External Hemorrhoids: Symptoms, Causes, and Treatment

Thrombotic external hemorrhoids

Hello, Dr.
Ke.
I have constipation, irritable bowel syndrome, and internal hemorrhoids.
Eleven years ago, I developed a soft, irregularly shaped lump about the size of a marble, located at the 4:30 position relative to the anus, approximately 0.5 cm from the anal opening.
The color of the lump is similar to the surrounding skin, and it does not hurt when pressed.
I do not experience pain while riding a motorcycle or sitting, and I usually do not feel any discomfort.
I also do not have symptoms of fever or cold.
However, if I experience constipation and strain during bowel movements, or if I eat fried chicken or spicy foods the day before, the lump sometimes appears to have a thrombosed color after defecation.
When I wipe, there is a small amount of bright red blood on the toilet paper, but it does not hurt.
When I press on the lump, I notice a faint amount of bright red blood coming from inside the anus, which is also painless.
After walking, when I go to the bathroom and wipe, there is blood on the toilet paper, but again, it does not hurt.
This has been going on for almost twelve years.
Could this be a thrombosed external hemorrhoid, or is there another condition? Thank you for your response, Dr.
Ke.

STAN, 30~39 year old female. Ask Date: 2016/12/27

Dr. Ke Fangxu reply Surgery

Based on your description, it seems to be a simple external hemorrhoid.
If it is a thrombosed external hemorrhoid, it should shrink or disappear within one to three weeks.
As for the possibility of other gastrointestinal diseases, it can only be ruled out through a colonoscopy or a barium enema examination.

Reply Date: 2016/12/27

More Info

External hemorrhoids, also known as external piles, are swollen veins located around the anus and lower rectum. They can cause discomfort, itching, and bleeding, particularly during bowel movements. Based on your description, it seems that you may be experiencing symptoms consistent with external hemorrhoids, particularly given your history of constipation and internal hemorrhoids.

Symptoms of External Hemorrhoids
1. Swelling and Lumps: You mentioned a soft lump near the anus, which is characteristic of external hemorrhoids. These lumps can vary in size and may become more pronounced during episodes of straining or constipation.

2. Bleeding: The presence of bright red blood on toilet paper after wiping, especially after a bowel movement, is a common symptom. This bleeding usually occurs when the hemorrhoid is irritated or when there is straining during defecation.

3. Discomfort or Itching: While you noted that the lump does not cause pain, external hemorrhoids can sometimes lead to itching or irritation around the anal area.

Causes of External Hemorrhoids
External hemorrhoids can be caused by several factors:
- Straining During Bowel Movements: This is often due to constipation, which you mentioned you experience. Straining increases pressure on the veins in the rectal area, leading to swelling.

- Pregnancy: Increased pressure on the pelvic veins can lead to hemorrhoids, although this may not apply to your situation.

- Obesity: Excess weight can put additional pressure on the veins in the rectal area.

- Prolonged Sitting: Sitting for long periods, especially on the toilet, can contribute to the development of hemorrhoids.

Treatment Options
1. Dietary Changes: Increasing fiber intake can help alleviate constipation and reduce straining during bowel movements. Foods rich in fiber include fruits, vegetables, whole grains, and legumes.

2. Hydration: Drinking plenty of water can help soften stools and promote regular bowel movements.

3. Over-the-Counter Treatments: There are various creams and ointments available that can help soothe the area and reduce inflammation. These may contain hydrocortisone or witch hazel.

4. Sitz Baths: Soaking the affected area in warm water for 10-15 minutes several times a day can help relieve discomfort and promote healing.

5. Avoid Straining: When using the bathroom, try to relax and avoid straining. If you find it difficult to pass stools, consider using a stool softener or laxative after consulting with a healthcare provider.

When to Seek Medical Attention
While many cases of external hemorrhoids can be managed at home, you should seek medical attention if:
- The bleeding persists or worsens.

- You experience significant pain or discomfort.

- The lump becomes hard or painful, which could indicate a thrombosed hemorrhoid (a hemorrhoid that has formed a blood clot).

- You notice any changes in your bowel habits or experience severe abdominal pain.

Conclusion
Based on your symptoms, it is likely that you are dealing with external hemorrhoids, possibly exacerbated by your history of constipation and dietary choices. Implementing lifestyle changes, such as increasing fiber intake and staying hydrated, can significantly improve your condition. However, if symptoms persist or worsen, it is advisable to consult a healthcare professional for a thorough evaluation and potential treatment options.

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