word for word from the abstract
- n Sixty-three patients were included in this study (perianal Crohn's disease; 45, cryptoglandular; 18).
- population all consecutive patients with an active perianal fistula undergoing examination under anaesthesia
- intervention Faecal and fistula tract scraping calprotectin levels were determined.
- comparator Faecal calprotectin levels were significantly higher in Crohn's disease patients compared with cryptoglandular fistula
- primaryOutcome The primary objective was to analyse whether FC levels could be used to differentiate between Crohn's disease and cryptoglandular perianal fistulas.
- result Faecal calprotectin levels were significantly higher in Crohn's disease patients compared with cryptoglandular fistula (354.3 [58.8-1076.3] vs. 47.3 [14.6-233.6] μg/g, p = 0.003).
United European Gastroenterol J · PMID 39680482 · Read it on PubMed ↗
Yamanaka-Takaichi et al. 2025
Differentiating clinical characteristics of perianal inflammatory bowel disease from perianal hidradenitis suppurativa
Found features that tell these two apart.RetrospectiveLow quality
263 people2025
certain features like tunnels and comedones pointed to HS, while fistulas, abscesses, ulcers and anal tags pointed to IBD, and a 15-feature model was built to tell them apart
Who was studied
patients with perianal lesions seen at a clinic, some with hidradenitis suppurativa and some with inflammatory bowel disease
What they received
clinical features and a machine-learning model used to identify hidradenitis suppurativa
Compared with
clinical features in patients with fistulizing perianal inflammatory bowel disease
Main outcome
which clinical features distinguish perianal hidradenitis suppurativa from perianal IBD
Quality
this is a retrospective chart review without an independent validation group, so it mainly describes patterns rather than proving the diagnostic tool works reliably.
Limitations
retrospective design; findings based on chart review data at a single center
Taken word for word from the abstract
- n A total of 263 patients were included (98 with HS, 100 with IBD, and 65 with both IBD and HS).
- population We conducted a retrospective chart review of patients with perianal disease evaluated at Mayo Clinic from January 1, 1998, through July 31, 2021.
- intervention random forests were used to select the 15 most important clinical features to construct the diagnostic prediction model to distinguish perianal HS from fistulizing perianal IBD
- comparator fistulas, abscesses, induration, anal tags, ulcers, and anal fissures were more common in patients with IBD
- primaryOutcome construct the diagnostic prediction model to distinguish perianal HS from fistulizing perianal IBD
- result Patients with HS had a higher mean body mass index, a higher smoking rate, and more commonly showed cutaneous manifestations of tunnels and comedones, while fistulas, abscesses, induration, anal tags, ulcers, and anal fissures were more common in patients with IBD.
Int J Dermatol · PMID 39306801 · Read it on PubMed ↗
Schwandner 2024
[Rectovaginal fistulas : Differentiated diagnostics and treatment]
Surgery often needed, frequently recurs.Narrative reviewLow quality
size not given2024
the abstract does not give specific success rates, but states all surgical procedures have high recurrence rates and often need multiple operations or a stoma
Who was studied
people with rectovaginal fistulas (abnormal connection between rectum and vagina)
What they received
surgical repair of rectovaginal fistula
Compared with
different surgical techniques compared to each other
Main outcome
successful closure of the fistula without recurrence
Quality
this is a general review describing diagnosis and treatment options rather than reporting results from a specific study or trial.
Limitations
no original patient data, numbers, or outcome statistics are reported; it is a descriptive overview of causes, diagnosis, and surgical options
Taken word for word from the abstract
- population Rectovaginal fistulas (RVF) represent less than 5% of anorectal fistulas.
- intervention Surgical techniques range from local procedures (e.g., endorectal advancement flap repair, transvaginal or transperineal closure) up to more invasive tissue interposition (e.g., bulbocavernosus muscle fat tissue flap or transposition of the gracilis muscle).
- comparator In "high" RVF transabdominal approaches such as coloanal anastomosis, pull through procedures or omental interposition are indicated.
- result All surgical procedures show high recurrence rates. Several operations are mostly necessary and a stoma creation is often required.
- primaryOutcome All surgical procedures show high recurrence rates.
Chirurgie (Heidelb) · PMID 39283323 · Read it on PubMed ↗
Coelho et al. 2024
Gastroenterology healthcare in LGBTQ+ individuals
Review mentions HPV-related anal lesions, not bumps generallyNarrative reviewVery low qualityRelated question
size not given2024
The review discusses anal conditions linked to HPV infection, including anal intraepithelial neoplasia (a precursor to anal cancer), anal cancer, and infectious proctitis, but does not study or report on causes of a general anal or buttock bump
Who was studied
LGBTQ+ individuals seen by gastroenterologists
Quality
This is a general narrative review summarizing existing knowledge rather than a study that tested a treatment or measured outcomes, so it cannot show whether anything works.
Limitations
This is a broad review covering many topics (endoscopy, liver disease, inflammatory bowel disease, proctology) in LGBTQ+ healthcare generally, not a focused study on anal or perianal lumps/bumps or their causes.
Taken word for word from the abstract
- population Lesbian, gay, bisexual, transgender, queer, or questioning individuals, as well as those with another diverse identity (LGBTQ+)
- result highlight the importance of retroflexion maneuver during a routine colonoscopy that allows detection of anal intraepithelial neoplasia lesions that can be anal cancer precursors
- result an up-to-date review is performed regarding anal cancer screening, HPV infection and related diseases, and infectious proctitis management
Eur J Gastroenterol Hepatol · PMID 38916210 · Read it on PubMed ↗
Sterzing 2024
[Syphilis in surgery-Safe diagnosis and correct treatment]
Bump may be syphilis, not fissure.Narrative reviewVery low quality
size not given2024
syphilis can be mistaken for anal fissures, genital warts, proctitis, or rectal cancer
Who was studied
patients seen in a proctology (anal/rectal) surgical center
What they received
recognizing syphilis as a cause of anal/rectal symptoms
Compared with
none reported
Main outcome
correctly distinguishing syphilis from other anal and rectal diseases
Quality
this is a descriptive review of one center's experience without a controlled study design, so it cannot show how well any treatment works.
Limitations
no study methodology, patient numbers, or outcomes data are given; it is based on clinical experience at one center.
Taken word for word from the abstract
- population Comprehensive footage of experiences in a proctological center demonstrates these manifestations and explains the correct management.
- intervention must know the differential diagnoses
- primaryOutcome The likelihood of confusion of syphilis with anal fissures, anogenital warts, proctitis and rectal cancer is high.
- result The likelihood of confusion of syphilis with anal fissures, anogenital warts, proctitis and rectal cancer is high.
- comparator CONCLUSION: Surgeons can encounter syphilis, the "chameleon of medicine" and must know the differential diagnoses.
Chirurgie (Heidelb) · PMID 38858242 · Read it on PubMed ↗
Bergh et al. 2024
[Not Available]
Anal fistula caused by tuberculosis, not Crohn's.Case seriesVery low qualityRelated question
1 people2024
the fistula was found to be caused by extrapulmonary (gastrointestinal) tuberculosis rather than Crohn's disease
Who was studied
young woman with complex anal fistula disease
What they received
screening for tuberculosis and biopsies of anal fistula tissue
Main outcome
identifying the underlying cause of the fistula disease
Quality
this is a single case report, so it cannot show how common this cause is or how well any treatment works.
Limitations
single patient case report; no comparison group; findings may not generalize
Taken word for word from the abstract
- population a young Danish woman with a progressive complex fistula disease
- intervention a screening test for TB as well as multiple biopsies from the anal fistula tissue
- primaryOutcome cause and treatment were uncovered by interprofessional collaboration between pulmonologists, gastroenterologists and surgeons
- result Extrapulmonary tuberculosis (TB) in the gastrointestinal tract is a rare, but yet an essential differential diagnosis to patients with complex fistula disease
- n a young Danish woman
Ugeskr Laeger · PMID 38305264 · Read it on PubMed ↗
Zhou et al. 2023
Perianal Paget's disease complicated with lung adenocarcinoma and anal canal carcinoma: A case report and literature review
Rare skin cancer with spread.Case seriesVery low quality
1 people2023
the lump was diagnosed as perianal Paget's disease with coexisting lung adenocarcinoma, anal canal cancer, and spread to lymph nodes
Who was studied
a 76-year-old woman with 5 years of abdominal pain and perianal itching
What they received
diagnostic workup with colonoscopy, PET/CT, histopathology for a perianal lump
Compared with
none
Main outcome
diagnosis and extent of the perianal tumor and related cancers
Quality
This is a single patient case report, so it cannot show how common this cause is or how well treatments work.
Limitations
Only one patient was described, so findings may not apply broadly; this is a case report, not a controlled study.
Taken word for word from the abstract
- population a 76-year-old female, had been experiencing recurrent lower abdominal pain and perianal pruritus for the past 5 years
- intervention Further evaluation with fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT)
- comparator This paper reported a case of PPD complicated by lung adenocarcinoma and anal canal cancer.
- primaryOutcome Histopathological examination confirmed the diagnosis of lung adenocarcinoma.
- result This resulted in the patient being diagnosed with PPD, lung adenocarcinoma, anal canal cancer, and systemic multiple lymph node metastasis.
- n a 76-year-old female
Zhong Nan Da Xue Xue Bao Yi Xue Ban · PMID 37875369 · Read it on PubMed ↗
Deng et al. 2024
Dual-energy Spectral CT Imaging of Primary Anorectal Malignant Melanoma: A Case Report
Rare melanoma found causing anal mass.Case seriesVery low quality
1 people2024
CT and MRI showed uneven thickening of the bowel wall, and imaging values differed from other rectal cancers; biopsy confirmed anorectal malignant melanoma
Who was studied
an 83-year-old woman with a rectal/anal mass
What they received
dual-energy spectral CT imaging to characterize the tumor
Compared with
no comparator (single case description)
Main outcome
identifying imaging features that distinguish this tumor from other rectal cancers
Quality
This is a single patient case report, so it cannot show how common this cause is or how reliable the imaging test is in general.
Limitations
Only one patient was studied, so findings may not apply to others with a similar bump.
Taken word for word from the abstract
- population an 83-year-old female patient with ARMM
- intervention Dual-energy spectral CT showed that the effective atomic number (Zeff) of the tumor and the iodine concentration in the arterial phase (AP) and venous phase (VP)
- comparator different from other rectal malignancies reported in the previous literature
- primaryOutcome could help distinguish between ARMM and other rectal malignancies
- result Computed tomography (CT) and Magnetic Resonance Imaging (MRI) showed uneven thickening of the intestinal wall about 7.0 cm from the anal margin
- result the pathological diagnosis was ARMM
- n an 83-year-old female patient with ARMM
Curr Med Imaging · PMID 37649288 · Read it on PubMed ↗
Uzuncakmak et al. 2022
Dermoscopy of Pilonidal Cyst Disease: A Case-series
Describes look of pilonidal cyst bumps.Case seriesVery low quality
4 people2022
The bumps showed a pink background with central ulceration or yellow/white areas, surrounded by dotted, glomerular, or hairpin-shaped blood vessels, patterns that differ from other cysts like epidermal cysts
Who was studied
young men with a single bump near the buttock crease, diagnosed with pilonidal cyst disease
What they received
dermoscopy (magnified skin surface examination) of the bump
Compared with
none; descriptive comparison to dermoscopy patterns of other cystic skin lesions
Main outcome
characteristic dermoscopic (magnified visual) features of pilonidal cyst bumps
Quality
This is a tiny descriptive report of only four patients with no comparison group, so it cannot show whether any treatment works, only describe how these bumps look under magnification.
Limitations
Very small number of cases (4), descriptive only, no control group, and the authors state dermoscopic knowledge of this condition is scarce and based on very few prior cases.
Taken word for word from the abstract
- population All patients were young men and presented with solitary, firm, pink, nodular lesions in the region in proximity to the gluteal cleft
- n Four patients who presented to our dermatology outpatient department for evaluation of a solitary lesion on buttocks were diagnosed with pilonidal cyst disease
- intervention Herein we report the dermoscopic features of four cases of pilonidal cyst disease encountered in our dermatology outpatient clinic.
- comparator The dermoscopic features of pilonidal cysts differ from other epithelial cysts and sinuses.
- primaryOutcome Demographics and clinical features of the four patients are summarized in Table 1.
- result Based on our cases and the two cases in the literature, pink background, central ulceration, peripherally arranged dotted vessels, and white lines seem to be common dermoscopic features of pilonidal cyst disease.
- limitations The current knowledge pertaining to dermoscopy of pilonidal cyst disease is scarce in the dermatologic literature, and was previously evaluated in only two cases.
Acta Dermatovenerol Croat · PMID 36812282 · Read it on PubMed ↗
Reissnerova et al. 2022
Inflammatory cloacogenic polyp in an adolescent - case report and review of the literature
Polyp removed, no more bleedingCase seriesVery low quality
1 people2022
polyp removed surgically and diagnosed as inflammatory cloacogenic polyp; no further problems after surgery
Who was studied
14-year-old boy with intermittent rectal bleeding
What they received
surgical removal of the polyp (transanal endoscopic microsurgery)
Compared with
none
Main outcome
removal of the lesion and resolution of symptoms
Quality
this is a single patient case report, so it cannot show how well treatment works in general
Limitations
only one patient described, no comparison group, and findings cannot be generalized
Taken word for word from the abstract
- n a 14-year-old boy presenting with intermittent rectal bleeding
- population a 14-year-old boy presenting with intermittent rectal bleeding in whom a polypoid lesion was found during digital rectal examination
- intervention the suspicious lesion was removed by transanal endoscopic microsurgery
- comparator Treatment involves transanal endoscopic microsurgery followed by a bowel regimen with stool softeners.
- primaryOutcome the histological diagnosis of inflammatory cloacogenic polyp was established
- result In the postoperative period, the patient was without any further problems.
Rozhl Chir · PMID 36402562 · Read it on PubMed ↗
Azab et al. 2022
Potential Composite Digenic Contribution of NPC1 and NOD2 Leading to Atypical Lethal Niemann-Pick Type C with Initial Crohn's Disease-like Presentation: Genotype-Phenotype Correlation Study
Rare genetic disease, not typical cause.Case seriesVery low qualityRelated question
1 people2022
gene variants in both NPC1 and NOD2 were found, suggesting a combined genetic cause of her Niemann-Pick disease with Crohn's-like bowel symptoms
Who was studied
a young girl with fever, diarrhea, skin tags and anal fissures who later developed neurological and lung decline, dying at age three and a half
What they received
genetic testing to find the cause of her combined bowel and neurological disease
Compared with
none
Main outcome
identifying the genetic cause linking her bowel symptoms (including anal fissures and skin tags) to her fatal neurological disease
Quality
this is a single patient case report, so it cannot show how common or reliable this cause is for most people with similar bumps
Limitations
only one patient was studied, the diagnosis was never fully confirmed clinically, and the genetic findings are proposed rather than proven
Taken word for word from the abstract
- n we investigated a patient with plausible multisystemic overlapping manifestations of both NPC and CD
- population she presented with recurrent skin tags and anal fissures
- intervention we utilized a genetic analysis approach to guide the diagnosis of this vague condition
- comparator Her initial hospitalization was due to a prolonged fever and non-bloody diarrhea.
- primaryOutcome Our phenotype-genotype association attempts led to the identification of candidate disease-causing variants in both NOD2 and NPC1.
- result we propose a potential composite digenic impact of these two genes as the underlying molecular etiology
Genes (Basel) · PMID 35741735 · Read it on PubMed ↗
Imamura et al. 2022
[A Case of Fournier's Gangrene during Second-Line IRIS plus Bevacizumab Chemotherapy for Rectal and Anal Canal Cancer]
Rare severe infection, not a typical bump.Case seriesVery low qualityRelated question
1 people2022
the swelling was diagnosed as Fournier's gangrene, a severe infection requiring emergency surgery
Who was studied
a 52-year-old man with rectal and anal canal cancer who had already had surgery and was on chemotherapy for cancer that had spread
What they received
second-line IRIS plus bevacizumab chemotherapy for cancer
Compared with
none reported
Main outcome
cause of fever and swelling of the buttock
Quality
This is a single patient case report, so it cannot show how common or likely this cause is for other people.
Limitations
Single case report in a cancer patient on chemotherapy; not about typical causes of a bump on the buttock or anus.
Taken word for word from the abstract
- n A 52-year-old man diagnosed with Stage ⅢA rectal and anal canal cancer
- population A 52-year-old man diagnosed with Stage ⅢA rectal and anal canal cancer underwent abdominal perineal resection using Miles's method.
- intervention second-line IRIS plus bevacizumab chemotherapy
- primaryOutcome fever and swelling of the right buttock appeared
- result a diagnosis of Fournier's gangrene was made
- comparator First-line chemotherapy of XELOX was administered for 4 months until the disease progressed
Gan To Kagaku Ryoho · PMID 35578943 · Read it on PubMed ↗
Assarzadegan et al. 2022
HPV-driven anal neoplasia: review and recent developments
Describes types of HPV-related anal growths.Narrative reviewVery low qualityRelated question
size not given2022
The article describes the range of appearances of HPV-related squamous and glandular anal lesions and discusses newly described non-squamous HPV-driven tumours, without testing a treatment or reporting outcome rates
Who was studied
men and women with HPV-related growths in the anal canal
What they received
not applicable (pathology review article)
Main outcome
how to classify and diagnose HPV-related anal lesions under the microscope
Quality
This is a descriptive review of pathology findings, not a study testing a treatment or comparing outcomes, so it cannot show whether anything works.
Limitations
Abstract does not describe methods, number of cases, or any quantitative results; it is a narrative overview of diagnostic categories, not a study of a specific bump or its causes/treatment.
Taken word for word from the abstract
- population identified in the anal canal in men and women
- intervention we review the classification and basic histopathological features of HPV-related squamous intraepithelial and invasive lesions as well as associated pitfalls
- primaryOutcome familiarity with the morphological spectrum associated with HPV-driven anal neoplasia is important for proper identification and diagnosis
- result we provide an update on recently described HPV-driven, non-squamous tumours
Pathology · PMID 34645567 · Read it on PubMed ↗
Mangalindan et al. 2023
Rectal Bleeding in the Clinic
Anal cancer missed by exam.Case seriesVery low quality
1 people2023
Diagnosis of anal cancer was delayed due to missed and misdiagnosed rectal exams
Who was studied
51-year-old woman with painful rectal bleeding
What they received
none (diagnostic case report)
Compared with
none
Main outcome
correct diagnosis of cause of rectal bleeding/bump
Quality
This is a single patient case report, so it cannot show how common this cause is or how well exams work in general.
