External Hemorrhoids: Symptoms, Treatments, and When to Seek Help

External hemorrhoids issue?

Hello, Doctor: I previously underwent a colonoscopy, during which the physician informed me that I have external hemorrhoids.
At that time, I didn't feel particularly uncomfortable, so I didn't pay much attention to it.
However, in the past few days, I've clearly felt a foreign body sensation when having a bowel movement, accompanied by some sharp pain.
When wiping, I noticed three external hemorrhoids and a bit of blood.
My stools are mostly soft, but I feel like they get stuck sometimes, prompting me to push harder to pass them.
Later, I looked in the mirror and realized that the hemorrhoids are slightly obstructing the anal opening.
Two of the external hemorrhoids are smaller and cause sharp pain when lightly touched, while the larger one does not hurt.
However, due to anal itching and not being able to clean properly after a bowel movement, I tend to push the hemorrhoids aside to wipe, which is painful.
I also try to push the larger external hemorrhoid back inside, but the itching seems relentless.
I purchased a hemorrhoid cream and have been using it for a week, but it doesn't seem to help much, and I feel like the itching has increased along with a burning sensation.
What could be the reason for this? Would using a hemorrhoid suppository be more effective? I have always eaten less meat and consume a lot of fruits and vegetables, drinking 1800cc of water daily.
I don't stay up late, exercise occasionally, and do Kegel exercises, but the results seem limited; only warm sitz baths provide some relief.
I want to see a proctologist, but due to the pandemic, I plan to wait until it is over.
Could you please provide me with some suggestions to alleviate the swelling of the hemorrhoids? Thank you! Additionally, I saw your other responses indicating that the only way to completely cure external hemorrhoids is through surgery, which makes me a bit anxious.
Given my situation, would you also recommend surgery? Thank you! My job makes it difficult to take extended leave; if surgery is necessary, can it be done on an outpatient basis or with discharge the day after surgery? Why can't rubber bands be used on external hemorrhoids? I've heard from friends that surgery for external hemorrhoids is indeed more painful than for internal hemorrhoids.
Thank you for your response, and I appreciate your help!

Yu Xin, 30~39 year old female. Ask Date: 2020/04/04

Dr. Ke Fangxu reply Surgery

If hemorrhoids do not involve significant bleeding or severe pain, surgical treatment is not necessary.
External hemorrhoid ligation can cause intense pain, so it is generally not recommended.
Only internal hemorrhoids can be ligated since they lack somatic nerve supply.
There are practitioners who claim to perform external hemorrhoid ligation, but I personally do not recommend it.
Anal itching may be caused by excessive wiping.
In addition to medication and topical treatments, three important points should be noted: 1.
Do not scratch to avoid wound infection.
2.
Temporarily avoid spicy foods to prevent capsaicin from irritating the skin.
3.
Avoid using soap or body wash to clean the anal area to prevent excessive removal of the skin's natural oils.
If these measures are followed, improvement can generally be seen within about a week.
If there is no improvement, a physician should be consulted for further evaluation and medication.

Reply Date: 2020/04/04

More Info

External hemorrhoids, also known as external piles, are swollen veins located around the anus and lower rectum. They can cause discomfort, pain, and bleeding, particularly during bowel movements. Your symptoms, including the sensation of a foreign body, pain, and bleeding, are common indicators of external hemorrhoids. It’s important to address these symptoms, especially since you’ve noticed changes and discomfort.

Symptoms of External Hemorrhoids
The symptoms you described align with typical presentations of external hemorrhoids:
1. Pain and Discomfort: This can occur during bowel movements or when sitting.

2. Bleeding: Bright red blood on toilet paper or in the toilet bowl can indicate hemorrhoidal bleeding.

3. Itching and Irritation: This can be exacerbated by poor hygiene or irritation from stool.

4. Swelling: The presence of lumps or swelling around the anus is a hallmark of external hemorrhoids.

Treatment Options
1. Over-the-Counter Medications: You mentioned using a hemorrhoid cream, which is a good first step. These creams often contain hydrocortisone or witch hazel to reduce inflammation and itching. However, if you’re not seeing improvement, it may be time to try a different product or consult a healthcare professional.

2. Sitz Baths: Soaking in warm water can help relieve discomfort and reduce swelling. This is a simple and effective home remedy.

3. Dietary Changes: Although you mentioned consuming a lot of fruits and vegetables, ensure you’re getting enough fiber to prevent constipation. Consider fiber supplements if necessary.

4. Hydration: Drinking plenty of water is essential for softening stools and preventing straining during bowel movements.

5. Avoid Straining: Try to avoid excessive straining during bowel movements, as this can worsen hemorrhoids. If you feel constipated, consider using a stool softener.

When to Seek Help
If your symptoms persist or worsen, it’s crucial to seek medical advice. Signs that warrant a visit to a healthcare provider include:
- Severe pain that does not improve with home treatment.

- Significant bleeding that does not stop.

- Symptoms that interfere with daily activities.

Surgical Options
Regarding your concerns about surgery, it’s true that surgical intervention is often considered when conservative treatments fail. However, not all cases require surgery. The decision to proceed with surgery depends on the severity of your symptoms and the impact on your quality of life.
1. Surgical Procedures: For external hemorrhoids, options include excisional hemorrhoidectomy or less invasive procedures like rubber band ligation, although the latter is typically used for internal hemorrhoids.

2. Recovery: Many procedures can be done on an outpatient basis, meaning you could potentially go home the same day. Recovery times vary, but many people can return to normal activities within a week or two.

3. Pain Management: While some patients report that external hemorrhoid surgery can be painful, effective pain management strategies can help minimize discomfort.

Conclusion
Given your situation, it’s advisable to consult a healthcare professional, preferably a colorectal specialist, to evaluate your condition and discuss treatment options. While it’s understandable to want to wait until after the pandemic, don’t delay seeking help if your symptoms worsen. Early intervention can prevent complications and improve your quality of life.
In the meantime, continue with home remedies, maintain a high-fiber diet, and stay hydrated. If you decide to try a hemorrhoid suppository, it may provide additional relief, but be cautious and consult with a healthcare provider if you have any concerns.

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