Lump under labia majora near anus

The presence of a lump under the labia majora near the anus may be due to a Bartholin's gland cyst. This symptom can cause a cyst to form under the labia majora and is more common in women of childbearing age. Patients need to receive timely treatment. The main symptoms of a lump under the labia majora near the anus are cysts and lumps on the labia majora. At this time, laser surgery can be used to remove the cyst and reduce the impact of gynecological diseases.

The Bartholin gland is a gland responsible for secreting mucus to lubricate the vagina. It has its own opening, but if it becomes inflamed or blocked by dirt and the mucus cannot be discharged, it will swell and form a Bartholin gland cyst. Bartholin gland (Vestibular gland) cyst is formed when the opening of the Bartholin gland is blocked, and secretions accumulate in the gland cavity. Secondary infection forms abscesses, which recur repeatedly. It is more common in women of childbearing age and rare in young girls and postmenopausal women. It is a common gynecological disease that is prone to recurrence and causes great pain to patients.

Causes

Obstruction of the Bartholin's gland duct due to chronic inflammatory stimulation can cause cystic dilatation of the gland. Cysts may also form after pus is absorbed during acute inflammatory infections. During childbirth, lacerations of the vagina and outer perineum cause heavy scar tissue, and episiotomy damages the Bartholin's gland ducts, causing the Bartholin's gland secretions to be drained into the vagina, leading to cyst formation.

Clinical manifestations

The cystic mass is located below the posterior part of the labia majora and protrudes toward the outside of the labia majora. The disease is usually unilateral but can also be bilateral. There may be no symptoms for a long time and it is often discovered during a gynecological examination. The cyst grows slowly and is usually no larger than an egg. Small cysts are oval or fusiform. Larger cysts can cause swelling of the vulva and discomfort during sexual intercourse. Examination revealed that the lump occupied the middle and lower 1/3 of the entire labia majora, the labia minora were completely flattened, and the vaginal opening was pushed to the healthy side. When a Bartholin's gland cyst becomes infected, it may form an abscess, and repeated infection may cause the cyst to expand. Bartholin's gland cyst is not difficult to diagnose through examination. However, care should be taken to differentiate it from labia majora inguinal hernia. The latter is connected to the inguinal ring and can be repositioned after compression, causing the lump to disappear. If you hold your breath downward, the lump will swell.

Treatment

Laser surgery: Treatment includes cystostomy and cystectomy. Ostomy is suitable for larger cysts and those with recurrent acute attacks; resection is suitable for cysts with infection. For larger cysts, select the lowest point and use CO2 laser focusing (power 25W) to cut the skin 0.5cm, or use ND:YAG laser fiber (power 20W) to cut 0.5cm from the lowest point of the tumor. Remove the contents of the cyst and clean and change the dressing of the drainage port every day.

Resection: The enlarged Bartholin's gland is removed. The surgery uses CO2 laser focusing (power above 25W). The operation was performed strictly according to routine disinfection and sterile dressing. Use local anesthesia (1% lidocaine); spare instruments include a skin clamp and a mastoid retractor. The laser is focused along the skin lines to cut the skin, and the curved hemostat is used to assist in the cyst wall peeling. The skin is cut without cutting the cyst wall. A retractor is used to expand the incision, and the curved hemostat is used to protect along the cyst wall. The laser output power is adjusted according to the situation of the incision into the cyst wall to gradually peel off the cyst wall. After the entire cyst was peeled off, the residual carbonized tissue in the wound was flushed with sterile saline, the retractor was removed, and sutured from the inside to the outside without leaving any dead space. The stitches on the wound will be removed after 7 to 10 days. Observe the incision every day after surgery. If the wound is wetted by urine, the dressing should be changed promptly. After resection of a smaller cyst, the skin incision can be sutured and covered with a sterile dressing for protection. After the operation, a double-layer condom can be used to make a special air bag, which can be inserted into the vagina and then inflated appropriately. Pay attention to the gas capacity and change it every day or every other day until the cyst walls are in contact with each other. Each time the vaginal balloon is inserted, it must be sterile to prevent infection. The balloon is removed after 7 to 10 days. After many tests, only the incision is sutured and the balloon is used to expand and compress the balloon wall for repair, which is also effective and the patient does not feel any discomfort.

Postoperative treatment: Postoperative auxiliary antibacterial and anti-inflammatory drugs and multi-vitamin preparations are used to provide supportive treatment for those with poor physical constitution.

30 The anal sinus is located at the dentate line of the anal canal, between the bases of two adjacent anal columns. It is half-moon shaped, with an upward opening, concave like a pocket, and 3 to 5 mm deep. There is an opening for the anal glands at its base. Anal sinusitis, also known as anal cryptitis, refers to the inflammatory lesions of the anal crypts in the dentate line of the anus. Anal sinusitis often causes anal infectious diseases such as perianal abscess.

Causes

Due to the special anatomical morphology of the anal sinus, feces are easily accumulated in the anal sinus or it is blocked by secretions, causing infection and inflammation. In addition, dietary factors may also cause anal sinusitis, such as fried and spicy foods, seafood, etc.

Clinical manifestations

1. Anal pain during defecation, and the location is very clear.

2. It is often more common in the posterior anus because this is where the pressure in the anal canal is the highest.

3. In addition, there will be a foreign body sensation in the anus, discomfort, a feeling of falling in the anal canal, and purulent secretions in the anus.

examine

1. Digital anal examination checks for sphincter tension, anal sinus and nipple induration and tenderness.

2. Anoscopy is used to check the congestion, redness and swelling of the anal sinuses and anal papillae.

diagnosis

The diagnosis is based on clinical symptoms and relevant examinations.

Differential Diagnosis

1. Anal fissure Anal fissure is characterized by periodic anal pain, constipation and bloody stool. The pain is more severe than that of anal cryptitis and the pain lasts longer.

2. Perianal abscess is the result of further development of anal cryptitis, and its main manifestations are gradually increasing perianal pain, chicken-pecking-like pain when pus forms, accompanied by chills and fever, and routine blood examination shows a significant increase in white blood cell count and neutrophil count.

treat

1. Conservative treatment: When anal sinusitis first occurs or the symptoms are mild, medication and sitz baths can be used.

2. Surgery is recommended for patients with anal sinusitis who have not responded to drug treatment, or whose anal sinus has formed an abscess, or who have hypertrophy of the anal papilla and hidden fistula. The treatment methods include anus incision and anus resection.