Limitations
Single case report; delayed and misdiagnosed exams; not a study of treatment effectiveness.
Taken word for word from the abstract
- population a 51-year-old woman who presented with painful hematochezia
- intervention missed and misdiagnosed digital rectal exams in an otherwise low-risk patient
- comparator missed and misdiagnosed digital rectal exams in an otherwise low-risk patient
- primaryOutcome delayed diagnosis of anal cancer
- result a delayed diagnosis of anal cancer in the setting of missed and misdiagnosed digital rectal exams
- n a 51-year-old woman
Mil Med · PMID 34050675 · Read it on PubMed ↗
Jovic et al. 2020
Unusual Clinical Presentation of Giant Extragenital Condyloma
Rare HPV wart found on abdomen, not anus.Case seriesVery low qualityRelated question
1 people2020
diagnosed as a wart-type infection (HPV type 6) causing condyloma, removed by electrosurgery
Who was studied
70-year-old man with a wart-like skin growth on his abdomen, not genital area
What they received
not applicable (case report describing diagnosis)
Compared with
none
Main outcome
identifying the cause of the skin lesion and successful treatment
Quality
this is a single patient case report so it cannot show how common this is or what causes it in general
Limitations
single case, unusual extragenital location on the abdomen rather than the anus/buttock area asked about
Taken word for word from the abstract
- population A 70-year-old Caucasian man was referred to our department for an atypical asymptomatic seborrheic keratosis presenting as a linear verrucous plaque (20 × 2 cm) with few solitary reddish satellite papules on the abdomen
- n A 70-year-old Caucasian man was referred to our department
- intervention The lesions were successfully removed by electrosurgery.
- comparator Regular follow-up was scheduled.
- primaryOutcome Diagnosis of CA is usually straightforward when the lesions are located on the anogenital area. However, involvement of extragenital skin may pose a diagnostic challenge.
- result a polymerase chain reaction (PCR) from lesional tissue sample was performed and found HPV type 6 positivity. The lesions were successfully removed by electrosurgery.
Acta Dermatovenerol Croat · PMID 33834999 · Read it on PubMed ↗
Peterknecht et al. 2021
Aggressive angiomyxoma of the ischioanal fossa in a post-menopausal woman
Rare tumour mistaken for an abscess.Case seriesVery low qualityRelated question
1 people2021
the lump was found to be a rare soft-tissue tumour called aggressive angiomyxoma, not an abscess
Who was studied
65-year-old post-menopausal woman with buttock pain, initially thought to have a perianal abscess
What they received
surgical removal of the lesion under anaesthesia
Compared with
none
Main outcome
diagnosis of the lump after examination and pathology testing
Quality
This is a single patient case report with a literature review, so it cannot show whether any treatment works.
Limitations
Only one patient is described, with a review of just eight other reported cases, so no general conclusions about treatment or outcomes can be drawn.
Taken word for word from the abstract
- population a 65-year-old woman who was admitted with left-sided buttock pain and initially diagnosed with a perianal abscess
- intervention She underwent examination under anaesthesia rectum with surgical excision of the lesion
- comparator the consensus has been for surgical excision
- primaryOutcome subsequent histopathological and immunochemical analysis was suggestive of aggressive angiomyxoma
- result subsequent histopathological and immunochemical analysis was suggestive of aggressive angiomyxoma
- n We present the case of a 65-year-old woman
Ann R Coll Surg Engl · PMID 33559550 · Read it on PubMed ↗
Mahalingam et al. 2020
Radiation-induced sarcoma presenting as a gluteal abscess: a diagnostic and therapeutic challenge
Rare cancer causing the bump.Case seriesVery low qualityRelated question
1 people2020
the gluteal abscess was found to be a radiation-induced sarcoma; bleeding was controlled with radiation after surgery and other treatments failed
Who was studied
middle-aged woman treated with chemo-radiation for cervical cancer 5 years earlier, who developed a gluteal lump
What they received
diagnostic workup and treatment of gluteal abscess-like lesion
Compared with
none
Main outcome
diagnosis of the gluteal mass and control of bleeding
Quality
this is a single patient case report, so it cannot show what causes bumps in general or how common this is.
Limitations
single case report; findings cannot be generalized to typical gluteal or anal bumps.
Taken word for word from the abstract
- population a middle-aged woman, post-chemo-radiation for carcinoma cervix 5 years ago, who presented with gluteal abscess
- intervention Achieving haemostasis post incision and drainage under anaesthesia was a challenge. On further evaluation, she was diagnosed with radiation-induced gluteal soft tissue sarcoma.
- comparator failed attempts of surgical and radiological interventions
- primaryOutcome Achieving haemostasis post incision and drainage under anaesthesia was a challenge.
- result Haemostasis was achieved after radiation following failed attempts of surgical and radiological interventions.
- n We present a case of a middle-aged woman
BMJ Case Rep · PMID 33318271 · Read it on PubMed ↗
Zaki et al. 2021
Anal skin tag - An unusual presenting feature of food protein-induced allergic proctocolitis in a neonate
Allergy-related rectal bleeding resolved with special formula.Case seriesVery low quality
1 people2021
baby fully recovered after switching to amino acid formula
Who was studied
a 26-day-old breastfed baby with blood in stool
What they received
amino acid formula after elimination diet and hydrolyzed formula failed
Compared with
elimination diet in mother and extensively hydrolysed formula
Main outcome
resolution of bloody stools and anal skin tag diagnosis
Quality
This is a single case report, so it cannot show whether this applies to other babies.
Limitations
Single case report with no control group or long-term follow-up details beyond recovery.
Taken word for word from the abstract
- n A 26-day-old baby presented with history of passing intermittent blood in stools for two days.
- population A 26-day-old baby presented with history of passing intermittent blood in stools for two days. The baby was exclusively breast-fed and was well-appearing with no failure to thrive.
- intervention the baby was started on amino acid formula with complete recovery
- comparator poor response to elimination diet in the mother and extensively hydrolysed formula
- primaryOutcome Colonoscopy was suggestive of food protein-induced allergic proctocolitis.
- result the baby was started on amino acid formula with complete recovery
J Neonatal Perinatal Med · PMID 33216045 · Read it on PubMed ↗
Bardac et al. 2020
Anal Metastasis from Lung Cancer: Report of a Case and Systematic Review of the Literature
Rarely, lung cancer spreads to the anus.Case seriesVery low qualityRelated question
13 people2020
the anal lump was found to be a metastasis from lung cancer, something that can look like hemorrhoids and be missed
Who was studied
people with lung cancer who develop an anal or perianal lump
What they received
surgical excision and pathology/immunohistochemistry evaluation of the anal mass
Compared with
none
Main outcome
diagnosis of the anal bump as cancer spread (metastasis) from lung cancer
Quality
This is just one new patient case plus 12 other reported cases found in the literature, not a study that tests a treatment or compares groups.
Limitations
Extremely rare condition with only 13 total cases ever described, no control group, and no statistical testing of outcomes.
Taken word for word from the abstract
- n The review included 12 papers reporting 12 cases.
- population patients with lung cancers and anal or perianal complaints should be evaluated for metastatic disease
- intervention The anal tumor was excised with primary wound closure in spinal anesthesia.
- comparator Case report and systematic review.
- primaryOutcome The pathology report and the immunohistochemistry of the specimen revealed metastasis of the lung adenocarcinoma.
- result Our patient presented an anal metastasis of a lung adenocarcinoma that was masquerading as a complicated hemorrhoidal disease.
Chirurgia (Bucur) · PMID 33138907 · Read it on PubMed ↗
Gosemann et al. 2020
Perianal Abscesses and Fistulas in Infants and Children
Often resolves on its own in babies.Narrative reviewLow quality
size not given2020
abstract describes the condition and treatment options but does not report a specific outcome measure or comparative result
Who was studied
infants and children with a lump near the anus (perianal abscess or fistula)
What they received
various treatments (conservative or surgical) depending on age
Compared with
different treatment approaches compared by age group
Main outcome
disease course and response to management
Quality
this is a narrative review summarizing existing knowledge rather than presenting new comparative data on outcomes
Limitations
pathogenesis remains unclear; treatment is described as empiric rather than evidence-based; no original outcome data reported
Taken word for word from the abstract
- population Perianal abscess (PA) and fistula-in-ano (FIA) are common entities in infancy.
- intervention Treatment remains empiric, comprises conservative, as well as surgical approaches, and is dependent on the age of the patient.
- comparator and is dependent on the age of the patient
- primaryOutcome The natural course of these diseases in infancy is self-limiting in the majority of cases whereas older children show similarities to PA/FIA in adults.
- result This review summarizes anatomical aspects, current evidence on disease pathogenesis, clinical presentation, and management of pediatric patients with PA and FIA.
Eur J Pediatr Surg · PMID 32987435 · Read it on PubMed ↗
Lu et al. 2020
Histologic diagnosis of a case of anal duct carcinoma with cytological correlation and differential diagnoses
Describes diagnosing a rare anal cancer.Case seriesVery low qualityRelated question
1 people2020
the cancer could be accurately identified using biopsy and cytology with careful attention to specific features
Who was studied
a patient with a bump/growth near the anus later diagnosed as anal duct carcinoma
What they received
biopsy and cytology testing to diagnose the growth
Compared with
no comparator described
Main outcome
accuracy of diagnosing anal duct carcinoma using tissue and cell samples
Quality
this is a single case report describing one patient, so it cannot show whether any treatment works or how common this cause of a bump is.
Limitations
only one case is described, focused on diagnostic pathology rather than treatment or outcomes, and findings from one patient cannot be generalized.
Taken word for word from the abstract
- population a case of anal duct carcinoma
- intervention the initial diagnosis on biopsy and subsequent cytology specimens
- comparator Additionally, differential diagnoses of this neoplasm are discussed.
- primaryOutcome anal duct carcinoma can be accurately diagnosed both on biopsy and on cytology
- result With a high index of suspicion, and attention to histological and immunohistochemical features, anal duct carcinoma can be accurately diagnosed both on biopsy and on cytology.
- n a case of anal duct carcinoma
Ann Diagn Pathol · PMID 32485535 · Read it on PubMed ↗
Fellegara et al. 2020
Anal Fibroepithelial Polyp With Epithelial Vascular Pseudoinvasion
Benign anal polyp, not cancer.Case seriesVery low quality
1 people2020
found to be a benign fibroepithelial polyp with a harmless pattern that can look like cancer spread under the microscope
Who was studied
a 38-year-old man with recurrent anal discomfort
What they received
surgical removal and microscopic examination of anal polyps
Compared with
none
Main outcome
type and cause of the anal polyp bump
Quality
This is a single patient case report, so it cannot show how common this cause is or how it compares to other treatments.
Limitations
Only one patient was studied, and the abstract does not report any follow-up outcome.
Taken word for word from the abstract
- population The patient was a 38-year-old Caucasian man, who presented at our institution for recurrent episodes of anal discomfort.
- n The patient was a 38-year-old Caucasian man
- intervention Clinical evaluation revealed the presence of 2 pedunculated anal polyps that were resected and submitted for histological evaluation.
- comparator we report a case of anal fibroepithelial polyp with benign squamous cell vascular pseudoinvasion
- primaryOutcome On microscopic evaluation, one of the polyps shows epithelial endovascular displacement associated with morphological signs of traumatism.
- result we report a case of anal fibroepithelial polyp with benign squamous cell vascular pseudoinvasion
Int J Surg Pathol · PMID 32434434 · Read it on PubMed ↗
Young et al. 2020
Anal Cancer
Explains anal cancer diagnosis, not treatment results.Narrative reviewVery low qualityRelated question
size not given2020
Not a clinical trial; article discusses evaluation and management, emphasizing timely diagnosis, accurate staging, and surveillance
Who was studied
people with suspected anal canal cancer or anorectal lesions
What they received
not applicable (review of diagnosis and management)
Main outcome
understanding diagnosis, staging, and treatment of anal canal tumors
Quality
This is a narrative review article with no original patient data, trial results, or comparisons, so it cannot show whether any treatment works.
Limitations
No study data, sample size, or outcomes reported; purely descriptive/educational review.
Taken word for word from the abstract
- population General surgeons who encounter suspected anal canal cancer
- primaryOutcome This article discusses the most commonly encountered anal canal tumors, the evaluation of these tumors, and their management.
- result The foundation for successful therapy includes timely diagnosis, accurate staging, and routine surveillance.
- intervention This article discusses the most commonly encountered anal canal tumors, the evaluation of these tumors, and their management.
Surg Clin North Am · PMID 32402305 · Read it on PubMed ↗
Peters et al. 2020
Human papillomavirus-negative epithelial proliferations resembling condylomata acuminata in a patient receiving vemurafenib for Stage IV melanoma
Anal bumps from cancer drug, not warts.Case seriesVery low qualityRelated question
size not given2020
patient developed anal wart-like growths that tested negative for HPV and common cancer mutations
Who was studied
patient with stage IV melanoma on vemurafenib treatment
What they received
vemurafenib (BRAF inhibitor) treatment for melanoma
Main outcome
development of anal bumps resembling genital warts
Quality
this is a single patient case report, so it cannot show how common this is or confirm the cause.
Limitations
single case, no control comparison, cause of the proliferations not fully determined
Taken word for word from the abstract
- population Here, we describe a case in which a patient developed extensive anal epithelial proliferations resembling condylomata acuminata, after starting vemurafenib treatment.
- intervention after starting vemurafenib treatment
- primaryOutcome extensive anal epithelial proliferations resembling condylomata acuminata
- result Interestingly, the lesions in our patient were negative for human papillomavirus, and mutations in BRAF, Neuroblastoma rat sarcoma viral oncogene homolog (NRAS), Kirsten rat sarcoma viral oncogene homolog (KRAS), and Harvey rat sarcoma viral oncogene homolog (HRAS) were not detected.
J Cancer Res Ther · PMID 32362631 · Read it on PubMed ↗
Hegde et al. 2020
Colorectal Surgery Review for Primary Care Providers
Bump likely a common anorectal condition.Narrative reviewLow quality
size not given2020
careful history and exam can distinguish conditions like hemorrhoids, abscesses, fistula, fissure, and genital warts, usually without need for imaging
Who was studied
people seen by primary care doctors with anal or rectal symptoms
What they received
not applicable - this is a review of diagnosis
Compared with
not applicable
Main outcome
telling apart different anorectal conditions by exam and history
Quality
this is a general review describing how to diagnose conditions rather than a study testing a treatment or outcome.
Limitations
no study data, patient numbers, or outcome results are given; it is a general educational overview for doctors.
Taken word for word from the abstract
- population Anorectal conditions are one of the most common problems evaluated by primary care physicians.
- intervention Thorough history and careful anorectal examination can differentiate common anorectal conditions
- comparator Most of these conditions can be diagnosed and treated without imaging.
- primaryOutcome Thorough history and careful anorectal examination can differentiate common anorectal conditions like hemorrhoids, anorectal abscesses, anal fistula, anal fissure, and anal condyloma.
- result Most of these conditions can be diagnosed and treated without imaging.
Mo Med · PMID 32308242 · Read it on PubMed ↗
Li et al. 2020
A rare case of recurrent primary anorectal melanoma emphasizing the importance of postoperative follow-ups
Rare melanoma cause, successfully re-removed.Case seriesVery low qualityRelated question
1 people5 years
the recurrent tumor was removed and she regained normal bowel control, with no spread seen on scans
Who was studied
85-year-old woman with a recurrence of a rare anal/rectal cancer called melanoma
What they received
surgical removal of the tumor again (wide local excision)
Compared with
a more extensive surgery (abdominoperineal resection)
Main outcome
whether the tumor was removed and bowel control was regained
Quality
this is a single patient's case report, so it cannot show how common this cause is or how most people would do.
Limitations
single case report; no comparison group; findings may not generalize to typical anal/rectal bumps which are usually not melanoma.
Taken word for word from the abstract
- population An 85-year-old female patient presented with fecal incontinence 5 years after local resection of a primary anorectal melanoma.
- intervention She underwent another wide local excision and regained fecal continence postoperatively.
- comparator wide local excision and abdominoperineal resection are considered the mainstay therapy
- primaryOutcome She underwent another wide local excision and regained fecal continence postoperatively.
- result There were no signs of locoregional or distant metastasis on the MRI and PET/CT. She underwent another wide local excision and regained fecal continence postoperatively.
- n An 85-year-old female patient
- followUp 5 years after local resection of a primary anorectal melanoma
BMC Surg · PMID 32264858 · Read it on PubMed ↗
Picciariello et al. 2021
Classifications and Clinical Assessment of Haemorrhoids: The Proctologist's Corner
Bump likely a haemorrhoid, needs assessmentNarrative reviewVery low qualityRelated question
size not given2021
classification systems and differential diagnosis are important for choosing the right treatment based on severity
Who was studied
adults with haemorrhoids
What they received
not applicable - this is a review of classification and assessment methods
Main outcome
how classification systems and clinical assessment guide treatment choice
Quality
this is a narrative review of assessment methods, not a study testing whether a treatment works
Limitations
no original data, no patient outcomes measured, purely a review of classification literature
Taken word for word from the abstract
- population Haemorrhoidal disease (HD) is a benign condition affecting a considerable part of adult population
- primaryOutcome The knowledge of classification systems and differential diagnosis for HD has been shown to play a central role in the clinical assessment and the best treatment choice
- result Classification systems are useful for the therapeutic choice and researches on new medical or surgical treatments.
- intervention preoperative assessment is essential and the use of classification system is recommended
Rev Recent Clin Trials · PMID 32164517 · Read it on PubMed ↗
Herold 2020
[Differential diagnosis of hemorrhoidal disease]
Many possible causes besides hemorrhoids.Narrative reviewLow quality
size not given2020
lists several possible causes of similar symptoms and lumps, without testing or comparing treatments
Who was studied
adults with symptoms or lumps around the anus
Main outcome
distinguishing hemorrhoids from other causes of similar symptoms or bumps
Quality
this is a narrative review describing possible diagnoses, not a study measuring outcomes or testing treatments
Limitations
no original data, no numbers of patients, purely descriptive review of differential diagnoses
Taken word for word from the abstract
- population Hemorrhoidal disease is one of the most common illnesses in industrialized nations. Up to 70% of adults suffer from the disease once in their lifetime.
