My husband has a round, hard knot on the inside of his rectum, just inside the sphincter. He is not having any rectal bleeding or current bowel obstructions. Is this condition something he should be concerned about? He is 41 years old and appears to be in good physical health, except for some obesity. He doesn't want to see a doctor. Should I push to him to see one?

Patients often complain of anal or rectal problems because they notice symptoms related to those areas, so I would be interested to know how your husband noticed this "hard knot." You say that he is not bleeding or having "obstruction." Is he complaining of constipation, diarrhea or painful defecation? Has he ever had hemorrhoids? These are questions that may help to pinpoint the cause of his problem.

The most common cause of problems such as those reported by your husband is hemorrhoids, which can be both internal (in the rectum) or external (at the anus). Hemorrhoids can become hard or painful if they thombrose, which means blood clots form within them. Another possibility is a hypertrophic anal papilla. This refers to normal tissue at the anus that has enlarged to form round nodules. Anal warts can also enlarge and form a hard mass that is felt by the patient.

All of the preceding conditions are benign and can be readily diagnosed. Another more worrisome possibility is anal or rectal cancer. Although your husband does not complain of bleeding (a typical symptom in this type of cancer), he will need a rectal and anal examination to make sure the "knot" is not malignant.

If the doctor does not make the diagnosis at that time, your husband may also require a proctoscopy or sigmoidoscopy. These exams enable a physician to more closely examine the inner rectum and sigmoid colon.