Brief Answer: Needs more close observation and physical examinat Detailed Answer: Hi XXXX! Good morning and a Happy New Year 2014. I am Dr Sharee, a general surgeon answering your query. From your history, it seems that she might have got a fissure in Ano, which is a crack in the muco-cutaneous junction of the anal canal due to passage of hard stool and it happens in chronically constipated people. This is not a serious condition, but have to be taken care of both with medical and dietary measures and if not cured or troubled frequently , then a small surgery will relieve your symptoms. The blood she is passing in the stool could also be due to the fissure , but an associated internal hemorrhoids could be the culprit, which can be known and diagnosed only by a proctoscopy examination or by a colonsocopy. If it is confirmed as internal hemorrhoids which is bleeding repeatedly, then it needs surgery. If I were her doctor, I would advise her a regular sitz bath (sitting for 5 minutes on a tub of warm water) three times a day, an antibiotic which will be effective in both aerobic and anaerobic infection, an anti inflammatory drug after meals, a proton pump inhibitor drug, a non irritant laxative which should soften her stool, and a local ointment which contains lignocaine and diltiazem, which might relieve her symptoms. As the basic problem is chronic constipation, I would advise her to modify her dietary habits towards more of roughage like salads and fruits, and plenty of liquids with avoidance of fast, spicy food and non veg like mutton. She can go for fish which is more safe. If all these measures do not help you or there is frequent recurrence of the problem after being relieved, there is a simple surgery called lateral sphicterotomy/ hemorrhoidectomy depending on the diagnosis, which will relieve her of her symptoms. This helps in stool getting evacuated easily. But she has to adhere to the dietary modifications as advised. As of blood loss through urine, she has to be sure that the urine is not mixed with the blood during periods which is a common occurrence sometimes for leading to false diagnoses. The imaging reports show a hepatic hemangioma, which might not need any immediate surgical intervention, but needs observation at regular intervals of 6 months to see if it is increasing or not. The adenomyosis could be the reason for more bleeding per vagina, which might have mixed with the urine while in the wash room. So she has to observe it closely. However you need a clinical examination by a qualified general surgeon first before we confirm the diagnosis. From your history, it seems that you have got a fissure in Ano, which is a crack in the muco-cutaneous junction of the anal canal due to passage of hard stool and it happens in chronically constipated people. This is not a serious condition as your colonoscopy report is clean, but have to be taken care of both with medical and dietary measures and if not cured or troubled frequently , then a small surgery will relieve your symptoms. The small bump you mentioned could be a small skin tag, which occurs as a natural protective mechanism due to the fissure (sometimes known as external piles) If I were your doctor, I would advise you a regular sitz bath (sitting for 5 minutes on a tub of warm water) three times a day, an antibiotic which will be effective in both aerobic and anaerobic infection, an anti inflammatory drug after meals, a proton pump inhibitor drug, a non irritant laxative which should soften your stool, and a local ointment which contains lignocaine and diltiazem, which might relieve your symptoms. As the basic problem is chronic constipation, I would advise you to modify your dietary habits towards more of roughage like salads and fruits, and plenty of liquids with avoidance of fast food and non veg like mutton. You can go for fish which is more safe. If all these measures do not help you or there is frequent recurrence of the problem after being relieved, there is a simple surgery called lateral sphicterotomy, which releases the tight anal sphincter which holds back the stool in chronic condition. This helps in stool getting evacuated easily. But you have to adhere to your dietary modifications as advised. However you need a clinical examination by a doctor first before we confirm the diagnosis. So I would advise you to see your family physician/surgeon soon. I hope this information would help you in discussing with your family physician/treating doctor in further management of your problem. Please do not hesitate to ask in case of any further doubts. Thanks for choosing health care magic to clear doubts on your health problems. Wishing you an early recovery. Dr Shareef.

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Brief Answer: confirmation only by biopsy with histopathology Detailed Answer: Hi XXXX ! Thanks for your reply. Hypodense or hypoechoic means the area is less dense than the other normal area, and in the ultrasound, it may come as a darker area. This suggests that there could be a space occupying lesion, most probably benign and not necessarily malignant. That is why a follow up imaging study after 6 months or earlier in case of any related problem like vaginal bleeding or any other symptoms in case of the report of the liver imaging. Whether one lesion is benign or malignant could be decided only on hitopathological examination by the pathologist. Only observation can be done with imaging tests. I hope I have cleared your doubt. Take care. Good night. Dr Shareef.

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