- primaryOutcome the necessity and importance of knowing about the differential diagnosis of hemorrhoids
- result One can differentiate between differential diagnoses of symptoms (bleeding, pain, itching, tumor) and differential diagnoses of the phenotype findings (anal prolapse, mucosal prolapse and rectal prolapse, skin tags, hypertrophied anal papillae, condylomata acuminata, anal fissure, perianal venous thrombosis, anal cancer).
Hautarzt · PMID 32077979 · Read it on PubMed ↗
Waheed et al. 2020
Magnetic resonance imaging findings in patients with initial manifestations of perianal fistulas
Complex fistula may signal Crohn's disease.RetrospectiveLow quality
171 people2020
Complex or high fistulas on MRI were much more likely to be linked to Crohn's disease than simple fistulas
Who was studied
people with newly found, untreated perianal fistulas (tunnels near the anus)
What they received
MRI scan of the fistula to classify it as simple/complex or low/high
Compared with
simple versus complex/high fistula types on imaging
Main outcome
whether the fistula type on MRI predicted a diagnosis of Crohn's disease
Quality
This was a small, retrospective, single-center study looking backward at records, which limits how much it can prove.
Limitations
Retrospective, small sample, single center, and short duration study.
Taken word for word from the abstract
- n SAMPLE SIZE: 171 patients.
- population All previously undiagnosed and untreated patients who presented for the first time to the outpatient clinics from September 2015-2018 with perianal fistulas were retrospectively evaluated.
- intervention Fistulas were categorized as low or high anal, simple or complex, and were graded per St. James University Hospital Classification.
- comparator Fourteen (40.4%) patients with complex fistulas had CD in comparison to only 5 (4.8%) simple fistula patients ( P=.0005).
- primaryOutcome Fistula features on MR imaging and diagnosis of CD.
- result More than half of patients with complex and high anal fistulas had CD ( P=.0005).
- limitations Retrospective, small sample, single center, and short duration study.
Ann Saudi Med · PMID 32026703 · Read it on PubMed ↗
Cohee et al. 2020
Benign Anorectal Conditions: Evaluation and Management
Lumps near anus usually benign.Narrative reviewLow quality
size not given2020
this is a general review describing how to diagnose and manage common anorectal conditions, not a single trial result
Who was studied
people with common bottom or anal problems (lumps, itching, pain)
What they received
various treatments depending on diagnosis (fiber, creams, drainage, surgery, biofeedback)
Main outcome
correct diagnosis and symptom improvement with appropriate treatment
Quality
it is a general review of expert recommendations, not a study testing one treatment against another.
Limitations
no original study data, numbers, or control groups; just summarises general management advice for multiple separate conditions.
Taken word for word from the abstract
- population Common anorectal conditions include hemorrhoids, perianal pruritus, anal fissures, functional rectal pain, perianal abscess, condyloma, rectal prolapse, and fecal incontinence.
- result Although these are benign conditions, symptoms can be similar to those of cancer, so malignancy should be considered in the differential diagnosis.
- intervention The primary treatment for hemorrhoids is fiber supplementation.
- primaryOutcome History and examination, including anoscopy, are usually sufficient for diagnosing these conditions
Am Fam Physician · PMID 31894930 · Read it on PubMed ↗
Liu et al. 2020
Genital nevus lipomatosus cutaneous superficialis: A diagnostic challenge in a pediatric patient
Benign fatty bump, not a wart.Case seriesVery low quality
1 people2020
the bump was found to be a benign fatty skin growth (nevus lipomatosus cutaneous superficialis), not a sexually transmitted wart
Who was studied
a 14-year-old boy with a genital skin bump
What they received
no treatment described; diagnostic evaluation of the skin lesion
Compared with
initial misdiagnosis as genital warts (condyloma acuminata)
Main outcome
correct diagnosis of the anogenital skin lesion
Quality
this is a single patient case report, so it cannot show how common this cause is or how it compares to other causes.
Limitations
only one patient described; no comparison group or broader data on how often this explains anal or buttock bumps.
Taken word for word from the abstract
- n We report a case of NLCS
- population a 14-year-old boy
- intervention We report a case of NLCS initially misdiagnosed as condyloma acuminata in a 14-year-old boy.
- comparator initially misdiagnosed as condyloma acuminata
- primaryOutcome differentiating benign anogenital lesions from sexually transmitted conditions
- result Nevus lipomatosus cutaneous superficialis (NLCS) is an idiopathic hamartomatous condition characterized by the presence of mature adipose tissue in the dermis.
Pediatr Dermatol · PMID 31867728 · Read it on PubMed ↗
Wheelwright et al. 2019
Perianal Histoplasmosis Presenting as a Mass Suspicious for Malignancy: A Case Report with Review of Gastrointestinal Manifestations of Histoplasmosis
Anal lump was a rare fungal infection, not cancer.Case seriesVery low quality
1 people5-months
Biopsy showed the mass was a fungal infection (histoplasmosis), not cancer, and symptoms improved significantly after antifungal treatment
Who was studied
66-year-old man with a painful lump near the anus
What they received
antifungal medication (itraconazole and terbinafine)
Compared with
none
Main outcome
improvement in symptoms and signs of infection after treatment
Quality
This is a single patient case report, so it cannot show how common this cause is or how reliably treatment works for others.
Limitations
Single case report with no comparison group; findings may not generalize to other patients with a perianal lump.
Taken word for word from the abstract
- population a 66-year-old male patient who presented with an indurated painful perianal lesion that appeared highly suspicious for malignancy on imaging
- intervention Treatment with itraconazole and terbinafine was initiated
- comparator Treatment with itraconazole and terbinafine was initiated
- primaryOutcome at 5-months follow-up, the patient reported significant improvement in signs and symptoms, with undetectable Histoplasma antigen on repeat testing
- result showing chronic inflammation with clusters of epithelioid histiocytes containing characteristic, PAS-fungus stain-positive, intracellular yeast forms consistent with histoplasmosis. There was no evidence of malignancy.
- n a 66-year-old male patient
- followUp at 5-months follow-up
Am J Case Rep · PMID 31761896 · Read it on PubMed ↗
Maas et al. 2020
Staging of Anal Cancer: Role of MR Imaging
Describes imaging for anal cancer, not bump causes.Narrative reviewLow qualityRelated question
size not given6 months
MRI is used for local T and N staging, and together with clinical evaluation assesses tumor and nodal response after chemoradiation, with maximal response seen at 6 months
Who was studied
people with anal cancer
What they received
MRI imaging for staging and tumor/nodal response assessment
Compared with
PET-CT or CT scans for whole-body staging
Main outcome
accuracy of local tumor (T) and nodal (N) staging and treatment response assessment
Quality
This is a narrative review describing imaging methods rather than a study testing a treatment, so it doesn't provide comparative outcome data.
Limitations
No patient numbers, outcome data, or study methodology are reported; this is a descriptive review article.
Taken word for word from the abstract
- population Anal cancer is a relatively rare malignancy.
- intervention Local evaluation of the T and N stage is performed by MR imaging.
- comparator Whole-body staging with 18F-fluorodesoxyglucose positron emission tomography computed tomography scans or computed tomography scans is used to detect metastases.
- primaryOutcome After chemoradiation, clinical evaluation and MR imaging is used to assess tumor and nodal response.
- result Maximal response is achieved 6 months after chemoradiation.
- followUp Maximal response is achieved 6 months after chemoradiation.
Magn Reson Imaging Clin N Am · PMID 31753232 · Read it on PubMed ↗
McBride et al. 2019
Peritoneal Carcinomatosis Arising from Primary Anorectal Melanoma
Rare melanoma spread widely, case report.Case seriesVery low qualityRelated question
1 people2019
Cancer had spread widely to the peritoneum (abdominal lining)
Who was studied
75 year old woman previously treated for anal/rectal melanoma
What they received
none (observational case report)
Main outcome
spread of cancer to the abdominal lining
Quality
This is a single patient case report, so it cannot show how common this is or what causes a bump.
Limitations
Single case report; no control group; cannot generalize to typical anal/butt bumps.
Taken word for word from the abstract
- population a 75 year old female with a history of transanal excision of primary anorectal melanoma
- intervention who presented with increasing abdominal pain and distention
- primaryOutcome Computed tomography scan of the abdomen and pelvis showed metastatic disease to the peritoneum
- result findings of extensive peritoneal carcinomatosis, demonstrating the aggressive nature of anorectal melanoma
- n a 75 year old female
J Radiol Case Rep · PMID 31565179 · Read it on PubMed ↗
Egal et al. 2019
[Anorectal manifestations in systemic diseases]
Bump may signal underlying systemic disease.Narrative reviewVery low qualityRelated question
size not given2019
the review describes that these diseases can cause perianal, rectal and anal lesions, sometimes with perforation or fistula, and emphasizes ruling out infection or Crohn's disease and routine proctology follow-up
Who was studied
people with systemic diseases such as vasculitis, connective tissue disease or sarcoidosis
What they received
recognizing and managing anorectal involvement from these systemic diseases
Main outcome
anorectal manifestations (perianal skin, rectum, anus) of systemic diseases
Quality
This is a narrative review describing possible manifestations without any patient data, numbers, or comparison, so it cannot show whether a treatment works.
Limitations
No original data, numbers of patients, or outcome measures are reported; it only describes known disease associations.
Taken word for word from the abstract
- population Numerous systemic diseases (vasculitis, connective tissue disease or sarcoidosis) can display an involvement of the perianal skin, the rectum and/or the anus.
- intervention Such knowledge is important in order to treat these complications specifically when possible.
- primaryOutcome Lesions of the anorectum arising from systemic diseases can sometimes cause perforations in the peritoneal cavity (if concerning the higher portion of the rectum) and/or fistulization to the anal margin.
- result Differential diagnosis, mostly infectious or inflammatory (Crohn's disease) must be ruled out in every case.
- result Other systemic diseases can display specific manifestations as this is the case in scleroderma which can lead to anal incontinence.
- result It should thus be detected in each consultation and a regular follow-up must be provided with a proctologist and/or a gastroenterologist when needed.
Rev Med Interne · PMID 31400822 · Read it on PubMed ↗
Hiraoka et al. 2020
Recurrent intestinal inflammation with a perianal abscess is not always Crohn's disease: a patient with a complex Meckel's diverticulum diagnosed by double-balloon endoscopy
Rare intestinal pouch caused the abscess.Case seriesVery low qualityRelated question
1 people6 years
The abscess was caused by an inflamed intestinal pouch (Meckel's diverticulum) rather than Crohn's disease; after surgery to remove it, the patient had no further symptoms for 6 years
Who was studied
25-year-old man with repeated abscesses near the anus for a year, initially thought to be Crohn's disease
What they received
Surgical removal of an inflamed Meckel's diverticulum (a pouch in the small intestine), found using a special scope called double-balloon endoscopy
Main outcome
Whether the perianal abscess was explained and resolved after treatment
Quality
This is a single patient's case report, so it cannot show how common this cause is or how reliable the treatment is for others.
Limitations
Only one patient was studied, there is no comparison group, and findings may not apply to most people with a bump near the anus.
Taken word for word from the abstract
- population A 25-year-old male with recurrent perianal abscesses for 1 year, suspected to be due to Crohn's disease, was referred for further evaluation.
- intervention Laparoscopic diverticulectomy was performed
- intervention Bidirectional double-balloon endoscopy (DBE) identified a long diverticulum in the ileum.
- result The perianal abscess was confirmed to be caused by an inflamed Meckel's diverticulum.
- result The patient has been asymptomatic for 6 years after resection.
- n A 25-year-old male
- primaryOutcome The perianal abscess was confirmed to be caused by an inflamed Meckel's diverticulum.
Clin J Gastroenterol · PMID 31240623 · Read it on PubMed ↗
Zeng et al. 2019
Laparoscopic extralevator abdominoperineal excision for the treatment of perianal Paget's disease: A case report
Surgery cleared rare perianal cancerCase seriesVery low qualityRelated question
1 people10 months
the patient recovered well and was disease-free at 10-month check-up
Who was studied
a 73-year-old woman with a perianal lesion initially misdiagnosed as eczema
What they received
laparoscopic extralevator abdominoperineal excision surgery
Compared with
none
Main outcome
whether the perianal area was free of disease after surgery
Quality
This is a single patient case report, so it cannot show whether this treatment works in general.
Limitations
Only one patient was studied, there was no comparison group, and this describes a rare cancer (Paget's disease), not common causes of anal bumps.
Taken word for word from the abstract
- population A 73-year-old female was admitted to several hospitals with diagnosed as "perianal eczema" in perianal lesion.
- intervention Laparoscopic Extralevator Abdominoperineal Excision (ELAPE) surgery was performed at our department.
- primaryOutcome After 10 months, a check-up revealed that her perianal area was disease-free.
- result The patient recovered well. After 10 months, a check-up revealed that her perianal area was disease-free.
- n A 73-year-old female was admitted to several hospitals
- comparator Laparoscopic ELAPE is a successful therapy.
Medicine (Baltimore) · PMID 31083156 · Read it on PubMed ↗
Stevens et al. 2019
Diagnostic accuracy of faecal calprotectin in patients with active perianal fistulas
Stool test helps identify Crohn's-related fistulas.RetrospectiveLow qualityRelated question
56 people2019
the stool marker was much higher in Crohn's-related fistulas and could help distinguish them, but it did not reliably predict gut ulcers in Crohn's patients
Who was studied
patients with active perianal fistulas (abscess/tunnel near the anus)
What they received
stool test (faecal calprotectin) to check for inflammation
Compared with
patients with non-Crohn's (cryptoglandular) perianal fistulas vs those with Crohn's-related fistulas
Main outcome
ability of the stool test to tell apart Crohn's-related fistulas from ordinary ones, and to detect gut ulcers
Quality
This was a small, retrospective study without a comparison treatment, so its findings on a diagnostic test can't tell you why a bump occurred or how to treat it.
Limitations
Retrospective design, small sample size, and the test's limited ability to predict ulcers.
Taken word for word from the abstract
- population Patients with active perianal fistulas who had FC measured and a complete ileocolonoscopy within 10 weeks were retrospectively included.
- intervention Faecal calprotectin (FC) is a marker of mucosal inflammation.
- comparator FC was significantly higher in pCD compared to cryptoglandular fistulas
- primaryOutcome The aim of this study was to determine the diagnostic accuracy of FC to (a) differentiate between perianal fistulizing Crohn's disease (pCD) and cryptoglandular perianal fistulas; and (b) detect mucosal inflammation in pCD.
- result FC discriminates pCD from cryptoglandular fistulas, even in the absence of intestinal ulcers. In active pCD, an elevated FC does not accurately predict the presence of ulcers and should be interpreted with caution.
- n Fifty-six patients were included (pCD, n = 37)
United European Gastroenterol J · PMID 31065367 · Read it on PubMed ↗
St Claire et al. 2019
Extramammary Paget disease
Rare skin condition, usually treated by removal.Narrative reviewLow quality
size not given2019
explains that this is a rare skin condition called extramammary Paget disease, which appears as a red patch and is usually treated by surgical removal with a generally good outlook
Who was studied
older men and women with lesions in apocrine gland areas like the perianal region, scrotum, or vulva
What they received
none (this is a review of the disease)
Compared with
none
Main outcome
description of the disease and how it is diagnosed and treated
Quality
this is a general review article describing the disease rather than a study testing a treatment, so it cannot show whether treatments work.
Limitations
The abstract does not report a study design with patients, outcomes measured, or results testing treatment effectiveness.
Taken word for word from the abstract
- population EMPD presents as an erythematous plaque on apocrine gland bearing areas (i.e. vulva, perineum, perianal region, scrotum, and penis) in older men and women.
- intervention Surgical excision currently is first line therapy and the prognosis is often favorable.
- primaryOutcome This review addresses the history, epidemiology, pathogenesis, clinical presentation, histopathology, differential diagnosis, diagnosis, management, and new observations with respect to extramammary Paget disease.
- result Surgical excision currently is first line therapy and the prognosis is often favorable.
- comparator Immunohistochemical staining allows for differentiation between primary and secondary EMPD in addition to the many other disease entities that clinically resemble this malignancy.
Dermatol Online J · PMID 31046904 · Read it on PubMed ↗
Wu et al. 2019
Condyloma acuminata on the nipple and coronary sulcus of the penis: A case report
Genital wart cleared with treatment.Case seriesVery low qualityRelated question
1 people6 months
No signs of the growths returning after six months
Who was studied
29-year-old man with wart-like growths on nipple and penis after sexual contact
What they received
Microwave therapy plus imiquimod cream applied to the skin
Compared with
No comparison treatment
Main outcome
Whether the growths came back after treatment
Quality
This is a single patient case report, which cannot show whether the treatment works in general.
Limitations
Only one patient, no comparison group, and the lesions were on the nipple and penis rather than the anus.
Taken word for word from the abstract
- population A 29-year-old male presented with lesions on the left nipple and coronary sulcus after heterosexual contact.
- intervention The patient was treated with microwave and topical imiquimod cream.
- comparator INTERVENTION: The patient was treated with microwave and topical imiquimod cream.
- primaryOutcome After 6 months follow-up, there was no sign of recurrence.
- result After 6 months follow-up, there was no sign of recurrence.
- n A 29-year-old male presented with lesions on the left nipple and coronary sulcus after heterosexual contact.
Medicine (Baltimore) · PMID 31008933 · Read it on PubMed ↗
Miray Kisla Ekinci et al. 2019
Hyperimmunoglobulinemia D syndrome with recurrent perianal abscess successfully treated with canakinumab
Rare disease; abscess healed with drug.Case seriesVery low qualityRelated question
1 people2019
the patient was clinically improved with complete healing of perianal fistulas/abscesses
Who was studied
an 18-month-old patient with recurrent attacks of fever and pharyngitis lasting 2-3 days every 10-15 days since the first two weeks of life
What they received
canakinumab (a medication that blocks inflammation)
Main outcome
improvement of symptoms and healing of perianal abscess/fistula
Quality
this is a single patient case report, so the findings may not apply to others and there is no comparison group to rule out other explanations.
