External Hemorrhoids: Symptoms, Treatment, and Concerns

External hemorrhoids issues?

Hello Doctor, I am 17 years old.
Two months ago, due to exam and assignment stress, I was only sleeping one hour a day, which led to constipation and severe rectal bleeding.
I subsequently underwent a rectal examination at Wan Fang Hospital, where I was diagnosed with an internal hemorrhoid (not large) and an external hemorrhoid (which has always been present externally and is not a prolapsed internal hemorrhoid).
The external hemorrhoid has always been soft and painless, like a piece of soft tissue.
The internal hemorrhoid occasionally bleeds, and I have been using suppositories.
Recently, my bowel movements have been smooth, with no bleeding or pain during the process, and my sleep schedule is normal without staying up late.
I completely avoid spicy foods and sugary drinks, drink sugar-free yogurt daily, and maintain regular exercise, along with warm sitz baths.
However, I have developed a sharp, white-colored growth near my anus that feels hard and is painful when pressed.
I have wondered if it could be a protruding internal hemorrhoid, but it cannot be pushed back in and is located right at the anal opening.
It appeared quite suddenly; just a few days ago, it wasn't there.
I have researched online and am also concerned it might be a condyloma acuminatum, but it seems that condyloma requires sexual contact.
Doctor, will applying external hemorrhoid cream help with this condition? Thank you, Doctor!

Ke Ke, 10~19 year old female. Ask Date: 2017/05/19

Dr. Ke Fangxu reply Surgery

Based on your description, it seems more like the typical symptoms of an anal fissure, which include pain during bowel movements accompanied by slight bleeding.
The common causes are often constipation or diarrhea.
Sometimes, polyps may develop at the edges of the fissure, which could be what you are describing as sharp and hard.
The fundamental treatment involves improving bowel habits, and warm sitz baths can also be beneficial.
You can also purchase hemorrhoid suppositories over the counter.
If the symptoms persist without improvement, it is advisable to consult a physician for further evaluation.

Reply Date: 2017/05/19

More Info

Understanding external hemorrhoids and their associated symptoms, treatment options, and concerns is crucial for managing your condition effectively. Based on your description, it seems you are experiencing some discomfort and changes around the anal area, which could be related to your existing external hemorrhoid or potentially a new condition.

Symptoms of External Hemorrhoids
External hemorrhoids are swollen veins located under the skin around the anus. They can cause various symptoms, including:
1. Pain or Discomfort: This is often the most noticeable symptom, especially when sitting or during bowel movements.

2. Swelling: You may notice a lump or swelling around the anal area.

3. Bleeding: While external hemorrhoids typically do not bleed as much as internal ones, they can still cause some bleeding, especially if they become irritated or thrombosed (developing a clot).

4. Itching or Irritation: The area may feel itchy or irritated, which can be exacerbated by hygiene products or excessive wiping.

Treatment Options
Since you mentioned that you have been using suppositories and maintaining a healthy lifestyle, here are some additional treatment options and considerations:
1. Topical Treatments: Over-the-counter creams or ointments specifically designed for hemorrhoids can help reduce inflammation and provide relief from itching and discomfort. These often contain ingredients like hydrocortisone or witch hazel.

2. Sitz Baths: Continuing with warm sitz baths can help soothe the area and promote healing. Soaking for 10-15 minutes several times a day can be beneficial.

3. Dietary Changes: Maintaining a high-fiber diet and staying hydrated can help prevent constipation, which is crucial for reducing strain during bowel movements.

4. Avoid Straining: It’s essential to avoid straining during bowel movements, as this can exacerbate hemorrhoids.

5. Medical Procedures: If your symptoms persist or worsen, you may need to consult a healthcare provider for further evaluation. In some cases, procedures like rubber band ligation or sclerotherapy may be recommended.

Concerns About New Growths
Regarding the new growth you described as "sharp, white, and hard" that causes pain when pressed, it’s essential to differentiate between various conditions:
- Thrombosed External Hemorrhoid: If the external hemorrhoid has developed a clot, it can become hard and painful. This typically requires medical intervention.

- Skin Tags: Sometimes, after hemorrhoids heal, they can leave behind skin tags, which are benign but can be bothersome.

- Warts or Other Lesions: While you mentioned concerns about genital warts (condyloma acuminata), these typically arise from HPV and are associated with sexual activity. However, they can also appear in individuals who have not been sexually active. A healthcare provider can perform a visual examination and possibly a biopsy to determine the exact nature of the growth.

When to Seek Medical Attention
Given your symptoms and the sudden appearance of a new growth, it is advisable to consult a healthcare professional. They can provide a thorough examination and determine whether the growth is related to your existing hemorrhoids or if it requires different treatment.
In summary, while topical treatments may help with your external hemorrhoids, the new growth warrants further investigation. Maintaining a healthy lifestyle and following up with your healthcare provider will be key in managing your symptoms effectively.

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