Perineal pyramidal refers to a protrusion of perineal tissue or a lump around the anus in young children, typically girls. This disease is known by different names such as infantile perianal pyramidal protrusion, infantile perineal protrusion, the perianal protrusion in childhood, and perianal pyramidal protrusion.
It is distinguished by a smooth flesh-colored or pink-red nodule at the anus. It is found in the perineal median raphe, which is located in the center and anterior to the anus. The smooth and pink perineal pyramidal protrusion can range in size from 5.5 to 28.5 millimeters square. This lump is characterized as leaf-shaped, tongue-shaped, oval, pyramidal, or triangular-shaped.
In most cases, the issue is detected during a normal physical check-up or while the mother is changing the child’s diaper or bathing the infant. The following three kinds of perianal pyramidal protrusion are known:
- Constitutional: The constitutional type is probably caused by a weakness in the perineal area or median raphe of females. The fact that the illness is more common in females and might sometimes be genetic or familial supports a constitutional propensity to infantile perianal protrusion.
- Acquired (often as a result of constipation): This type is mostly caused by forceful wiping of the perianal area after defecation or urine.
- Lichen-induced: Anogenital lichen sclerosis can cause an infant’s perianal protrusion. This is the type that is considered least frequent.
Perianal Pyramidal Protrusion Symptoms
Perianal Pyramidal Protrusion doe not need any typical diagnostic methods. The majority of the diagnosis is clinical. A laboratory test is not required for the examination because of the outward visibility of the lesion. The doctors examine the lump without any instruments. The doctors mostly diagnose the disease through the following features:
- Traumatic lesion.
- Genital wart.
- Perianal skin tag.
- Dilated capillaries.
- Fibrous tissue.
The above-mentioned diagnostic features appear due to granulomatous lesion of inflammatory bowel disease, capillary hemangioma, rectal prolapse, hemorrhoid, and sexual abuse.
The clinical symptoms of infantile perianal protrusion are so unique that diagnosis becomes straightforward. A timely diagnosis is possible only if the doctors have all the expertise over this illness.
Perianal Pyramidal Protrusion Causes
The perineal pyramidal protrusion has an unknown etiology. Constipation is frequently related to perineal pyramidal protrusion. It is also seen in children who have lichen sclerosis. The affected children mostly complain about constipation. Perianal pyramidal protrusions are associated with dysuria or painful defecation, regional enteritis, dysuria or painful defecation, local irritation as a result of wiping, and urinary tract infections.
The congenital form of Perianal Pyramidal Protrusion is caused by the dysfunction of the median raphe and is also considered a residual of the urogenital septum. This kind is mostly present in males and is mostly inherited. A perineal nodule is a female-specific developmental abnormality that eventually returns to its original form with age. The perineum is created during the development of the fetus by extension of the urogenital septum. As a result, the perineal nodule could be a remnant of the urogenital septum’s projected tip.
The acquired form of a perianal pyramidal protrusion is caused by the following:
- Perianal fistulas.
- Anal fissures.
- Chronic diarrhea.
Thus, the causes for each type are different, the treatment also depends on these causes.
Perianal Pyramidal Protrusion Treatment
The treatment for perineal pyramidal protrusion is managing the underlying causes such as constipation and lichen sclerosis.
If there is anogenital lichen sclerosis, it should be treated with either topical immunomodulators like tacrolimus or pimecrolimus or ultrapotent topical steroids like clobetasol. Neither surgical techniques nor physical modalities are appropriate.
The children with perianal pyramidal protrusion are treated for their complaint of constipation. The protrusion disappears on its own after a few months. Treatments to loosen the stools can help in the healing of the lesion in children with constipation. Children who are affected by this condition can be addressed by increasing their consumption of foods that are high in fiber, drinking plenty of fluids, and, if necessary, taking lactulose which is a stool softener drug.
The methods for treating this disease include; cryotherapy, simple surgical excision, destruction by electrodesiccation, or observation. If the patient has constipation then certain dietary changes and fluid intake is suggested by the doctors. The parents are assured that this disease is recoverable and manageable.
The patients are also treated through therapy. The doctors inform the parents that this condition is sometimes a subsequent symptom of lichen sclerosis and atrophicus in the perianal region. Thus, the treatment options differ because there is no fixed treatment for this asymptomatic disease.