Limitations
only one patient was reported, with no control group, and the underlying condition (hyperimmunoglobulinaemia D syndrome) is a rare specific disease rather than typical causes of a perianal bump.
Taken word for word from the abstract
- population an 18-month-old patient with recurrent attacks of fever and pharyngitis lasting 2-3 days every 10-15 days since the first two weeks of life
- intervention After the initiation of canakinumab
- primaryOutcome complete healing of perianal fistulas/abscesses
- result the patient was clinically improved with complete healing of perianal fistulas/abscesses
- n an 18-month-old patient
Scott Med J · PMID 30862258 · Read it on PubMed ↗
Dos Santos et al. 2018
Rare perianal extramammary Paget disease successfully treated using topical Imiquimod therapy
Rare cancer, cleared with cream.Case seriesVery low qualityRelated question
size not given2018
the lesion was successfully treated with Imiquimod cream
Who was studied
a patient with perianal Paget's disease, a rare skin cancer near the anus
What they received
topical Imiquimod 5% cream
Compared with
none (single case, no comparison group)
Main outcome
successful treatment of the perianal lesion
Quality
This is a single patient case report, so it cannot show whether this treatment works reliably for others.
Limitations
Single case report; no comparison group; abstract does not report follow-up duration or confirm this reflects typical bumps near the anus, which are usually due to far more common causes like hemorrhoids or skin tags.
Taken word for word from the abstract
- population Our PPD patient was successfully treated using Imiquimod 5% cream.
- population Perianal Paget's disease (PPD) is a rare intraepithelial adenocarcinoma of the anal margin.
- intervention topical Imiquimod therapy
- intervention Imiquimod 5% cream
- comparator Surgical excision is the standard treatment; however, previous studies have demonstrated good response with Imiquimod 5% cream in patients with vulval extramammary Paget disease (EMPD).
- primaryOutcome Our PPD patient was successfully treated using Imiquimod 5% cream.
- result effectively treated using topical Imiquimod therapy
BMC Cancer · PMID 30253739 · Read it on PubMed ↗
Spasic et al. 2019
Epithelioid Hemangioendothelioma of the Bowel in Crohn's Disease: The First Reported Case
Rare tumor hidden under anal ulcer.Case seriesVery low qualityRelated question
1 people2019
a rare blood vessel tumor (epithelioid hemangioendothelioma) was found hidden under an anal ulcer, mimicking scar tissue and fissures from Crohn's disease
Who was studied
a woman with long-term severe Crohn's disease and anal pain and bleeding
What they received
none (diagnostic case report, treated with full colon and rectum removal surgery)
Compared with
none
Main outcome
what type of growth or mass was found in the bowel
Quality
This is a single patient's case, so it cannot show how common or likely this is for anyone else.
Limitations
Single case report; no comparison group; findings may not generalize to typical anal bumps.
Taken word for word from the abstract
- n A 43-year-old woman with a 6-year history of severe CD presented with anal pain and bleeding.
- population A 43-year-old woman with a 6-year history of severe CD presented with anal pain and bleeding.
- result Beneath an ulcer of the anal canal within the muscularis propria was a 1.2-cm poorly circumscribed, firm, white-tan mass.
- result The morphology, immunoprofile, and molecular genetics were diagnostic of EHE.
- primaryOutcome The colonic mucosa exhibited segmental ulceration and irregular thickening of the colon wall.
- intervention The patient underwent total proctocolectomy.
- comparator CASE DESCRIPTION
Int J Surg Pathol · PMID 30238810 · Read it on PubMed ↗
Ruano Campos et al. 2018
Adenocarcinoma of the anal canal with an exceptional immunohistochemistry in a patient with serrated polyposis syndrome: a diagnostic challenge
Rare cancer found incidentally.Case seriesVery low qualityRelated question
1 people2018
anal cancer (adenocarcinoma) found incidentally after haemorrhoid surgery, with unusual test results making diagnosis difficult
Who was studied
a patient with serrated polyposis syndrome who had haemorrhoid surgery
What they received
none (incidental diagnostic finding)
Main outcome
diagnosis of the anal lump after surgery
Quality
this is a single patient case report, so it cannot show how common this cause is or how to treat it.
Limitations
single case report; no information on treatment or outcome; diagnosis itself described as difficult
Taken word for word from the abstract
- n We present the case of an adenocarcinoma
- population a patient with endoscopically controlled serrated polyposis syndrome
- intervention as an incidental finding after haemorrhoidectomy
- primaryOutcome Histopathological analysis of the specimen was a challenge in terms of differential diagnosis
- result an adenocarcinoma of the proximal anal canal with exceptional immunohistochemistry as an incidental finding after haemorrhoidectomy
Rev Esp Enferm Dig · PMID 30168336 · Read it on PubMed ↗
Pittman et al. 2018
Treatment Effects Can Mimic Recurrent Extramammary Paget Disease in Perianal Skin
Treatment changes can look like recurrence.Case seriesVery low qualityRelated question
3 people2018
treatment caused look-alike cell changes that could be mistaken for recurrent disease, but a special stain (CK7) could tell real recurrence apart
Who was studied
women previously treated for perianal Paget disease (a skin condition near the anus)
What they received
surgical removal with skin grafting plus topical chemotherapy (5-fluorouracil) after treatment
Compared with
no comparator; looked at biopsy samples over time in the same patients
Main outcome
whether treatment-related changes in skin cells could be told apart from true disease recurrence under the microscope
Quality
this is a report of only 3 patients with no comparison group, so it cannot show whether a treatment works, only describe diagnostic appearances.
Limitations
Only 3 patients studied; descriptive pathology review, not a treatment comparison; findings specific to a diagnosed skin cancer condition (Paget disease), not to bumps in general.
Taken word for word from the abstract
- n we reviewed 412 posttreatment tissue samples from 3 women with primary perianal Paget disease
- population 3 women with primary perianal Paget disease who underwent wide excision, skin grafting, and topical 5-fluorouracil therapy
- intervention wide excision, skin grafting, and topical 5-fluorouracil therapy
- comparator we reviewed 412 posttreatment tissue samples from 3 women with primary perianal Paget disease
- primaryOutcome To evaluate the therapy-related changes and possible diagnostic pitfalls in patients with Paget disease
- result treatment of perianal Paget disease can elicit cytologic abnormalities in benign epithelial cells that simulate the cytologic features of recurrent disease, and can diminish the atypia of Paget cells. Immunohistochemical stains for CK7 can be helpful when evaluating surveillance samples from these patients.
Am J Surg Pathol · PMID 30045063 · Read it on PubMed ↗
Luglio et al. 2018
Diagnostic Accuracy of 3-Dimensional Endoanal Ultrasound in Identifying Perianal Crohn's Fistulas
Ultrasound tells fistula types apart.Prospective cohortModerate qualityRelated question
158 people2018
the width of the fistula tract and other ultrasound features were highly accurate at telling the two fistula types apart, with some combinations being very specific or very sensitive
Who was studied
patients referred for suspected perianal sepsis
What they received
3-dimensional endoanal ultrasound scan of the anus
Compared with
final diagnosis of fistula type (Crohn's disease vs. cryptoglandular)
Main outcome
how well ultrasound features could tell Crohn's-related fistulas apart from ordinary (cryptoglandular) fistulas
Quality
it was a single-center study where some patients labeled as having an ordinary fistula could later turn out to have Crohn's disease, which could skew the accuracy numbers
Limitations
Patients included in the cryptogenic group might be diagnosed as having Crohn's disease at follow-up.
Taken word for word from the abstract
- n 158 patients, of whom 33 had a diagnosis of Crohn's disease, were included.
- population Consecutive patients referred for suspected perianal sepsis from September 2015 to December 2016 were included.
- intervention Three-dimensional endoanal ultrasonography was the studied intervention.
- comparator discriminating between cryptoglandular and Crohn's disease fistulas
- primaryOutcome Sensitivity, specificity, and positive and negative likelihood ratios of 4 ultrasonographic features (Crohn's ultrasound fistula sign, the presence of a double track, debris or an abscess within the fistula track, and the maximum width of the track) in discriminating between cryptoglandular and Crohn's disease fistulas were calculated.
- result The maximum width of the fistula track was highly accurate for discriminating between cryptogenic and Crohn's disease fistulas (area under the receiver operating characteristic curve = 0.922).
Dis Colon Rectum · PMID 29944581 · Read it on PubMed ↗
Prasad et al. 2018
Mucinous adenocarcinoma arising from chronic perianal fistula mimicking horseshoe abscess
Rare cancer mimicking an abscess.Case seriesVery low quality
1 people2018
Imaging looked like a large abscess, but biopsy showed it was actually a rare cancer (mucinous adenocarcinoma) growing from the chronic fistula
Who was studied
34-year-old woman with a long-standing perianal fistula
What they received
none (diagnostic workup of the fistula)
Main outcome
diagnosis of the mass arising from the fistula
Quality
This is a single patient case report, so it cannot show how common or likely this cause is, only that it can happen.
Limitations
Only one patient is described, so findings cannot be generalised.
Taken word for word from the abstract
- population A case of mucinous adenocarcinoma arising in chronic perianal fistula in a 34-year-old woman is being described.
- n a 34-year-old woman
- intervention Transrectal ultrasound-guided biopsy and subsequent histopathological examination confirmed the presence of mucinous adenocarcinoma with tumour cells immunopositive for CK7 and CK20.
- primaryOutcome histopathological examination confirmed the presence of mucinous adenocarcinoma
- result On MRI, the lesion was mimicking a large horseshoe abscess. Transrectal ultrasound-guided biopsy and subsequent histopathological examination confirmed the presence of mucinous adenocarcinoma with tumour cells immunopositive for CK7 and CK20.
BMJ Case Rep · PMID 29622704 · Read it on PubMed ↗
Eberspacher et al. 2017
Pilonidal disease mimicking anterior anal fistula and associated with posterior anal fistula: a two-step surgery. Case report
Rare bump was misdiagnosed pilonidal disease, healed after surgery.Case seriesVery low quality
1 peopleabout one month
good healing of the posterior anal fistula and successful removal of the pilonidal sinus after two-step surgery
Who was studied
a 36-year-old man with an anal fistula
What they received
two-step surgery (fistulectomy, abscess drainage, seton placement, then excision of pilonidal sinus)
Compared with
none
Main outcome
healing of the fistula and pilonidal disease
Quality
this is a single patient case report, so it cannot show how often this happens or how well treatment works in general.
Limitations
only one patient described, no comparison group, and diagnosis was missed before surgery even with imaging.
Taken word for word from the abstract
- population A 36-year old man was referred to our department with an anal fistula with an anterior opening.
- n A 36-year old man
- intervention We performed a two-step surgery with a first fistulectomy of the anterior tract, a drainage of abscess and the positioning of a seton for the posterior fistula.
- comparator We refused an aggressive approach and chose a two-step surgery
- primaryOutcome we evaluate the good healing of posterior anal fistula and excised the residual pilonidal sinus
- result we evaluate the good healing of posterior anal fistula and excised the residual pilonidal sinus
- followUp After about one month and the fall of the seton
G Chir · PMID 29442064 · Read it on PubMed ↗
Negbenebor et al. 2017
A rare case of amelanotic anorectal melanoma
Rare melanoma mistaken for hemorrhoid.Case seriesVery low quality
1 people2017
Anal nodule initially misdiagnosed as a hemorrhoid was later found by biopsy to be an amelanotic (non-pigmented) anorectal melanoma
Who was studied
74-year-old man with rectal bleeding and an anal nodule
What they received
none (diagnostic case report)
Compared with
none
Main outcome
correct diagnosis of the anal lesion
Quality
This is a single patient case report, so it cannot show how common this cause is or how well any treatment works.
Limitations
Single case only, no comparison group, and diagnosis was delayed by a month.
Taken word for word from the abstract
- n A 74-year-old man presented with a week's history of "blood on toilet tissue"
- population A 74-year-old man presented with a week's history of "blood on toilet tissue" without bowel complaints or history of cutaneous melanoma.
- intervention Rectal exam was negative for blood, but revealed an anal nodule, interpreted as a hemorrhoid.
- comparator We report an exceedingly rare case of amelanotic anorectal melanoma misdiagnosed as hemorrhoids.
- primaryOutcome After one month, colonoscopy detected a non-pigmented anal lesion. Biopsy showed melanoma.
- result We report an exceedingly rare case of amelanotic anorectal melanoma misdiagnosed as hemorrhoids.
R I Med J (2013) · PMID 28873483 · Read it on PubMed ↗
Erden 2018
MRI of anal canal: common anal and perianal disorders beyond fistulas: Part 2
Describes possible causes, not a treatment finding.Narrative reviewVery low qualityRelated question
size not given2018
The abstract describes MRI findings for conditions like tumors, hemorrhoids, vascular malformations, and sphincter damage, without reporting a specific comparative result
Who was studied
people with anal pain or anorectal symptoms
What they received
MRI imaging of the anal canal
Main outcome
identifying the cause of anal/perianal symptoms such as neoplasms, hemorrhoids, or sphincter damage
Quality
This is a narrative review describing imaging findings rather than a study testing a treatment or comparing outcomes.
Limitations
No patient numbers, no outcome data, and no comparison group; this is a descriptive imaging review, not a study of treatment effectiveness.
Taken word for word from the abstract
- population individuals with anorectal symptoms
- intervention MR imaging (MRI) has become increasingly widely used method over the past two decades for the evaluation of individuals with anorectal symptoms
- primaryOutcome MRI findings of a number of pathologies such as anal and perianal neoplasms, hemorrhoidal disease, arteriovenous malformation of the perianal region, and anal sphincter lesions (defects, scarring, atrophy) which may lead to fecal incontinence are presented
- result MRI is particularly useful as a noninvasive method of excluding severe neoplastic conditions
Abdom Radiol (NY) · PMID 28871380 · Read it on PubMed ↗
Kentley et al. 2017
Intestinal tuberculosis: a diagnostic challenge
Perianal lump can be TB.RetrospectiveLow qualityRelated question
61 people2017
median time from symptom onset to diagnosis was 13 weeks, and five patients had isolated perianal disease
Who was studied
adults with intestinal tuberculosis, mostly born abroad in TB-endemic areas
What they received
none (observational study of diagnosis, not a treatment)
Compared with
not reported
Main outcome
time to diagnosis and diagnostic findings of intestinal TB
Quality
This is a small retrospective single-hospital case series without a comparison group, so it can only describe patterns, not prove cause or treatment effect.
Limitations
Retrospective design, single center, no comparator group, and diagnosis was often delayed or initially misattributed to IBD.
Taken word for word from the abstract
- n Retrospective study of 61 consecutive ITB patients diagnosed between 2008 and 2014 at a large East London hospital.
- population 93% of patients were born abroad, mostly from TB-endemic areas
- intervention Retrospective study of 61 consecutive ITB patients diagnosed between 2008 and 2014
- comparator Ten patients were initially treated for IBD, although patients had ITB.
- primaryOutcome To describe characteristics, presentation, time to diagnosis and diagnostic findings of patients with intestinal tuberculosis (ITB) in a low-burden country.
- result Median time from symptom onset to ITB diagnosis was 13 weeks (IQR 3-26 weeks).
- result Five patients had isolated perianal disease.
Trop Med Int Health · PMID 28609809 · Read it on PubMed ↗
Guttenplan 2017
The Evaluation and Office Management of Hemorrhoids for the Gastroenterologist
Bump may be a hemorrhoid, often treatable without surgery.Narrative reviewVery low qualityRelated question
size not given2017
most patients can be treated in the office and avoid surgery
Who was studied
people with hemorrhoid disease seen by gastroenterologists
What they received
office-based evaluation and treatment of hemorrhoids
Compared with
surgical intervention
Main outcome
ability to manage hemorrhoids without surgery
Quality
this is a narrative review summarizing general knowledge and practice recommendations, not a study testing an intervention.
Limitations
no original data, no defined outcomes or comparisons, purely descriptive review
Taken word for word from the abstract
- population Hemorrhoid disease is extremely common, and seldom requires surgical intervention.
- intervention the proper evaluation and office-based treatment of these patients
- comparator avoid the expense and morbidity of surgical intervention
- primaryOutcome Comprehensive management of all of these issues will allow all but the most severely affected patients to avoid the expense and morbidity of surgical intervention.
- result Comprehensive management of all of these issues will allow all but the most severely affected patients to avoid the expense and morbidity of surgical intervention.
Curr Gastroenterol Rep · PMID 28567655 · Read it on PubMed ↗
Rashidi et al. 2017
Unexpected Presentation of Perianal Granular Cell Tumor in a Young Woman
Rare benign perianal tumor found.Case seriesVery low quality
1 people2017
the lump was a rare benign tumor called a granular cell tumor
Who was studied
a 36-year-old woman with a painless lump near the anus
What they received
surgical removal of the lump
Compared with
none
Main outcome
what the lump turned out to be on biopsy
Quality
this is a report of a single patient, so it cannot show how common this cause is or how well treatment works in general
Limitations
only one case is described, with no comparison group or follow-up data
Taken word for word from the abstract
- n a previously healthy 36-year-old woman
- population a previously healthy 36-year-old woman who presents with a slow growing, painless lump in her perianal region
- intervention underwent surgical excision
- comparator underwent surgical excision and was found to have a granular cell tumor on microscopic evaluation
- primaryOutcome was found to have a granular cell tumor on microscopic evaluation
- result was found to have a granular cell tumor on microscopic evaluation
Curr Probl Diagn Radiol · PMID 28284459 · Read it on PubMed ↗
Bassas-Vila et al. 2016
Hidradenitis suppurativa and perianal Crohn disease: differential diagnosis
Review explaining two possible causes.Narrative reviewLow qualityRelated question
size not given2016
the abstract describes both conditions and says telling them apart can be hard, especially when perianal; it does not report a study result
Who was studied
people with perianal bumps or sores possibly from Crohn disease or hidradenitis suppurativa
What they received
not applicable - this is a review about telling two conditions apart
Compared with
not applicable
Main outcome
how to distinguish hidradenitis suppurativa from perianal Crohn disease
Quality
this is a narrative review describing a clinical challenge, not a study testing a treatment, so it can't show whether any treatment works.
Limitations
no original data, patient numbers, or outcome measures are given; it is a descriptive review, not a controlled study.
