External Hemorrhoids: Symptoms, Causes, and Treatment

Thrombosed external hemorrhoid?

Hello, doctor.
Recently, I've been having bowel movements every day, but they are often not smooth.
I frequently pass very hard stools, which require me to hold my breath and push forcefully to get them out.
This has been going on for about four days.
I notice blood when wiping, and often after using the restroom, I experience anal pain that lasts almost all day, along with a burning and itching sensation.
Additionally, I have an unusual wet and sticky feeling nearby, accompanied by a foul odor, and the burning sensation is quite common.
On the second day, while showering, I felt a small protrusion near my anus that is painful to touch.
Since it is external, could this be an external hemorrhoid with a thrombosis? When I intentionally tighten my anal sphincter, it also hurts and feels burning.
Normally, I don't feel anything unusual in that area, but I do experience slight pain when sitting.
I'm not sure if I have both anal fissures and hemorrhoids at the same time.
Will this resolve on its own?

Jennifer, 20~29 year old female. Ask Date: 2021/08/13

Dr. Ke Fangxu reply Surgery

Based on the photo, it appears to be a typical symptom of an anal fissure accompanied by a small skin tag, characterized by pain during bowel movements along with slight bleeding.
The pain usually lasts for several days, sometimes exceeding a week.
The common causes are often related to constipation or diarrhea.
The fundamental treatment involves addressing the bowel movement issues, along with warm sitz baths.
Warm sitz baths can help alleviate pain, maintain cleanliness, and promote blood circulation.
Over-the-counter hemorrhoid suppositories can also be purchased for use.
If symptoms persist without improvement, it is advisable to consult a physician for further examination.

Reply Date: 2021/08/13

More Info

External hemorrhoids, commonly referred to as "piles," are swollen veins located around the anus and lower rectum. They can cause a variety of symptoms, including pain, discomfort, itching, and bleeding during bowel movements. The symptoms you are experiencing—hard stools, straining during bowel movements, pain, burning, itching, and the presence of a lump—are indeed indicative of external hemorrhoids, potentially complicated by a thrombosis (blood clot) in the hemorrhoid.

Symptoms of External Hemorrhoids
1. Pain and Discomfort: This is often exacerbated during bowel movements, especially if you are straining or passing hard stools.

2. Bleeding: Bright red blood on toilet paper or in the toilet bowl after a bowel movement is common.

3. Itching and Irritation: The area around the anus may feel itchy or irritated, often due to moisture or irritation from bowel movements.

4. Swelling: You may notice a lump near the anus, which can be painful to touch. This lump may be a thrombosed hemorrhoid, which occurs when a blood clot forms inside the hemorrhoid.

Causes of External Hemorrhoids
The primary causes of external hemorrhoids include:
- Straining during bowel movements: This is often due to constipation or hard stools, which you mentioned experiencing.

- Prolonged sitting: Sitting for long periods, especially on the toilet, can increase pressure on the veins in the anal area.

- Pregnancy: Increased pressure from the growing uterus can lead to hemorrhoids.

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

- Chronic diarrhea or constipation: Both conditions can contribute to the development of hemorrhoids.

Treatment Options
1. Dietary Changes: Increasing fiber intake can help soften stools and reduce straining. Foods rich in fiber include fruits, vegetables, and whole grains. Staying hydrated is also crucial.

2. Over-the-Counter Remedies: Topical treatments, such as hydrocortisone creams or witch hazel pads, can help reduce inflammation and relieve itching.

3. Warm Baths: Soaking in a warm bath (sitz bath) can provide relief from pain and discomfort.

4. Avoid Straining: Try to avoid straining during bowel movements. If you are constipated, consider using a stool softener or laxative as recommended by a healthcare provider.

5. Medical Procedures: If conservative treatments do not provide relief, procedures such as rubber band ligation, sclerotherapy, or surgical removal may be necessary.

Will It Heal on Its Own?
In many cases, external hemorrhoids can resolve on their own, especially if you make lifestyle changes to address the underlying causes. However, if you are experiencing significant pain, persistent bleeding, or if the lump does not improve, it is essential to consult a healthcare professional. They can provide a proper diagnosis and recommend appropriate treatment options.

When to Seek Medical Attention
You should seek medical attention if:
- You experience severe pain that does not improve with home treatment.

- There is significant bleeding that does not stop.

- You notice changes in bowel habits or any new symptoms.

In conclusion, while external hemorrhoids can be uncomfortable and painful, they are generally manageable with lifestyle modifications and over-the-counter treatments. However, if symptoms persist or worsen, it is crucial to consult a healthcare provider for a thorough evaluation and tailored treatment plan.

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