External Hemorrhoids: Causes, Symptoms, and Treatment Options

The external mole swells every day after a bowel movement?

Hello, Doctor: I have had my external hemorrhoids for about five years now, both internal and external.
They have not caused me any pain, bleeding, or itching during these years, and I have been managing well.
However, recently, after having a bowel movement, the two external hemorrhoids swell up like small tomatoes, but they do not hurt and rarely bleed, unless I wipe too hard.
I suspect this might be a thrombosed external hemorrhoid.
After researching, I found that others experience this occasionally, with swelling subsiding after a few days, but mine occurs daily.
However, it does not hurt, and after a slight massage around the anal area, the swelling goes down in less than a minute, returning to the usual size of the external hemorrhoids.
Is my condition considered more severe or less common? Since applying ointments makes me feel itchy (due to a benzocaine allergy), I am currently taking capsules (Ningzhi swelling) and doing warm sitz baths.
If using ointments would be more effective, could you please recommend one or two suitable ointments for me? Thank you.
People around me who have undergone surgery say it is very painful and may have aftereffects, so I am reluctant to consider surgery, but I would like to have the thrombosis removed.
If I see a doctor after the thrombosis has resolved, can the doctor still address the issue, or must the swelling be present for the clot to be removed? Do you have any additional reminders or suggestions regarding my situation? Thank you.

Kunrao Zhe, 50~59 year old female. Ask Date: 2021/03/20

Dr. Ke Fangxu reply Surgery

It is essential to have a medical examination to determine whether it is simply hemorrhoids.
If they resolve on their own, it may not be considered particularly serious.
I cannot recommend any medications without a consultation, so please seek medical advice for appropriate prescriptions.
If a thrombosis resolves, the doctor will need to assess what needs to be removed, specifically evaluating the situation at the time of thrombosis formation to determine if hemorrhoids can be addressed.
Key precautions for hemorrhoids include avoiding constipation, shortening the time spent during bowel movements, and increasing dietary fiber intake, which can be beneficial.
Warm sitz baths may help alleviate symptoms.
Laxatives should not be used indiscriminately.
If symptoms persist without improvement, it is advisable to consult a physician.
If necessary, a colonoscopy can also be arranged.

Reply Date: 2021/03/20

More Info

External hemorrhoids, commonly referred to as "痔瘡" in Chinese, are swollen veins located in the lower rectum and anus. They can cause discomfort and various symptoms, and understanding their causes, symptoms, and treatment options is crucial for effective management.

Causes of External Hemorrhoids
External hemorrhoids develop when the veins around the anus become swollen due to increased pressure. This pressure can result from several factors, including:
1. Straining during bowel movements: This is often due to constipation or diarrhea, which can lead to increased pressure in the rectal area.

2. Prolonged sitting: Spending long periods sitting, especially on the toilet, can contribute to the development of hemorrhoids.

3. Pregnancy: The increased pressure from the growing uterus can lead to swollen veins in the rectal area.

4. Obesity: Excess weight can put additional pressure on the pelvic veins.

5. Heavy lifting: Regularly lifting heavy objects can increase abdominal pressure, contributing to hemorrhoid formation.

Symptoms of External Hemorrhoids
The symptoms of external hemorrhoids can vary, but common signs include:
- Swelling: The most noticeable symptom is swelling around the anus, which can resemble a small lump or "tomato" as you described.

- Pain or discomfort: While you mentioned that your hemorrhoids are not painful, many individuals experience discomfort, especially during bowel movements.

- Bleeding: You noted that there is some bleeding when wiping after a bowel movement, which can occur if the hemorrhoid is irritated.

- Itching: This can be a common symptom, although you have experienced itching with certain topical treatments.

Treatment Options
Given your situation, where the external hemorrhoids swell after bowel movements but do not cause significant pain, there are several treatment options to consider:
1. Dietary Changes: Increasing fiber intake can help prevent constipation and reduce straining during bowel movements. Foods rich in fiber include fruits, vegetables, and whole grains.

2. Hydration: Drinking plenty of water can help keep stools soft and easier to pass.

3. Warm Sitz Baths: Soaking in warm water for 10-15 minutes can help relieve discomfort and reduce swelling.

4. Topical Treatments: Since you have experienced itching with benzocaine, you might want to consider other topical treatments. Over-the-counter creams containing hydrocortisone can reduce inflammation and itching. However, it’s essential to consult with a healthcare provider before trying new medications.

5. Oral Medications: You mentioned taking capsules for swelling. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help reduce pain and inflammation.

6. Surgical Options: If conservative treatments do not provide relief, surgical options such as hemorrhoidectomy or rubber band ligation may be considered. It’s understandable to be apprehensive about surgery due to potential pain and complications, but these procedures can provide long-term relief.

When to See a Doctor
If your symptoms persist or worsen, or if you experience significant bleeding, it’s crucial to consult a healthcare provider. They can assess the condition of your hemorrhoids and determine the best course of action. If the blood clot (thrombus) resolves, it may still be possible for a doctor to treat the area, but it is generally more effective to address it while it is swollen.

Conclusion
Your situation, where the external hemorrhoids swell daily but resolve quickly, is not uncommon. However, it is essential to monitor your symptoms and seek medical advice if you have concerns about the severity of your condition or if you experience new symptoms. A healthcare provider can offer tailored advice and treatment options based on your specific situation.

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