Taken word for word from the abstract
- population deep, painful and inflamed lesions in the areas of the body with apocrine glands, usually the axillary, inguinal and anogenital regions
- primaryOutcome The differential diagnosis between hidradenitis suppurativa and Crohn disease can be challenging, especially when the disease is primarily perianal.
- result When they occur simultaneously, hidradenitis suppurativa and Crohn disease show severe phenotypes and patients can respond to anti-tumour necrosis factor therapy, although adalimumab is currently the only treatment with demonstrated efficacy in hidradenitis suppurativa and Crohn disease.
- intervention adalimumab is currently the only treatment with demonstrated efficacy in hidradenitis suppurativa and Crohn disease
- comparator there is sometimes a need for different complementary surgical procedures
Actas Dermosifiliogr · PMID 28081767 · Read it on PubMed ↗
Hoff et al. 2017
Pathology of Anal Cancer
Explains cancer types, not symptoms like a bumpNarrative reviewVery low qualityRelated question
size not given2017
describes tumor types, HPV's role, and diagnostic markers but does not test a treatment or report patient outcomes
Who was studied
people with anal canal cancer or precancerous lesions
What they received
not applicable (pathology review)
Main outcome
classification and diagnosis of anal cancer types
Quality
this is a descriptive pathology review, not a study testing an intervention or outcome, so it cannot show benefit or harm
Limitations
review article summarizing pathology classification; no original patient outcome data, no treatment comparison, no information on prognosis biomarkers
Taken word for word from the abstract
- population Anal canal cancer is rather an uncommon disease but its incidence is increasing.
- intervention For differential diagnosis, immunostaining markers such as CK5/6 and p63 can be used to distinguish SCC and CK7 for adenocarcinoma.
- result Currently, there are no biomarkers able to predict prognosis or response to treatment in clinical practice.
- primaryOutcome Many other tumor types can arise in the anal canal, including adenocarcinomas, neuroendocrine tumors, malignant melanomas, lymphomas and various types of mesenchymal tumors.
Surg Oncol Clin N Am · PMID 27889037 · Read it on PubMed ↗
Oliveira et al. 2017
MRI features of perianal fistulas: is there a difference between Crohn's and non-Crohn's patients?
Crohn's fistulas show more rectal inflammation.RetrospectiveLow qualityRelated question
126 people2017
Rectal inflammation was seen more often in Crohn's-related fistulas (29.2%) than in non-Crohn's fistulas (6.7%), while fistula type and abscess rates were similar between groups
Who was studied
patients with perianal fistulas (a tunnel-like tract near the anus)
What they received
having a perianal fistula caused by Crohn's disease
Compared with
having a perianal fistula not caused by Crohn's disease
Main outcome
MRI features of the fistula, including type, abscess, and rectal inflammation
Quality
This was a retrospective chart review without randomization or blinding, so it can show patterns but not prove cause and effect.
Limitations
Retrospective design; excluded patients with prior surgery or unclear findings; only looked at imaging features, not symptoms or causes of a visible bump.
Taken word for word from the abstract
- n One hundred and twenty six of 207 patients met inclusion criteria.
- population perianal fistulas are commonly seen in patients with Crohn's disease, they can also be seen in patients without inflammatory bowel disease
- intervention 96 (76.2%) had Crohn's disease
- comparator 30 (23.8%) did not
- primaryOutcome anatomic type of fistula (Parks Classification), luminal origin (hour clock position), anal verge distance, signs of acute inflammation, circumference of anus involved by inflammation, presence of rectal inflammation. and abscess
- result Rectal inflammation was present in 29 patients with Crohn's disease (29.2%) and in 2 without Crohn's (6.7%). This finding was statistically significant (p = 0.0009).
Abdom Radiol (NY) · PMID 27885389 · Read it on PubMed ↗
Tutino et al. 2016
Polypoid anal melanoma. A case report and review of the literature
Anal bump was rare melanoma, not hemorrhoidCase seriesVery low quality
1 people2016
the mass was found to be a rare anal melanoma, not a hemorrhoid, with tumor cells at the edge of the removed tissue
Who was studied
55-year-old woman with rectal bleeding, anal pain, and anal mass thought to be a hemorrhoid
What they received
surgical removal of the anal mass (transanal excision)
Main outcome
diagnosis and nature of the anal mass
Quality
this is a single patient case report, so it cannot show how common this is or what treatment works best
Limitations
single case, no long-term outcome reported since patient declined further treatment
Taken word for word from the abstract
- population A 55-years-old woman, complaining of rectal bleeding, frequent anal pain and anal mass suspected for haemorroidal thrombosis was referred for evaluation and possible treatment.
- intervention The hystological examination of the neoplasm, transanally removed, revealed the presence of a polypoid melanoma partially involving the resection margin.
- primaryOutcome A brown polypoid mass arising from the anal canal/lower rectum with a maximum diameter of 6 cm was diagnosed.
- result revealed the presence of a polypoid melanoma partially involving the resection margin
- n A 55-years-old woman
Ann Ital Chir · PMID 27857005 · Read it on PubMed ↗
Cocorullo et al. 2016
Rectal bleeding and prolapse… not always benign diseases rather anal cancer. The importance of a correct decision making since primary care
Anal bump was actually cancer.Case seriesVery low quality
1 people2016
the mass was misdiagnosed as hemorrhoids at first, but was later found to be anal cancer (squamous carcinoma) on biopsy
Who was studied
a 61-year-old woman with rectal bleeding and an anal mass
What they received
not applicable - diagnostic case report
Compared with
not applicable - no comparator
Main outcome
correct diagnosis of the cause of the anal mass and bleeding
Quality
this is a single patient case report, so it cannot show how common any cause is or how well any treatment works.
Limitations
only one patient is described, and the abstract is about diagnostic delay rather than testing a treatment or measuring outcomes across patients.
Taken word for word from the abstract
- n a 61-years-old woman
- population a case of a 61-years-old woman, complaining rectal bleeding and an anal mass
- primaryOutcome Inspection and digital rectal examination revealed an anal mass.
- result Histologic samples showed an epithelial proliferation compatible with a squamous carcinoma.
- intervention family doctor who does a visit but without a digital rectal examination and diagnosed a hemorrhoidal prolapse suggesting medical therapy
- comparator Oncological consult was requested and a chemo-radiotherapy treatment was proposed.
G Chir · PMID 27734798 · Read it on PubMed ↗
Perungo et al. 2016
An elusive cause of perianal pain in a patient with Hirschsprung's disease
Rare cyst caused bump and pain.Case seriesVery low quality
1 people2016
a presacral epidermoid (sebaceous) cyst was found and removed, initially mistaken for a nerve sheath tumour on imaging
Who was studied
23-year-old woman with Hirschsprung's disease, previously operated as infant, with perianal pain and constipation
What they received
surgical excision of presacral lesion via perineal route
Compared with
none
Main outcome
identification and removal of cause of perianal pain
Quality
This is a single patient case report, so it cannot show how common this cause is or how well treatment works in general.
Limitations
Single case, no long-term follow-up reported, rare condition.
Taken word for word from the abstract
- n A 23-year-old woman presented to the outpatients department
- population A 23-year-old woman presented to the outpatients department with symptoms of acute onset perianal pain of 2 weeks' duration and constipation. She was a known case of Hirschsprung's disease and was operated on in infancy.
- intervention The tumour was excised by the perineal route
- comparator Presacral tumours are very rare lesions which most colorectal surgeons never come across in their careers.
- primaryOutcome subsequent colonoscopy was normal. Because of persistent symptoms, she was evaluated further by imaging
- result the histopathology report revealed an epidermoid (sebaceous) cyst
BMJ Case Rep · PMID 27733417 · Read it on PubMed ↗
Surabhi et al. 2016
Tumors and Tumorlike Conditions of the Anal Canal and Perianal Region: MR Imaging Findings
Imaging helps identify tumor type, biopsy needed.Narrative reviewLow qualityRelated question
size not given2016
MRI can help characterize anal and perianal tumors but overlapping features mean a definite diagnosis usually requires a tissue biopsy
Who was studied
people with tumors or growths in the anal canal or perianal area
What they received
MRI imaging to evaluate the growth
Compared with
none
Main outcome
how well MRI findings help identify and characterize the type of tumor
Quality
This is a descriptive review of imaging features, not a study testing an outcome or treatment.
Limitations
The abstract notes overlap in imaging features among different tumor types, so imaging alone cannot give a definitive diagnosis.
Taken word for word from the abstract
- population Tumors and tumorlike conditions of the anus and perianal region originate from the anal canal and anal margin or result from direct extension of tumors from adjacent organs.
- intervention Imaging plays an important role in the evaluation, staging, and follow-up of patients with anal and perianal tumors.
- comparator a definitive diagnosis is best established at histopathologic examination
- primaryOutcome familiarity with the pathogenesis, imaging features, and treatment of these tumors can aid radiologic diagnosis and guide appropriate patient treatment
- result because of the overlap in imaging features among these diverse entities, a definitive diagnosis is best established at histopathologic examination
Radiographics · PMID 27618320 · Read it on PubMed ↗
Glowka et al. 2016
[Anorectal malignant melanoma : Treatment recommendations]
Rare anal cancer, surgery main treatment.Narrative reviewVery low qualityRelated question
8 people2016
median survival was 12 months with disease-free survival of 6 months; surgery was the only effective therapy and local excision was enough if margins were clear
Who was studied
patients with anorectal malignant melanoma, a rare cancer that can look like hemorrhoids
What they received
surgical removal of the tumor (local excision or more extensive abdominoperineal resection)
Compared with
different surgical approaches compared to each other, based on tumor size and stage
Main outcome
survival time and cancer recurrence after surgery
Quality
it's a tiny case series of 8 patients combined with a non-systematic literature review, with no control group to compare against.
Limitations
Very small number of own patients, no systematic review methodology described, no control group, and no therapy guidelines exist.
Taken word for word from the abstract
- population Anorectal malignant melanoma is a rare tumor with a poor prognosis.
- population Typical symptoms (bleeding, pain, perianal mass) are characteristic of hemorrhoids.
- intervention Six underwent abdominoperineal resection; two had local excision.
- comparator Local excision is sufficient when free resection margins are achieved.
- primaryOutcome Median survival was 12 months with a disease-free survival of 6 months.
- result Median survival was 12 months with a disease-free survival of 6 months.
- result Surgery is the only effective therapy.
- n Eight patients (six women) with a mean age of 65 ± 8 years were treated at our institution.
Chirurg · PMID 27392764 · Read it on PubMed ↗
Al-Tarakji et al. 2016
Rare occurrence of metastasis from lung cancer to the anus: case report and review of the literature
Rare cancer spread mistaken for abscessCase seriesVery low qualityRelated question
1 people2016
the lung cancer had spread to the anus, appearing like an abscess
Who was studied
a patient with non-small cell lung cancer
What they received
not applicable (case report)
Main outcome
diagnosis of perianal/anal mass
Quality
this is a single case report, which cannot show how common or likely a cause this is for people in general
Limitations
only one patient described; no comparison group; based on a rare, advanced cancer case rather than typical causes of anal bumps
Taken word for word from the abstract
- population a patient with non-small cell lung cancer presenting with perianal metastasis mimicking an abscess
- intervention We report a case of a patient with non-small cell lung cancer presenting with perianal metastasis mimicking an abscess.
- result Because perianal masses may be misdiagnosed, patients with lung and other cancers should be evaluated for metastatic disease.
- n We report a case of a patient with non-small cell lung cancer
- primaryOutcome Because perianal masses may be misdiagnosed, patients with lung and other cancers should be evaluated for metastatic disease.
World J Surg Oncol · PMID 27278524 · Read it on PubMed ↗
Tupe et al. 2016
Anorectal Complaints in the Emergency Department
Review discusses causes, not findings.Narrative reviewVery low qualityRelated question
size not given2016
the abstract does not report a specific result, just general guidance on diagnosis and management
Who was studied
patients presenting to the emergency department with anorectal complaints
Main outcome
recognizing and distinguishing benign from serious anorectal conditions
Quality
this is a general review discussing diagnosis, not a study testing any treatment or reporting outcomes.
Limitations
no study design, patient data, or outcomes are reported; it is a general overview for clinicians.
Taken word for word from the abstract
- population Patients commonly present to the emergency department with anorectal complaints.
- primaryOutcome It is important to maintain a broad differential diagnosis of anorectal disease and to distinguish benign from serious processes.
- result Most of these complaints are benign and can be managed conservatively; however, there are a few anorectal emergencies that clinicians must be aware of in order to prevent further complications.
Emerg Med Clin North Am · PMID 27133243 · Read it on PubMed ↗
Kreuter 2016
Proctology - diseases of the anal region
Describes causes, not treatment results.Narrative reviewVery low quality
size not given2016
describes an algorithm using five key symptoms to help diagnose anal/perianal conditions
Who was studied
people with perianal region, anal canal, or rectum symptoms
What they received
not applicable (review article)
Compared with
not applicable (review article)
Main outcome
identifying the diagnosis causing perianal symptoms
Quality
This is a narrative review describing disease categories and a diagnostic approach, not a study testing a treatment or reporting outcome data.
Limitations
Abstract does not report any study data, participant numbers, or comparative outcomes; it is a descriptive overview of disease categories and diagnostic symptoms.
Taken word for word from the abstract
- population Proctology is a medical subspecialty that encompasses diseases of the perianal region, anal canal, and rectum.
- primaryOutcome there are only five key symptoms prompting patients to consult a proctologist, including anal pruritus and burning, discharge, bleeding, pain, and foreign body sensation
- result A simple algorithm, which incorporates these symptoms as well as key clinical features, may assist in quickly establishing the correct diagnosis in everyday clinical practice.
- intervention the present article highlights all relevant disease groups in the field of proctology
- comparator Despite the wide variety of disorders, there are only five key symptoms prompting patients to consult a proctologist
J Dtsch Dermatol Ges · PMID 27027745 · Read it on PubMed ↗
Sasaki et al. 2016
Condyloma acuminatum of the anal canal, treated with endoscopic submucosal dissection
No recurrence after removal.Case seriesVery low quality
1 people16 mo
no recurrence seen 16 months after the procedure
Who was studied
28-year-old man with a wart-like growth in the anal canal causing rectal bleeding
What they received
endoscopic submucosal dissection (a scope procedure to remove the growth)
Compared with
standard surgical removal or topical treatment
Main outcome
whether the growth came back after removal
Quality
this is a single patient case report, so it cannot show whether this treatment works better than others in general
Limitations
only one patient was studied, so findings may not apply to others
Taken word for word from the abstract
- population A 28-year-old man presented with a chief complaint of hematochezia.
- intervention we performed diagnostic ESD
- comparator Standard therapies include surgical treatments (trans-anal resection and trans-anal endoscopic microsurgery) and immunotherapeutic and topical methods (topical imiquimod)
- primaryOutcome There was no recurrence at 16 mo after the initial ESD.
- result There was no recurrence at 16 mo after the initial ESD.
- n A 28-year-old man presented with a chief complaint of hematochezia.
World J Gastroenterol · PMID 26937152 · Read it on PubMed ↗
Vecchio et al. 2015
A rare case of myeloid sarcoma presenting as anal fissure
Rare leukemia-related tumor causing fissureCase seriesVery low qualityRelated question
size not given2015
the fissure was found to be caused by myeloid sarcoma, a rare tumor related to leukemia
Who was studied
a patient with a history of acute myeloid leukemia who had a painful anal fissure
What they received
none (diagnostic surgical excisional biopsy)
Main outcome
identifying the cause of the anal fissure
Quality
this is a single rare case report, so it cannot show how common this cause is or how it compares to other treatments
Limitations
only one patient described; no comparison group; specific to a patient with existing leukemia history
Taken word for word from the abstract
- population We report a unique case of myeloid sarcoma presenting as a painful anal fissure, in a patient with a history of acute myeloid leukemia.
- intervention The diagnosis was achieved by a surgical excisional biopsy and immunoistochemical staining.
- primaryOutcome We report a unique case of myeloid sarcoma presenting as a painful anal fissure, in a patient with a history of acute myeloid leukemia.
- result We report a unique case of myeloid sarcoma presenting as a painful anal fissure, in a patient with a history of acute myeloid leukemia.
- n We report a unique case
G Chir · PMID 26712260 · Read it on PubMed ↗
Roberts et al. 2016
Papillary Immature Metaplasia of the Anal Canal: A Low-grade Lesion That Can Mimic a High-grade Lesion
Harmless lesion that can look dangerous.Case seriesVery low qualityRelated question
15 people2016
PIM was a low-grade lesion that looked immature under the microscope, tested negative for p16, and contained a single low-risk HPV type (6 or 11), but could be mistaken for a high-grade lesion
Who was studied
homosexual men being studied for anal HPV infection
What they received
identification of papillary immature metaplasia (PIM) lesions in anal biopsy samples
Compared with
conventional low-grade squamous intraepithelial lesion (eLSIL/condyloma)
Main outcome
characteristics and HPV type of the PIM lesion, including p16 status
Quality
This is a small descriptive case series of only 15 biopsy samples with no comparison group or outcome tracking, so it cannot show whether any treatment works.
Limitations
Abstract does not report long-term follow-up or clinical outcomes; study only describes microscopic and HPV features, with a note that 'further study of the natural history of anal canal PIM is needed.'
Taken word for word from the abstract
- n we identified 15 examples of papillary immature metaplasia (PIM) in anal biopsy samples
- population a natural history study of anal human papillomavirus (HPV) infection and HPV-related lesions among homosexual men in Sydney, Australia
- intervention we identified 15 examples of papillary immature metaplasia (PIM) in anal biopsy samples
- comparator PIM is a form of exophytic low-grade squamous intraepithelial lesion (eLSIL) also known as condyloma
- primaryOutcome PIM was characterized by close proximity to conventional eLSIL, was negative for p16 (p16) expression, and revealed the presence of a single low-risk HPV genotype (either 6 or 11) in laser capture microdissected lesions
- result The clinical significance of recognizing PIM lies in preventing misdiagnosis as high-grade squamous intraepithelial lesion, (the presumed precursor to anal cancer), due to the morphologic immaturity of the cell population.
