Can Hemorrhoids Cause Perineum Swelling?

Hemorrhoids can affect the perineum, but they don’t cause perineum swelling.

The perineum is the area between the anus and genitals (scrotum or vaginal opening). Many conditions can lead to perineum swelling, and most are nothing to worry about. Perineum swelling often resolves with home treatment and management. However, it’s best to see a doctor to rule out any serious issues.

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What is the perineum?

The perineum is the area of skin and tissue between the anus and the vulva or scrotum. The perineum covers the pelvic floor muscles and blood vessels supplying the urinary tract and genitals, and it also covers the nerves used to urinate or achieve an erection.

What are hemorrhoids?

Hemorrhoids, or piles, are a common condition affecting millions of people around the world. According to the National Institute of Health, hemorrhoids affect about 1 in 20 Americans,¹ and about 50% of adults older than 50 have hemorrhoids.

Hemorrhoids occur when veins in the lower rectum or around the anus become swollen and inflamed, usually due to constipation, pregnancy, excess straining during bowel movements, or sitting on the toilet for long periods. The rectum is the last part of the bowel and leads to the anus.

Hemorrhoids can be internal (inside the rectum and not visible) or external (under the skin around the outside of the anus). They can be painful and bothersome, particularly if they are recurrent. However, they're not life-threatening or dangerous, and symptoms often improve or resolve within a few days.

Hemorrhoids can lead to complications, including perineal pain, blood clots, infection of a sore, and strangulated hemorrhoids.

Why does hemorrhoid pain extend to the perineum?

Hemorrhoids are often accompanied by pain and discomfort in the perineum. Several factors contribute to this pain, including nerve irritation, pressure on the perineum, and inflammation of tissues in this region. The pain may be worse during or immediately after a bowel movement.

What causes perineum swelling?

While hemorrhoids may trigger perineum pain, they don’t cause perineum swelling. Perineum swelling is associated with a variety of conditions, including: 

  • Cysts and abscesses: Cysts (which are fluid-filled sacs) develop due to infection or irritation in the perineum. Abscesses are pus-filled “cysts”. Both cysts and abscesses can cause localized inflammation and discomfort, leading to swelling and pain around the perineum.

  • Hematoma: A hematoma is a collection of blood that pools in the soft tissues under the skin, which can develop around the perineum. This results in swelling that push the skin, resulting in a painful lump.

  • Perineal injuries: Injuries from childbirth, straining during bowel movements or urination, or weight lifting can cause inflammation and swell around the perineum.

  • Pelvic floor dysfunction: Poor control of the pelvic floor muscles can occur when the ligaments and muscles around the bottom of the hips are strained, weak, or injured and unable to properly support the organs in the pelvis.

  • Sexually transmitted infections: Infections like herpes or genital warts can affect the delicate tissues in the perineum and lead to unpleasant symptoms, such as itching and burning. In severe cases, they may also cause painful sores or lesions that require medical treatment.

  • Cancer: Certain types of cancer can affect the vulvar region and lead to perineum swelling.

In some cases, perineum swelling may be linked to chronic pelvic pain syndromes, where the pain is long-term and not associated with any of the above-noted conditions.

In men

Prostatitis² and other prostate conditions are the leading causes of perineal pain (which may be accompanied by swelling) in men. Prostatitis is a condition that occurs when the prostate becomes inflamed or infected, leading to swelling and pain in the area around the perineum. The most common causes of acute prostatitis (severe and sudden) are bacteria entering the prostate from urinary tract infections.

However, other factors can also contribute to the development of prostatitis, particularly chronic prostatitis (where symptoms come and go over a longer period), which is most commonly not associated with bacteria and may be triggered by an autoimmune response, physical exertion, or damage to the surrounding tissues.

In women 

Several conditions and circumstances can lead to perineum pain (and possibly swelling) in women. Some of the most common causes include:

  • Urinary tract infections: These infections typically occur when bacteria enter the urinary tract through the vagina.

  • Pregnancy and childbirth: These can cause perineum swelling as the body goes through several changes. Some women also experience swelling due to complications from an episiotomy performed during delivery.

  • Vulvodynia³: Refers to chronic pain or discomfort around the opening of the vagina.

  • Infantile perianal pyramidal protrusion⁴: A rare, benign condition characterized by a protrusion in the perineal midline. It can be skin-colored, pink, or red. 

Can hemorrhoids cause vulvar pain?

Hemorrhoids can cause referred pain in the vulvar, vaginal, and perineal areas. In addition, the itching commonly caused by hemorrhoids can also trigger irritation and itching around the vaginal area.

Can you get hemorrhoids on your perineum?

No. Hemorrhoids form strictly within the rectal canal (internal hemorrhoids) and around the circumference of the anus (external hemorrhoids). The perineum starts where the anus ends, so there’s no overlap, and hemorrhoids cannot form on the perineum.

How do you treat or ease swollen hemorrhoids?

There are a variety of treatment options for hemorrhoids. Common treatments include:

  • Topical creams and ointments: Over-the-counter treatments can help soothe itching, burning, and pain around the anus. They may also help reduce inflammation and swelling.

  • Sitz baths: These shallow, warm water baths can help cleanse the area and relieve symptoms.

  • Stool softeners and laxatives: These can help make it easier to have a bowel movement and reduce straining, which can aggravate hemorrhoids.

  • Fiber-rich food: Incorporate more fiber-rich foods into your diet to soothe inflammation and reduce pressure in the perineum.

  • Surgery: In severe cases, surgery may be necessary to remove the hemorrhoids. Surgery is often the last resort when other treatments have failed.

When to see a doctor

Perineum pain from minor tears or injuries (such as those associated with childbirth) often goes away on its own. However, if your perineum pain is severe or persistent, you’ll need to see a doctor. With the appropriate care, most cases of perineum pain are treatable. Sometimes, a doctor may recommend seeing a physical therapist for pelvic floor strengthening exercises. 

The lowdown

Perineum swelling can cause pain, making it hard to carry out routine activities. Luckily, many causes of perineum pain are treatable and don't result in long-term damage. Still, it's crucial to seek medical help from a professional for diagnosis and treatment. 

Likewise, hemorrhoids, while not associated with perineum swelling, can be painful. Most hemorrhoids resolve with over-the-counter treatments and home remedies, such as sitz baths, but surgery may be necessary in rare cases.

  1. Definition & facts of hemorrhoids | NIH: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

  2. Prostatitis | NHS

  3. Vulvodynia (2022)

  4. Infantile perianal pyramidal protrusion: A report of 8 new cases and a review of the literature (2012)

Other sources:

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