Internal and External Hemorrhoids: Pain Management and Treatment

I have tied off another internal hemorrhoid!

Hello, Doctor! Last August, I had two hemorrhoids banded, and one of them was completely numb.
However, two to three days later, I developed a thrombosed hemorrhoid extending from the inside to the anal opening, so I quickly sought medical attention again.
The second time was so painful that I couldn't sleep at night, and the pain medication was completely ineffective.
On the third day, after a bowel movement, it fell off, and the pain subsided.
Recently, due to gastrointestinal issues, I developed an external hemorrhoid that was so painful I couldn't even sit down.
Since it coincided with the Qingming Festival holiday, I first took oral medication from a general surgery clinic for three days, applied hemorrhoid ointment, and took sitz baths, but the pain persisted! During the holiday, I mostly stayed in bed and continued with sitz baths and medication.
The day after the holiday ended, I went to the hospital, and the doctor said I had an internal hemorrhoid that could be banded, while the external hemorrhoid was reduced to a small size.
Pressing on it was painful, especially at the anal opening, which felt hard and painful when pressed.
The doctor mentioned it was a thrombosed external hemorrhoid and advised that more sitz baths and massage would help.
The pain from the banded internal hemorrhoid has been continuous since the procedure.
The next morning, I still felt it, but by noon, it seemed to have fallen off, and the pain was not as intense, becoming more of a mild, intermittent discomfort.
Now, the external hemorrhoid has disappeared, but the anal opening still feels a bit hard, and pressing on it is slightly painful, as if the "wound" from the banding inside is still causing discomfort.
After the previous hemorrhoid fell off, I no longer felt pain, so I wonder if this time the wound is larger, which is causing the discomfort? The hospital doctor mentioned that a suppository could be used or not, so I didn't use it on the day of the banding.
The next day, since I felt it had fallen off, I used it, but it didn't seem to alleviate the pain.
I can only try to take sitz baths to reduce the discomfort.
Could this lead to a fistula due to the wound? This experience feels different from last year, so I'm a bit worried, especially since the doctor said I didn't need a follow-up appointment.
Previously, I had the banding done because of bleeding from the internal hemorrhoid, but this time, there was no bleeding at all, so I don't understand why it was necessary to band it.
The outpatient clinic I initially visited was fully booked, so I went to another hospital I had never been to before.
Thank you!

Hao tong……, 40~49 year old female. Ask Date: 2016/04/08

Dr. Ke Fangxu reply Surgery

The location of the hemorrhoid ligation wound is related to pain; if the ligation is closer to the anus, it tends to be more painful and the discomfort may last longer.
As long as the pain does not continue to intensify and there are no signs of redness, swelling, or heat, there is no need for excessive concern or treatment.

Reply Date: 2016/04/08

More Info

Understanding internal and external hemorrhoids, along with their pain management and treatment options, is crucial for anyone experiencing these conditions. Hemorrhoids are swollen veins in the lower rectum and anus, and they can be classified into two types: internal and external. Internal hemorrhoids occur inside the rectum and are usually painless, while external hemorrhoids develop under the skin around the anus and can be quite painful, especially when thrombosed (when a blood clot forms).

From your description, it seems you have experienced both internal and external hemorrhoids, with significant pain and discomfort associated with them. The pain you felt during your second episode, which was severe enough to disrupt your sleep, is not uncommon with thrombosed external hemorrhoids. The fact that the pain subsided after the thrombosed hemorrhoid resolved indicates that the acute pain was likely due to the clot and inflammation associated with it.

In terms of pain management, it is essential to address both the symptoms and the underlying issues. Here are some strategies that can help:
1. Sitz Baths: You mentioned using sitz baths, which are highly recommended for hemorrhoid relief. Soaking in warm water for about 15-20 minutes several times a day can help reduce inflammation and soothe the area.

2. Topical Treatments: Over-the-counter creams and ointments containing hydrocortisone or witch hazel can provide temporary relief from itching and discomfort. However, you noted that using a suppository did not significantly alleviate your pain. It might be worth trying different formulations or consulting with your doctor about alternatives.

3. Pain Relief Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help manage pain and reduce inflammation. Acetaminophen is another option, but it does not have anti-inflammatory properties. If over-the-counter options are insufficient, your doctor may prescribe stronger pain relief.

4. Dietary Adjustments: To prevent further issues, maintaining a high-fiber diet is crucial. This can help soften stools and reduce straining during bowel movements, which can exacerbate hemorrhoids. Consider incorporating fruits, vegetables, whole grains, and plenty of fluids into your diet.

5. Avoid Straining: When using the bathroom, try to avoid straining, as this can worsen hemorrhoids. If you feel the urge to go, respond promptly rather than waiting, as delaying can lead to harder stools.

6. Follow-Up Care: Since you mentioned that your doctor said follow-up was unnecessary, it’s still important to monitor your symptoms. If you experience persistent pain, bleeding, or any new symptoms, seeking further medical advice is crucial.
Regarding your concern about the potential for a fistula (an abnormal connection between the rectum and the skin), this is generally a rare complication following hemorrhoid surgery. However, if you notice any unusual drainage or persistent pain, it would be wise to consult a healthcare professional.

In conclusion, managing hemorrhoids involves a combination of lifestyle changes, topical treatments, and pain management strategies. If your symptoms persist or worsen, do not hesitate to seek medical advice. It’s essential to ensure that you are receiving appropriate care tailored to your specific situation.

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