Am J Surg Pathol · PMID 26551619 · Read it on PubMed ↗
Choi et al. 2015
Clinical Features of Tuberculous Versus Crohn's Anal Fistulas, in Korea
TB and Crohn's fistulas look similar but differ.RetrospectiveLow qualityRelated question
203 people2015
TB fistula patients were older and had more chronic illness, pulmonary TB signs, and fewer colon mucosal lesions than Crohn's fistula patients
Who was studied
patients who had surgery for anal fistulas
What they received
tuberculous anal fistula
Compared with
Crohn's disease anal fistula
Main outcome
clinical, pathological, and colonoscopic features distinguishing TB from Crohn's anal fistula
Quality
This is a retrospective comparison of two conditions without a control or treatment, so it only describes differences, not what helps.
Limitations
Retrospective design; no information on treatment outcomes; findings specific to a TB-endemic country.
Taken word for word from the abstract
- population 13872 patients who underwent anal fistula surgery from 2003 to 2014, 87 patients with TB fistulas and 116 patients with CD fistulas were included
- intervention TB anal fistula
- comparator Crohn's disease [CD] anal fistula
- primaryOutcome clinical, pathological, ultrasonographic, colonoscopic and surgical data were analysed
- result the TB group was older [median: 37 vs 22 years] and underlying chronic illness was more common [20.3% vs 2.6%]
- result mucosal lesions were observed more frequently in CD [96.9% vs 16.9%]
- n 87 patients with TB fistulas and 116 patients with CD fistulas were included
J Crohns Colitis · PMID 26374663 · Read it on PubMed ↗
Gopal et al. 2015
Primary Anal Canal Syphilis in Men: The Clinicopathologic Spectrum of an Easily Overlooked Diagnosis
Anal bump or ulcer can be syphilis.Case seriesVery low quality
4 people2015
all 4 cases showed characteristic inflammation pattern and syphilis bacteria confirmed by special staining, often missed clinically
Who was studied
men with anal canal ulcers or masses, some HIV positive
What they received
pathologic review including tissue staining for syphilis bacteria
Compared with
none
Main outcome
identifying syphilis as the cause of anal ulcers or mass
Quality
this is a tiny case series of only 4 patients with no comparison group, so it cannot show whether any treatment works, only that syphilis can cause anal ulcers or masses and be missed.
Limitations
only 4 cases, no control group, descriptive pathology study not a treatment trial
Taken word for word from the abstract
- n To describe 4 cases of primary syphilis presenting in the anal canal
- population All 4 patients were male, of whom 2 were HIV positive.
- intervention Clinical presentation, hematoxylin-eosin-stained sections, and Treponema pallidum immunohistochemical staining were reviewed in detail in all 4 cases.
- comparator CONTEXT: The incidence of syphilis is on the rise
- primaryOutcome Syphilis was clinically suspected in only 1 case; in 2 cases, confirmatory evaluation and treatment were prompted by pathologic diagnosis.
- result All 4 cases had bandlike chronic plasma cell-rich inflammation at the squamous epithelium and lamina propria junction
- result Treponema pallidum immunohistochemistry highlighted homing of organisms in a perivascular pattern and at the junction of squamous epithelium and lamina propria.
Arch Pathol Lab Med · PMID 26317454 · Read it on PubMed ↗
Nagra et al. 2015
A perianal presentation of myeloid sarcoma
Rare blood cancer mimicking hemorrhoids.Case seriesVery low quality
1 people2015
the lump was found to be myeloid sarcoma linked to a blood cancer (CMML transforming to AML), not haemorrhoids or an abscess
Who was studied
a 51-year-old man with a perianal lump initially treated for haemorrhoids and abscess
What they received
biopsy and histological examination of the perianal lesion
Main outcome
underlying cause of the perianal lump
Quality
this is a single patient case report, so it cannot show how common this cause is or how reliable the finding is for others.
Limitations
Findings come from only one patient, so they may not apply to most people with a similar bump.
Taken word for word from the abstract
- population a rare presentation of myeloid sarcoma in the perianal region of a 51-year-old man, who was seen by various clinicians and treated for haemorrhoids and perianal abscess
- intervention A histological biopsy demonstrated myeloid sarcoma
- primaryOutcome A histological biopsy demonstrated myeloid sarcoma and bone marrow aspirate, and trephine confirmed CMML transforming to AML.
- result A histological biopsy demonstrated myeloid sarcoma and bone marrow aspirate, and trephine confirmed CMML transforming to AML.
- n a 51-year-old man
BMJ Case Rep · PMID 25969499 · Read it on PubMed ↗
Spornraft-Ragaller et al. 2015
[Sexually transmitted infections of the anorectal region]
Bumps can be an STI signNarrative reviewLow quality
size not given2015
Anorectal STIs often cause lumps, ulcers, or proctitis and can be mistaken for cancer or bowel disease; different infections have different typical patterns
Who was studied
people with sexually transmitted infections affecting the anal/rectal area, including men who have sex with men and heterosexuals practicing anal intercourse
What they received
not applicable (review of diagnosis and clinical features)
Main outcome
clinical appearance, diagnosis and treatment of anorectal STIs
Quality
This is a narrative review describing clinical patterns rather than testing a treatment, so it cannot show whether any intervention works.
Limitations
No original data, sample size, or outcome statistics are given; abstract does not report study methodology.
Taken word for word from the abstract
- population Sexually transmitted infections (STIs) are increasingly observed in men who have sex with men (MSM)
- intervention This review will focus on the clinical picture, diagnosis and therapy of frequent STIs involving the anorectal region.
- result Anorectal manifestations of STIs consist of tumorous masses, ulcers or proctitis and may be misdiagnosed as malignancy or inflammatory bowel disease.
- result Herpes simplex and syphilis primarily show ulcerations and may involve the perianal region, whereas gonorrhoea and lymphogranuloma venereum mainly cause proctitic symptoms with exsudation.
- primaryOutcome clinical picture, diagnosis and therapy of frequent STIs involving the anorectal region
Hautarzt · PMID 25898890 · Read it on PubMed ↗
Raptis et al. 2015
The differential diagnosis and interdisciplinary treatment of anal carcinoma
A bump could be anal cancer, needs checkingNarrative reviewLow qualityRelated question
size not given2015
5-year survival of 80-90% with combined radiochemotherapy as the preferred treatment
Who was studied
people with anal cancer
What they received
combined radiation and chemotherapy (5-fluorouracil and mitomycin C)
Compared with
surgery alone
Main outcome
survival and cure of anal cancer
Quality
This is a narrative review of guidelines and literature, not a study testing a treatment against a comparison group.
Limitations
The abstract does not describe study methodology, sample size, or how evidence was selected or weighed; it is a selective literature review.
Taken word for word from the abstract
- population Anal carcinoma accounts for 2-4% of all cases of colorectal and anorectal carcinoma.
- intervention Radiochemotherapy with 5-fluorouracil and mitomycin C is the treatment of choice.
- comparator Primary surgery with curative intent is indicated only for well-differentiated carcinoma of the anal margin (T1, N0).
- primaryOutcome The 5-year survival rate is 80-90%.
- result The 5-year survival rate is 80-90%.
Dtsch Arztebl Int · PMID 25891807 · Read it on PubMed ↗
Rougé-Maillart et al. 2015
Anal lesions presenting in a cohort of child gastroenterological examinations. Implications for sexual traumatic injuries
Anal bumps often just from constipationProspective cohortLow qualityRelated question
100 people2015
most lesions were anal fissures and skin tags located at the median line, linked to constipation, not abuse signs
Who was studied
children under 15 years old seeing a doctor for digestive symptoms like constipation
What they received
gastroenterology exam looking for anal lesions
Compared with
none
Main outcome
type and location of anal lesions found during exam
Quality
this is a descriptive study without a comparison group, so it only describes findings rather than testing a treatment
Limitations
abstract does not mention blinding, control group, or statistical testing
Taken word for word from the abstract
- n This prospective descriptive study included 100 children under 15 years of age
- population consulting due to digestive symptoms
- intervention pediatric gastroenterology consultation when the reason for the complaint was related to a digestive disease
- comparator This prospective descriptive study included 100 children under 15 years of age over a 13-month period, consulting due to digestive symptoms.
- primaryOutcome Fifty-one anal lesions were observed, of which 58.8% were anal fissures, 15.7% were skin tags and 5.8% were venous congestions related to straining.
- result The two most common anal lesions were anal fissures and skin tags. These anal lesions were mainly observed at the median line and were due to constipation.
J Forensic Leg Med · PMID 25882145 · Read it on PubMed ↗
Dietrich et al. 2015
[Differential diagnosis of anal eczema]
Review on diagnosing anal skin problems.Narrative reviewVery low qualityRelated question
size not given2015
the review describes common symptoms and recommends careful history-taking, examination, and biopsy when diagnosis is uncertain
Who was studied
people with skin problems around the anus
Main outcome
how to correctly identify the cause of anal skin problems
Quality
this is a narrative review describing diagnostic approach, not a study testing a treatment or reporting outcomes.
Limitations
abstract does not describe a study with patients, interventions, or measured outcomes - it is a diagnostic guidance review.
Taken word for word from the abstract
- population Dermatologic disorders often show involvement of the (peri)anal skin.
- result In case of atypical presentation or uncertainty a biopsy needs to be obtained to ensure correct diagnosis and treatment.
- primaryOutcome Careful history of symptoms, stool, hygiene, sexual practice as well as thorough inspection of the entire body and proctological examination are crucial to make the correct diagnosis.
Hautarzt · PMID 25874442 · Read it on PubMed ↗
Pirog 2015
Immunohistochemistry and in situ hybridization for the diagnosis and classification of squamous lesions of the anogenital region
Lab stains help diagnose abnormal cells correctlyNarrative reviewLow qualityRelated question
size not given2015
certain stains (Ki-67, p16, ProEx C) help accurately confirm or rule out precancerous HPV-related lesions versus benign mimics
Who was studied
people with abnormal-looking anogenital skin lesions being evaluated by a pathologist
What they received
special stains (immunohistochemistry/in situ hybridization markers like Ki-67, p16, ProEx C) to test tissue samples
Compared with
standard microscopic examination alone
Main outcome
accuracy in telling apart HPV-related precancerous lesions from benign look-alike bumps
Quality
this is a review article discussing diagnostic markers, not a study that counted patient outcomes or measured accuracy with numbers.
Limitations
this is a review summarizing lab techniques for pathologists, not a patient study; it doesn't address why someone develops a bump or how common any cause is
Taken word for word from the abstract
- population Distinguishing anogenital squamous intraepithelial lesions from benign conditions and mimics may be problematic.
- intervention Immunohistochemistry for surrogate markers of HPV infection, such as Ki-67, p16, and ProEx™ C, may aid the diagnosis in equivocal cases.
- comparator Confirmation of the diagnosis of dysplasia by HPV detection in tissue sections using HPV capsid protein immunohistochemistry, HPV DNA or HPV RNA in situ hybridization offers lower sensitivity as compared to immunohistochemistry for surrogate markers
- primaryOutcome A marker with high sensitivity and specificity for the detection of HSIL in cervical, vulvar, and anal mucosa is p16.
- result When interpreted correctly, Ki-67 is a sensitive and specific marker for dysplasia in mature squamous epithelium and is therefore useful for confirmation of LSIL and condyloma.
Semin Diagn Pathol · PMID 25862555 · Read it on PubMed ↗
Grundei 2015
[Frequent proctologic findings from a surgeon's viewpoint]
Overview of causes of anal bumps.Narrative reviewVery low qualityRelated question
size not given2015
the abstract does not give a specific result; it is an overview ranking anal diseases by frequency and describing symptoms associated with hemorrhoids
Who was studied
people with anal complaints
What they received
not applicable (review of diagnosis of anal conditions)
Main outcome
identifying the cause of anal symptoms, ranked by how common they are
Quality
this is a general review summarizing clinical experience rather than presenting study data or testing a treatment.
Limitations
abstract gives no study design, numbers, or outcome data; it is a general clinical overview, not original research.
Taken word for word from the abstract
- population Patients with anal complaints require a high level of sensitivity of the involved healthcare professionals.
- result The following summary ranks anal diseases by frequency considering their clinical appearance and delimitation and provides an overview of symptoms associated with hemorrhoids.
- primaryOutcome The following summary ranks anal diseases by frequency considering their clinical appearance and delimitation
- intervention A carefully guided history interview is able to target in many cases the underlying condition.
Hautarzt · PMID 25862524 · Read it on PubMed ↗
Kyrklund et al. 2015
Bowel function and lower urinary tract symptoms in females with anterior anus treated conservatively: Controlled outcomes into adulthood
Mostly normal bowel function, more constipation.Case-controlLow qualityRelated question
45 people2015
overall bowel control was similar to peers, but constipation was more common in patients; urinary symptoms and toilet-training age were similar to peers
Who was studied
females born with anterior anus (abnormally positioned anus) treated without surgery
What they received
conservative (non-surgical) management of anterior anus
Compared with
age- and gender-matched peers without the condition
Main outcome
bowel control, constipation, and urinary symptoms later in life
Quality
this is a small, single-center survey study relying on questionnaires, not a controlled trial, so it can't prove cause and effect.
Limitations
cross-sectional postal questionnaire, single institution, response rate 67%, no information on what causes a 'bump' near the anus in general.
Taken word for word from the abstract
- population All females treated conservatively for AA between 1983 and 2006
- intervention conservatively treated anterior anus
- comparator Each patient was matched by age and gender to 3 controls that had answered the same questionnaire.
- primaryOutcome characterize the controlled, long-term bowel functional outcomes and lower urinary tract symptoms (LUTS) in females with conservatively treated anterior anus
- result fecal continence was comparable to controls overall (p=NS). Constipation affected a significantly higher proportion patients (36%) than controls (13%; p=0.002)
- n Among 45 respondents (67%; median age 10.2 (4-20) years)
J Pediatr Surg · PMID 25783328 · Read it on PubMed ↗
Plumb et al. 2015
Perianal Sepsis in Hematologic Malignancy: MR Imaging Appearances and Distinction from Cryptoglandular Infection in Immunocompetent Patients
Different swelling and fistula patterns by causeRetrospectiveModerate qualityRelated question
76 people2015
Patients with blood cancers had more swelling around the anus but fewer fistulas than immunocompetent patients, with similar rates of abscesses; MRI could reliably tell the two groups apart
Who was studied
adults with perianal symptoms or systemic infection, comparing those with blood cancers to those without immune problems
What they received
MRI imaging to look at the pattern of perianal infection
Compared with
immunocompetent patients with no history of immune suppression or Crohn's disease, matched by age and sex
Main outcome
MRI appearance of abscesses, fistula tracts, and swelling around the anus, and whether MRI could tell the two groups apart
Quality
it compared two carefully matched groups with blinded image review, but it was a retrospective study that only looked at pictures rather than testing a treatment
Limitations
retrospective design, relatively small matched groups, and focused only on people with blood cancers or systemic sepsis rather than the general population with a perianal lump
Taken word for word from the abstract
- population 38 patients with an HM were matched by age and sex to 38 control patients with no history of immunocompromise or Crohn disease. Both groups had undergone MR imaging for perianal symptoms and/or systemic sepsis.
- intervention To use magnetic resonance (MR) imaging to document the appearance of perianal infection in patients with a hematologic malignancy (HM)
- comparator compared with that in immunocompetent control patients
- primaryOutcome recorded the size and distribution of abscesses and/or fistula tracts, the extent of perianal edema, and the likely diagnosis
- result Patients with an HM had significantly greater perianal edema than did control patients (mean arc angle of anal canal involved, 220° vs 60°; P < .001). However, they had significantly lower rates of fistula (15 [39.5%] vs 35 [92.1%] of 38; P < .001). Abscesses were similar in frequency (10 [26.3%] vs 17 [44.7%] of 38; P = .15)
- n 38 patients with an HM were matched by age and sex to 38 control patients
Radiology · PMID 25759970 · Read it on PubMed ↗
Tengberg et al. 2015
[Pre-sacral cyst as differential diagnosis to recurrent pilonidal cyst with abscess]
Rare hidden cyst mimicking pilonidal disease.Case seriesVery low qualityRelated question
1 people2015
after removing the pre-sacral cyst via a different surgical approach, recovery was uneventful with no further problems reported
Who was studied
31-year-old man with repeated abscess in the crease between the buttocks
What they received
surgical removal of a cyst in front of the tailbone (pre-sacral cyst)
Compared with
previous surgeries for presumed pilonidal sinus
Main outcome
resolution of the recurrent abscess/lump
Quality
this is a single patient case report, so it cannot show how often this happens or what works in general.
Limitations
only one patient described; no comparison group; cause of cyst and long-term outcome beyond 'uneventful' post-op course not detailed.
Taken word for word from the abstract
- population A 31-year-old man presented with a recurrent abscess in the gluteal cleft.
- intervention a pre-sacral cyst, which was excised in toto with laterosacral approach of Kraske
- comparator he underwent surgery several times. The modified Bascom's asymmetric midgluteal cleft closure technique was used without satisfying clinical remission.
- primaryOutcome The post-operative course was uneventful.
- result The post-operative course was uneventful.
- n A 31-year-old man presented with a recurrent abscess in the gluteal cleft.
Ugeskr Laeger · PMID 25612946 · Read it on PubMed ↗
Malisiewicz et al. 2015
[Diagnosis and therapy of genitoanal ulcers of infectious etiology]
Bump may be herpes, syphilis, or other STINarrative reviewLow quality
size not given2015
herpes simplex virus and syphilis remain most common causes, with lymphogranuloma venereum and other STIs also important in differential diagnosis, especially in unusual locations like the anus or mouth
Who was studied
people with genital or anal ulcers, including risk groups like men who have sex with men, sex workers, or sex tourists
What they received
diagnostic and treatment approach for infectious genital/anal ulcers
Main outcome
identifying the infectious cause of genital/anal ulcers
Quality
this is a narrative review summarizing literature and guidelines rather than original research testing a treatment or outcome.
Limitations
The abstract does not report a systematic review methodology or quantitative pooling of data; it is a narrative review based on literature search and clinical experience.
Taken word for word from the abstract
- population Particular risk groups, such as men who have sex with men (MSM), sex workers or sex tourists are affected.
- intervention In this review article the diagnostic and therapeutic principles of genital ulcers of infectious etiology are highlighted.
- primaryOutcome In this review article the diagnostic and therapeutic principles of genital ulcers of infectious etiology are highlighted.
- result Infections with herpes simplex virus (first) and syphilis (second) are still the most common causes of infectious genital ulcers.
- result Even less common locations, such as the mouth or the rectum, lymphogranuloma venereum (LGV) and atypical clinical symptoms (e.g. pelvic pain in pelvic lymphadenopathy with LGV) must be considered in the differential diagnosis.
Hautarzt · PMID 25523404 · Read it on PubMed ↗
Chavada et al. 2014
Uncommon manifestations of Listeria monocytogenes infection
Rare bacterial infection, treated successfully.Case seriesVery low qualityRelated question
3 people2014
all three patients, including the one with a perianal abscess, recovered well with antibiotics and surgery
Who was studied
adults with unusual infections caused by the bacteria Listeria monocytogenes, including one man with a perianal abscess
What they received
antibiotics and surgery to treat the Listeria infection
Compared with
none
Main outcome
whether treatment led to recovery
Quality
this is a report of just three unusual cases with no comparison group, so it cannot show how common this cause is or how well treatments generally work
Limitations
only one of the three cases involved a perianal abscess; this is a rare, unusual cause identified only after lab testing, not a general explanation for anal or buttock lumps
Taken word for word from the abstract
- n Three unrelated cases of unique focal infections caused by Listeria monocytogenes are presented.
- population 3) A 60 year old Asian man with perianal abscess.
- intervention They were managed with antibiotics and surgery with favourable outcomes.
- comparator They were managed with antibiotics and surgery with favourable outcomes.
- primaryOutcome They were managed with antibiotics and surgery with favourable outcomes.
- result They were managed with antibiotics and surgery with favourable outcomes.
BMC Infect Dis · PMID 25466213 · Read it on PubMed ↗
Khati et al. 2015
CT of acute perianal abscesses and infected fistulae: a pictorial essay
CT can spot anal abscesses.Narrative reviewVery low qualityRelated question
size not given2015
CT can show fluid/air-filled tracts and collections that indicate abscess or infected fistula, helping guide ER management
Who was studied
Emergency room patients with suspected perianal abscess or infected fistula
What they received
Contrast-enhanced CT imaging
Compared with
MRI and endorectal ultrasound
Main outcome
Usefulness of CT for diagnosing anorectal infection (abscess or fistula)
Quality
This is a descriptive picture-based review article, not a study comparing patient outcomes, so it can't show whether one method works better than another.
Limitations
No original patient data, outcomes, or comparative results are reported; it is a pictorial/review article summarizing imaging appearances.
Taken word for word from the abstract
- population evaluation of the emergency room (ER) patients with the clinical suspicion of perianal abscess and/or infected fistulous tract (anorectal sepsis)
- intervention Contrast-enhanced CT is a very useful tool to diagnose anorectal sepsis
- comparator Magnetic resonance imaging (MRI) is the best imaging test to accurately detect fistulous tracts
- comparator Endorectal ultrasound has also been used to identify perianal abscesses
- primaryOutcome The purpose of this article is to demonstrate the usefulness of contrast-enhanced CT in the diagnosis of acute anorectal sepsis in the ER setting.
- result An infected fistula is indicated by a fluid-/air-filled soft tissue tract surrounded by inflammation. A well-defined round to oval-shaped fluid/air collection is indicative of an abscess.
Emerg Radiol · PMID 25421387 · Read it on PubMed ↗
Weyers 2015
Hypertrophic lichen sclerosus sine sclerosis: clues to histopathologic diagnosis when presenting as psoriasiform lichenoid dermatitis
Microscopic clues identify lichen sclerosus bumps.Case seriesLow qualityRelated question
100 people2015
Researchers found a group of microscopic clues (like tiny damaged tissue spots, thickened collagen fibers, dead skin cells, and patterns of inflammation) that together can confirm a diagnosis of lichen sclerosus even without the usual sclerosis.
Who was studied
people with lichen sclerosus skin lesions on genital or perianal skin
What they received
microscopic examination of skin biopsy tissue
Compared with
biopsies from other skin conditions (mycosis fungoides, lichen planus, lichen simplex chronicus)
Main outcome
identifying microscopic features that help diagnose lichen sclerosus when the typical scar-like thickening is absent
Quality
This is a descriptive lab-based review of biopsy samples with no comparison of treatments or patient outcomes, so it mainly helps pathologists recognize a condition under the microscope rather than showing what works for patients.
Limitations
The abstract does not describe patient symptoms, treatment, or outcomes—only microscopic diagnostic criteria.
Taken word for word from the abstract
- population 100 biopsy specimens of LS from genital or perianal skin
- n 100 biopsy specimens of LS
- intervention We studied 28 criteria in 100 biopsy specimens of LS
- comparator Fifteen cases each of the early plaque stage of mycosis fungoides, lichen planus and lichen simplex chronicus were studied for comparison
- primaryOutcome We sought to assess histopathologic findings that allow recognition of LS in the absence of sclerosis
- result Findings that were more common and may be utilized as clues to the histopathologic diagnosis of non-sclerotic LS include tiny foci of homogenized tissue in dermal papillae, marked fibrosis with thickening of the papillary dermis, marked thickening of individual collagen fibers, lymphocytes aligned in rows between those fibers, necrotic keratinocytes
J Cutan Pathol · PMID 25413733 · Read it on PubMed ↗
Compton et al. 2014
Perianal disease in pediatric Crohn disease: a review of MRI findings
Anal bump may be Crohn's fistula.Narrative reviewLow qualityRelated question
size not given2014
MRI described as excellent for characterizing perianal fistulas in children, with fistulas more common in male patients
Who was studied
children with Crohn disease and perianal complications
What they received
MRI imaging to evaluate perianal fistulas
Compared with
other imaging modalities
Main outcome
characterization of perianal fistulas and anatomy
Quality
This is a narrative review describing imaging methods, not a study measuring treatment outcomes or testing a hypothesis.
Limitations
No patient outcome data, study design, or sample size reported; purely descriptive/educational review.
Taken word for word from the abstract
- population Perianal complications of Crohn disease are a common occurrence in children
- intervention MRI is an excellent imaging modality for the evaluation of perianal inflammatory bowel disease - allowing characterization and detailed description of perianal fistulas
- comparator MRI has many advantages over other imaging modalities for the pediatric patient
- primaryOutcome the classification of perianal fistulas, the advantages MRI offers in characterization of perianal fistulas
- result Perianal fistulas are found at a high rate in pediatric referrals and are more commonly found in male patients.
Pediatr Radiol · PMID 25246189 · Read it on PubMed ↗
Brummeisl et al. 2015
[Urethral condylomata acuminata]
Anal/genital bump is a wart from HPV.Case seriesVery low quality
2 people2015
two patients had genital warts extending through the entire urethra, illustrating causes, diagnosis, and treatment options
Who was studied
people with genital/anal warts caused by HPV affecting the urethra
What they received
description of urethral condyloma acuminata (genital warts) affecting the whole urethra
Main outcome
cause and treatment of urethral warts
Quality
This is just a report of two patient cases plus a general review, not a study that tests whether a treatment works.
Limitations
Only two cases described, with no control group or statistical comparison, and no outcome data on how well treatments worked.
Taken word for word from the abstract
- population Condyloma acuminata are the most frequent cause of infections in the anal genital area.
- intervention This article reports on two cases with condyloma acuminata affection of the total urethra.
- primaryOutcome The current diagnostic, different treatment modalities, and prophylaxis are reviewed.
- result This article reports on two cases with condyloma acuminata affection of the total urethra.
- n two cases
Urologe A · PMID 25234950 · Read it on PubMed ↗
Dohan et al. 2014
Diffusion-weighted MR imaging for the diagnosis of abscess complicating fistula-in-ano: preliminary experience
Better imaging spots hidden abscess.RetrospectiveLow qualityRelated question
24 people2014
DWMRI detected fistulas and abscesses with higher sensitivity and specificity, and showed fistulas more clearly than standard T2-weighted MRI
Who was studied
patients with an anal fistula (fistula-in-ano)
What they received
diffusion-weighted MRI (DWMRI)
Compared with
standard T2-weighted MRI (T2-TSE)
Main outcome
accuracy of detecting an abscess complicating the fistula
Quality
This was a small, retrospective study of only 24 patients testing an imaging technique, not a treatment, so it says little about the cause or management of a bump near the anus.
Limitations
Retrospective design, small sample size (24 patients), described by the authors as 'preliminary experience'.
Taken word for word from the abstract
- population 24 patients with a fistula-in-ano
- intervention diffusion-weighted magnetic resonance imaging (DWMRI)
- comparator fat-suppressed T2-weighted turbo spin-echo (T2-TSE) MRI
- primaryOutcome To investigate the role of diffusion-weighted magnetic resonance imaging (DWMRI) in the diagnosis of abscess-complicating fistula-in-ano.
- result Sensitivity was 91.2 % [95 % CI: 76 %-98 %] for T2-weighted TSE MRI and 100 % [95 % CI: 90 %-100 %] for DWMRI detecting fistulas.
- result Fistula conspicuity was greater with DWMRI than with T2-TSE MRI for the two observers (P = 0.0034 and P = 0.0007).
- n 24 patients with a fistula-in-ano
Eur Radiol · PMID 25038854 · Read it on PubMed ↗
Kołodziejczak et al. 2014
Ultrasonographic evaluation of anal endometriosis: report of four cases
Lump was endometriosis, seen on ultrasound.Case seriesVery low qualityRelated question
4 people2014
ultrasound showed hypoechoic cystic lesions with microcalcifications that matched surgical and pathology findings in all four cases
Who was studied
women with lumps near the anus found to have endometriosis in that area
What they received
transperineal and high-resolution 3D endoanal ultrasound to look at the lesion before surgery
Compared with
surgical and pathology findings after removal
Main outcome
whether ultrasound appearance matched the actual diagnosis found at surgery/pathology
Quality
This is only four cases with no comparison group, so it cannot show how common this cause of a bump is or rule out other causes.
Limitations
Very small number of patients (4), all women, no control group, and the abstract does not describe how typical or common this presentation is among people with anal/buttock lumps in general.
Taken word for word from the abstract
- n Four patients were evaluated by transperineal and high-resolution three-dimensional endoanal ultrasonography.
- population The presence of endometriosis in the anal canal and perianal tissues is rare and difficult to suspect at clinical examination.
- intervention Four patients were evaluated by transperineal and high-resolution three-dimensional endoanal ultrasonography.
- comparator Surgery and pathologic exam confirmed the ultrasonographic findings.
- primaryOutcome Surgery and pathologic exam confirmed the ultrasonographic findings.
- result Anal endometriosis appeared as hypoechoic cystic lesions with areas of microcalcification, not well delimited and highly vascularized.
- result Surgery and pathologic exam confirmed the ultrasonographic findings.
Tech Coloproctol · PMID 24915940 · Read it on PubMed ↗
Vos et al. 2014
[A 37-year-old woman with anogenital warts]
Bump caused by underlying Crohn's diseaseCase seriesVery low qualityRelated question
1 people2014
the lumps were found to be a rare skin manifestation of Crohn's disease, not genital warts
Who was studied
a 37-year-old woman with Crohn's disease who had wart-like bumps near her vulva and anus
What they received
none described - this was a diagnostic work-up, not a treatment study
Compared with
none described
Main outcome
figuring out what was causing the wart-like lumps in the genital and anal area
Quality
this is a single patient case report, so it cannot show how common this cause is or how it compares to other causes
Limitations
single case report with no control group or long-term outcome data
Taken word for word from the abstract
- population A 37-year-old woman, who had been suffering from Crohn's disease since twenty-two years, visited our dermatology outpatient clinic with complaints of wart-like lesions in the vulvar and perianal regions
- n A 37-year-old woman
- intervention On physical examination, nodules, plaques and tumours were seen.
- comparator On physical examination, nodules, plaques and tumours were seen.
- primaryOutcome Histological examination showed features compatible with Crohn's disease.
- result The diagnosis metastatic Crohn's disease was made.
Ned Tijdschr Geneeskd · PMID 24893818 · Read it on PubMed ↗
Klein 2014
Common anal problems
No specific finding reported.Narrative reviewVery low qualityRelated question
size not given2014
Who was studied
people with anal problems seen by primary care providers
What they received
primary care evaluation and management of anal problems
Quality
This is a general review article that does not present study data, methods, or outcome results to judge effectiveness.
Limitations
The abstract gives no information on study design, population numbers, specific interventions compared, or measured outcomes.
Taken word for word from the abstract
- population Anal problems are pervasive, embarrassing and vexing to patients.
- intervention Primary care providers should be well versed in addressing these concerns, which uncommonly require referral for specialty care.
Med Clin North Am · PMID 24758964 · Read it on PubMed ↗
Fox et al. 2014
Anorectal conditions: hemorrhoids
A bump on your anus is likely a hemorrhoid.Narrative reviewLow quality
size not given2014
Different treatments work depending on severity; banding is most effective office procedure for milder grades, surgery needed for severe or resistant cases
Who was studied
People with hemorrhoids (swollen blood vessels around the anus)
What they received
Various treatments including fiber, sitz baths, drugs, rubber band ligation, and surgery
Compared with
Comparison between non-surgical and surgical treatment approaches
Main outcome
Resolution of hemorrhoid symptoms like bleeding, pain, or prolapse
Quality
This is a general review article describing typical practice rather than presenting new trial data comparing treatments.
Limitations
No original data, sample size, or comparative outcomes reported; it's a narrative summary of accepted management approaches.
Taken word for word from the abstract
- population Hemorrhoids are engorged fibrovascular cushions lining the anal canal.
- intervention Nonsurgical treatment for nonthrombosed hemorrhoids includes increased fiber intake, sitz baths, and drugs.
- comparator If nonsurgical management is unsuccessful, rubber band ligation is the most effective office-based procedure for grades I, II, and III hemorrhoids.
- primaryOutcome Bright red, painless rectal bleeding during defecation is the most common presentation.
- result Surgical hemorrhoidectomy is indicated after failure of nonsurgical management and office-based procedures and also as initial management for grades III and IV hemorrhoids.
FP Essent · PMID 24742083 · Read it on PubMed ↗
Fujii et al. 2014
A rare case of granular cell tumor of the anal region: diagnostic difficulty to masses in the anal area
Rare benign tumor found and removed.Case seriesVery low quality
1 people2014
the mass was a rare benign tumor called granular cell tumor
Who was studied
a 66-year-old woman with a lump near the anus
What they received
surgical removal of the mass
Compared with
none
Main outcome
diagnosis of the anal mass after removal
Quality
this is a report of just one patient, so it cannot show how common or risky this is for others
Limitations
single case report with no comparison group, so findings may not generalize
Taken word for word from the abstract
- n a 66-year-old Japanese woman was found to have a polypoid lesion in the anus with hemorrhoids
- population a 66-year-old Japanese woman was found to have a polypoid lesion in the anus with hemorrhoids
- intervention The mass detected as an anal polypoid lesion with ulceration was resected
- comparator The mass detected as an anal polypoid lesion with ulceration was resected and diagnosed as granular cell tumor by histologic examination.
- primaryOutcome diagnosed as granular cell tumor by histologic examination
- result diagnosed as granular cell tumor by histologic examination
Int Surg · PMID 24444268 · Read it on PubMed ↗
Ortiz et al. 2013
Recognizing and treating anal cancer: training medical students and physicians in Puerto Rico
Training improved doctors' anal cancer knowledge.RegistryVery low qualityRelated question
34 people2013
knowledge scores improved after training
Who was studied
medical students, residents, and faculty in Puerto Rico
What they received
educational training session on anal cancer
Compared with
before vs after training (pre-test vs post-test)
Main outcome
change in knowledge about anal cancer screening and treatment
Quality
This is a small educational survey of medical trainees, not a study of patients or of what causes anal lumps, so it cannot answer the question.
Limitations
Small sample, self-selected respondents (68% response), no control group, measures knowledge not patient outcomes.
Taken word for word from the abstract
- population a group of medical students, residents and several faculty members, all from the Medical Sciences Campus of the University of Puerto Rico (n = 50)
- n Thirty-four participants (68%) answered the survey.
- intervention An educational activity (1.5 contact hours) was attended by a group of medical students, residents and several faculty members
- comparator A demographic survey and a 6-item pre- and post-test on anal cancer were given to assess knowledge change.
- primaryOutcome A significant increase in the test scores was observed after the educational activity (pre-test: 3.4 +/- 1.2; post-test: 4.7 +/- 0.71).
- result A significant increase in the test scores was observed after the educational activity (pre-test: 3.4 +/- 1.2; post-test: 4.7 +/- 0.71).
P R Health Sci J · PMID 24397221 · Read it on PubMed ↗
Moktefi et al. 2013
[Anal verruciform xanthoma in a transplant background for primary hyperoxaluria. Anal verruciform xanthoma after a combined hepato-renal transplantation]
Rare benign growth, not cancer.Case seriesVery low quality
1 people2013
The bump was a rare, benign growth called verruciform xanthoma, linked to a weakened immune system from transplant drugs
Who was studied
A patient who had a combined liver and kidney transplant for a genetic disease called primary hyperoxaluria
What they received
Not applicable - this is a case report describing a condition, not a treatment
Main outcome
What the anal lesion was and what caused it
Quality
This is a single patient case report, so it cannot show how common this is or what causes it in general.
Limitations
Only one patient; cause of the condition is not well understood even by the authors.
Taken word for word from the abstract
- population We report a case of anal verruciform xanthoma in a patient who underwent a combined liver and kidney transplantation for primary hyperoxaluria.
- primaryOutcome We report a case of anal verruciform xanthoma
- result Verruciform xanthoma is a rare and benign lesion arising in oral cavity and genital mucosa.
- result This condition, whose pathogenesis remains unclear, has been reported in immunosuppressive background or associated with underlying dermatosis.
- n We report here the second case of anal verruciform xanthoma.
- intervention We report a case of anal verruciform xanthoma in a patient who underwent a combined liver and kidney transplantation for primary hyperoxaluria.
Ann Pathol · PMID 24238247 · Read it on PubMed ↗
Jabir et al. 2013
Perianal Paget's disease: a diagnostic dilemma
Rare skin condition, needs cancer workup.Case seriesVery low quality
1 people2013
case illustrates difficulty diagnosing perianal Paget's disease and need for workup to exclude underlying cancer
Who was studied
a 50-year-old man with a perianal skin lesion
What they received
none (diagnostic workup and treatment of perianal Paget's disease)
Compared with
none
Main outcome
diagnosis and management of perianal Paget's disease
Quality
This is a single patient case report, so it cannot show whether treatments work or how common this is.
Limitations
Single case report; no comparison group or outcome data on treatment effectiveness.
Taken word for word from the abstract
- population a 50-year-old man who was referred to us with PPD
- primaryOutcome investigative workup to exclude possible malignancy with associated metastatic spread as well as the treatment options available are also discussed
- result This case highlights the difficulties associated with making a clinical diagnosis of this condition.
- n a 50-year-old man
- intervention investigative workup to exclude possible malignancy with associated metastatic spread as well as the treatment options available are also discussed
- comparator We present a case of a 50-year-old man who was referred to us with PPD.
BMJ Case Rep · PMID 24072832 · Read it on PubMed ↗
Coblijn et al. 2013
[Perianal fistulae and abscesses in children: consider Crohn's disease]
Anal lumps went away once Crohn's disease treatedCase seriesVery low qualityRelated question
4 people2013
the perianal lesions disappeared after Crohn's disease was treated, without needing surgery
Who was studied
children with repeated lumps, tunnels, or abscesses around the anus
What they received
medical treatment for Crohn's disease once diagnosed
Compared with
surgery for the perianal lesions
Main outcome
whether the perianal lumps and abscesses went away
Quality
this is just four children's case reports, not a controlled study, so it can't reliably prove what works.
Limitations
only four cases described, no comparison group, and it focuses specifically on children where Crohn's disease is the cause rather than all causes of anal bumps.
Taken word for word from the abstract
- n We present four children of different ages with recurrent perianal fistulae and abscesses.
- population We present four children of different ages with recurrent perianal fistulae and abscesses.
- intervention Only after the diagnosis Crohn's disease was established and adequate treatment was initiated, the perianal lesions disappeared without further surgical treatment.
- comparator therapy is indicated to induce and maintain remission of the underlying disease instead of surgical intervention
- primaryOutcome the perianal lesions disappeared without further surgical treatment
- result Only after the diagnosis Crohn's disease was established and adequate treatment was initiated, the perianal lesions disappeared without further surgical treatment.
Ned Tijdschr Geneeskd · PMID 24063673 · Read it on PubMed ↗
Kahn et al. 2013
A hyperpigmented perianal nodule
Bump was skin cancer (BCC).Case seriesVery low quality
1 people2013
the nodule was identified as a basal cell carcinoma
Who was studied
a patient with a perianal skin nodule, found during a routine colonoscopy
What they received
none (diagnostic evaluation of the nodule)
Compared with
not applicable
Main outcome
diagnosis of the perianal nodule
Quality
this is a single patient case report, so it cannot show how common this cause is or how it compares to other causes.
Limitations
only one patient described, no treatment or outcome follow-up reported
Taken word for word from the abstract
- population We report a rare case of BCC that was initially detected during a routine colonoscopy.
- intervention initially detected during a routine colonoscopy
- comparator We report a rare case of BCC that was initially detected during a routine colonoscopy.
- primaryOutcome We report a rare case of BCC
- result We report a rare case of BCC that was initially detected during a routine colonoscopy.
- n We report a rare case of BCC
Dermatol Online J · PMID 24011278 · Read it on PubMed ↗
Oh et al. 2014
Müllerian-type, cutaneous ciliated cyst in the gluteal cleft mimicking a pilonidal cyst
Rare cyst mimicked pilonidal cyst.Case seriesVery low quality
1 people2014
the lump was found to be a rare Müllerian-type cutaneous ciliated cyst, not a pilonidal cyst
Who was studied
a 13-year-old female with a lump in the gluteal cleft
What they received
not applicable (case report describing diagnosis)
Compared with
none
Main outcome
identifying the cause of the lump, initially thought to be a pilonidal cyst
Quality
this is a single case report, so it cannot show how common this cause is or how it compares to other treatments.
Limitations
only one patient; abstract gives no information on treatment or outcome after diagnosis.
Taken word for word from the abstract
- n a case of 13-year-old female
- population a case of 13-year-old female with one in the gluteal cleft
- intervention initially presenting as a pilonidal cyst
- result Here, we report a case of 13-year-old female with one in the gluteal cleft, initially presenting as a pilonidal cyst
- primaryOutcome We also discuss the differential diagnosis of pediatric sacrococcygeal lesions and pathogenesis of a Mullerian-type, cutaneous ciliated cyst.
- comparator initially presenting as a pilonidal cyst
Pediatr Surg Int · PMID 23913265 · Read it on PubMed ↗
Mesina et al. 2013
Problems of diagnosis and treatment caused by ingested foreign bodies
Buttock lump from swallowed chicken bone.Case seriesVery low qualityRelated question
4 people2013
physical examination revealed an ischiorectal abscess.During incision and drainage a 3 cm chicken bone was found inside the abscess cavity.
Who was studied
a 52-year-old female presented with left buttock painful swelling for 1 week associated with fever
What they received
During incision and drainage a 3 cm chicken bone was found inside the abscess cavity.
Main outcome
Evolution was favorable in all 4 cases.
Quality
this is a report of only four unusual cases with no comparison group, so it cannot show how common or typical this cause is.
Limitations
tiny case series of accidental foreign body ingestion, not a study of common causes of buttock or anal lumps
Taken word for word from the abstract
- n We present 4 cases
- population a 52-year-old female presented with left buttock painful swelling for 1 week associated with fever
- intervention During incision and drainage a 3 cm chicken bone was found inside the abscess cavity.
- primaryOutcome Evolution was favorable in all 4 cases.
- result physical examination revealed an ischiorectal abscess.During incision and drainage a 3 cm chicken bone was found inside the abscess cavity.
Chirurgia (Bucur) · PMID 23790792 · Read it on PubMed ↗
Patil et al. 2013
Clinicopathological analysis of basal cell carcinoma of the anal region and its distinction from basaloid squamous cell carcinoma
Lab tests distinguish two rare anal cancers.Case seriesVery low qualityRelated question
24 people2013
perianal location, retraction artifact, lack of atypical mitoses, and specific immunostain patterns (Ber-EP4/BCL2 vs CDKN2A/SOX2) distinguished basal cell carcinoma from basaloid squamous cell carcinoma
Who was studied
patients with basal cell carcinoma or basaloid squamous cell carcinoma of the anal region
What they received
histological review and immunostaining (Ber-EP4, BCL2, TP63, CK5/6, CDKN2A, SOX2) of tumor samples
Compared with
basal cell carcinoma compared with basaloid squamous cell carcinoma of the anus
Main outcome
features that help tell the two anal cancer types apart
Quality
This is a small retrospective review of only 24 rare tumor samples looking at lab features, not a treatment or outcome study.
Limitations
Small sample size (9 vs 15 cases), retrospective, single-institution pathology review with no patient outcomes reported.
Taken word for word from the abstract
- n We reviewed morphological features of 9 basal cell carcinomas and 15 basaloid squamous cell carcinomas from the anal region
- population Basal cell carcinoma of the anal region is rare and morphologically difficult to distinguish from basaloid squamous cell carcinoma
- intervention determined the utility of Ber-EP4, BCL2, TP63, CK5/6, CDKN2A, and SOX2 as diagnostic tools
- comparator We reviewed morphological features of 9 basal cell carcinomas and 15 basaloid squamous cell carcinomas from the anal region diagnosed during 1993-2011
- primaryOutcome This distinction has therapeutic and prognostic implications.
- result Perianal location, retraction artifact, and lack of atypical mitoses are histological features that help distinguish basal cell carcinoma from basaloid squamous cell carcinoma.
- result Immunostains are extremely helpful as diffuse Ber-EP4 and BCL2 expression is a feature of basal cell carcinoma and basaloid squamous cell carcinoma is typified by diffuse CDKN2A and SOX2 expression.
Mod Pathol · PMID 23599161 · Read it on PubMed ↗
Ho et al. 2013
Anal phyllodes tumor in a male patient: a unique case presentation and literature review
Rare benign tumor found, not cancer.Case seriesVery low quality
1 people2013
found to be a rare benign phyllodes tumor of anogenital mammary-like glands with gynecomastia-like tissue nearby
Who was studied
41-year-old man with anal bleeding
What they received
no treatment tested; tumor removed surgically (papillectomy) and examined
Compared with
none
Main outcome
type and nature of the anal tumor
Quality
This is a single patient case report, so it cannot show how common this is or how it compares to other causes of a bump.
Limitations
Only one patient was studied, and this condition is described as extremely rare, so findings may not generalize.
Taken word for word from the abstract
- population a 41-year-old male presenting anal bleeding
- intervention Papillectomy was performed.
- primaryOutcome The excised tumor was circumscribed in shape, and after it was sliced into sections, it was noted that there were leaf-like slits on the surface of cut side.
- result this case report represents the first case of phyllodes tumor of anogenital mammary-like glands with gynecomastoid hyperplasia at the periphery in a male patient
- n a 41-year-old male presenting anal bleeding
- comparator Papillectomy was performed.
Diagn Pathol · PMID 23531415 · Read it on PubMed ↗
Ho et al. 2012
Clinics in diagnostic imaging (143). Perianal mucinous adenocarcinoma arising from chronic fistula-in-ano
Unclear resultCase seriesVery low qualityRelated question
1 people2012
imaging correctly showed a rare cancer (mucinous adenocarcinoma) arising from the chronic fistula; the man died after surgery due to complications
Who was studied
43-year-old man with long-standing anal fistula and recurrent perianal pain and bleeding
What they received
MRI and CT imaging to diagnose the growth, followed by surgical removal of the tumour
Compared with
none
Main outcome
correct identification of the type of tumour using imaging, and outcome after surgery
Quality
this is a single patient case report, so it cannot show whether any treatment works in general.
Limitations
only one patient; no comparison group; author's note that literature on this imaging appearance is scarce; patient died of surgical complications
Taken word for word from the abstract
- n a 43-year-old man
- population a 43-year-old man who had a relapse of perianal pain and bloody discharge after six years of defaulted follow-up
- intervention He underwent magnetic resonance (MR) and computed tomography imaging with correct identification of the disease entity on imaging.
- comparator We report a case of mucinous adenocarcinoma arising in the perianal soft tissue in association with chronic fistula-in-ano
- primaryOutcome correct identification of the disease entity on imaging
- result He underwent abdominoperineal resection of the tumour but succumbed due to postoperative complications.
Singapore Med J · PMID 23268160 · Read it on PubMed ↗
Kołodziejczak et al. 2012
Utility of transperineal and anal ultrasonography in the diagnostics of hidradenitis suppurativa and its differentiation from a rectal fistula
Ultrasound reliably identified the lump's cause.RetrospectiveLow qualityRelated question
51 people2012
ultrasound findings matched surgical findings in 66 of 67 operations (98.5%), and also detected a fistula coexisting with the condition in 6 cases and skin cancer in 2 cases
Who was studied
patients who had surgery for hidradenitis suppurativa near the anus and perineum
What they received
transperineal and anal ultrasound imaging before surgery
Compared with
findings seen during the actual surgery
Main outcome
how well ultrasound matched what was found during surgery, including telling hidradenitis suppurativa apart from an anal fistula
Quality
this was a retrospective look-back at one hospital's records without blinding or a separate comparison test, so the results may not hold up elsewhere.
Limitations
retrospective design, single center, no mention of blinded assessment of ultrasound images against surgical findings
Taken word for word from the abstract
- n Retrospective analysis was performed on 51 patients (5 females, 46 males) aged 20-71 years
- population who were operated on in the years 2006-2011 for HS in the area of the anus and perineum, and pre-operatively had been imaged with TPUS and AUS
- intervention transperineal ultrasound (TPUS) and anal ultrasound (AUS)
- comparator the pre-operative TPUS and AUS were in accordance with the intraoperative findings
- primaryOutcome We aim to determine the utility of transperineal ultrasound (TPUS) and anal ultrasound (AUS) in the diagnosis of HS and its differentiation from an anal fistula.
- result In 66 out of 67 cases (98.5%), the pre-operative TPUS and AUS were in accordance with the intraoperative findings.
Postepy Hig Med Dosw (Online) · PMID 23175339 · Read it on PubMed ↗
Kim 2013
The 18F-FDG PET/CT finding of a condyloma acuminata mimicking primary anorectal carcinoma in an HIV-infected patient
Anal wart mistaken for cancerCase seriesVery low qualityRelated question
1 people2013
The bump turned out to be a wart (condyloma acuminata), not cancer, despite looking like a tumor on the scan
Who was studied
44-year-old HIV-positive man with history of lymphoma
What they received
PET/CT imaging with surgical excision and pathology
Compared with
none
Main outcome
whether the anorectal lesion was cancer or something else
Quality
This is a single patient case report, which cannot show what usually causes anal bumps.
Limitations
Only one patient; findings may not generalize to others with anal bumps.
Taken word for word from the abstract
- n A 44-year-old HIV-positive homosexual man with a history of lymphoma underwent an 18F-FDG PET/CT for restaging
- population A 44-year-old HIV-positive homosexual man with a history of lymphoma
- intervention The tumor was surgically excised and proven to be condyloma acuminata by permanent pathology
- comparator the lesion was not detected on the contrast-enhanced abdominal CT
- primaryOutcome it was suggested as a tumorous lesion
- result the lesion was not detected on the contrast-enhanced abdominal CT. Via a sigmoidoscopy, cauliflower-like masses were visualized in the intra-anal area. The tumor was surgically excised and proven to be condyloma acuminata by permanent pathology.
Clin Nucl Med · PMID 22996249 · Read it on PubMed ↗

How we searchedThe exact query, the date it ran, and what came back — so you can run it yourself.

Searched: PubMed · ClinicalTrials.gov · Crossref on 2026-10-13
The exact search — paste this into PubMed to repeat it: ("Hemorrhoids"[Mesh] OR "Skin Tags"[tiab] OR "Pilonidal Sinus"[Mesh] OR "Condylomata Acuminata"[Mesh] OR "Anus Diseases"[Mesh] OR "Rectal Fistula"[Mesh]) AND ("Diagnosis, Differential"[Mesh] OR "differential diagnosis"[tiab]) AND (perianal[tiab] OR anal[tiab] OR gluteal[tiab] OR buttock[tiab] OR "natal cleft"[tiab]); PubMed expanded that to: ("Hemorrhoids"[MeSH Terms] OR "Skin Tags"[Title/Abstract] OR "Pilonidal Sinus"[MeSH Terms] OR "Condylomata Acuminata"[MeSH Terms] OR "Anus Diseases"[MeSH Terms] OR "Rectal Fistula"[MeSH Terms]) AND ("diagnosis, differential"[MeSH Terms] OR "differential diagnosis"[Title/Abstract]) AND ("perianal"[Title/Abstract] OR "anal"[Title/Abstract] OR "gluteal"[Title/Abstract] OR "buttock"[Title/Abstract] OR "natal cleft"[Title/Abstract])
What came back: 665 records found · 200 read · 133 answered the question
Included: Human, animal or laboratory studies reporting an outcome relevant to the question
Excluded: Records about a different condition or intervention
Records reporting no outcome
Retracted publications, which are listed but excluded from every count
Limits: Details were read from abstracts, not full papers, so anything reported only in a paper's methods section is not captured here.
Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured.
Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.

665records came back from the search
200were read
133actually answered the question

Why people try thisThe reasoning behind the question — not a claim that it works.

Hemorrhoids and skin tags are common and usually harmless, so it's natural to assume any new bump in that area is the same thing.
Embarrassment about examining or discussing the anal area can lead people to wait rather than get a new bump checked.
A bump that doesn't hurt feels less urgent, even though painlessness does not rule out something serious.
Online searches and forums often reassure people that butt bumps are 'probably nothing,' which can delay getting a proper exam.

Common questionsShort answers, drawn from the same studies.

Why is there a bump on my butthole or in my butt crack?: Most bumps in this area are common and treatable things like hemorrhoids, skin tags, folliculitis (an irritated hair follicle), or a pilonidal cyst near the tailbone. The research on this exact question is very limited — mostly single-patient case reports — but it also shows that occasionally a similar-looking bump turns out to be something more serious, like an infection or a growth that needs different treatment. A doctor can usually tell these apart with an exam.
What does it mean if you have a small bump at the top of your butt crack?: A bump right at the top of the buttock crease, near the tailbone, is a classic location for a pilonidal cyst — a small pocket that can form around a hair follicle and sometimes becomes infected. Case reports also describe rarer look-alikes in this exact spot, so a bump that keeps coming back or becomes painful is worth having looked at rather than assumed.
Why do I keep getting bumps on my butt?: Recurring bumps are often described in case reports as pilonidal disease, hidradenitis suppurativa (a condition causing recurring boil-like lumps), or folliculitis. No study in this review measured how often each cause leads to repeat bumps, so there's no reliable number to give you — but a pattern of repeat bumps in the same spot is a good reason to get a diagnosis rather than keep treating each one as new.
Why do I have bumps on my inner butt cheeks?: Bumps on the buttock skin itself, rather than right at the anus, are more often related to irritated hair follicles, skin infections, or cysts than to anal conditions like hemorrhoids. This review didn't find a study that sorted out causes specifically by location on the buttock, so this answer is based on how these conditions are generally described rather than a dedicated study.
How do I get rid of a bump on my butt — and when should I see a doctor instead of waiting?: What gets rid of a bump depends entirely on what's causing it, and no study has tested one treatment against another for an undiagnosed bump — so there's no single answer here. Given that case reports in this review describe serious conditions (including cancer and severe infection) that were first mistaken for an ordinary bump, see a doctor rather than self-treat if yours is new, growing, bleeding, very painful, or hasn't improved after a couple of weeks.

This is information, not advice

This page summarises published research. It cannot tell you what is happening in your own body, and evidence changes. If something is bleeding, painful, or new, it is worth being looked at — that is a different question from the one on this page, and a better one to bring to a consultation.

Contact the office

Automated evidence review — PubMed, ClinicalTrials.gov, Crossref. Search strategy, grading rules and the checks that must pass before anything publishes were written by Allen Kamrava, MD, MBA, FACS, FASCRS, colon & rectal surgery, Beverly Hills. The pages themselves are compiled by software running that method and are not read one by one before publication — saying otherwise would be the one claim here that could not be checked.

Allen Kamrava, MD, MBA, FACS, FASCRS · 435 N. Bedford Dr., Suite 308, Beverly Hills, CA 90210 · 424.279.8222

Educational information — not medical advice.