External Hemorrhoids: Symptoms, Causes, and Treatment Options

Thrombosed external hemorrhoid (with image)

Hello, Dr.
Ke! I apologize for asking again due to the image issue, and I appreciate your willingness to take the time to respond.
Recently, I have been having daily bowel movements, but they are often not smooth.
I frequently pass very hard stools, which require me to hold my breath and push hard to expel them.
This has been ongoing for about four days.
I notice blood when wiping, and often after using the restroom, I experience anal pain that lasts almost the entire day, along with a burning and itching sensation.
Additionally, I have an unusual wet and sticky feeling nearby, accompanied by an odor, and the burning sensation is quite common.

On the second day, while showering, I felt a small raised bump near the anus, which is very painful when touched or pressed, making it difficult to wash.
I cannot push it back in because it hurts too much.
I would like to know if this could be hemorrhoids.
When I intentionally contract my anus, it is very painful and there is a burning sensation.
I usually do not feel anything unusual in that area, but sitting causes some discomfort.
I am uncertain whether this is an anal fissure, hemorrhoids, or possibly both.

Will this resolve on its own? What dietary choices should I make? Below are the image links; could you please tell me if this looks severe? I have read online that external hemorrhoids may require surgery, but I am very afraid of surgery and do not want to cause any trouble due to my family's financial situation.
When I took the pictures, I was a bit shocked because the color around the anus is not the same as my skin color.
Is this normal?
[Image Link 1](https://drive.google.com/file/d/14fOzoyTUsZAUu6FNvMdZ1MJOWISiJOCF/view?usp=sharing)
[Image Link 2](https://drive.google.com/file/d/1Ousvc84yU-zZnrpYZFm4H7ib1yewdFcI/view?usp=sharing)
[Image Link 3](https://drive.google.com/file/d/1Z4K1_Ks2iLs8PZsWiQVXBDk8YWK9H8kt/view?usp=sharing)

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 tag of skin.
The hallmark symptoms include pain during bowel movements and slight bleeding, with the pain often lasting several days or even more than a week.
The common causes are usually 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 evaluation.

Reply Date: 2021/08/13

More Info

External hemorrhoids are swollen veins in the anal region that can cause discomfort, pain, and bleeding, especially 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, and possibly anal fissures as well.

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 can occur due to irritation or tearing of the hemorrhoid.

3. Itching and Irritation: This can be caused by moisture and irritation in the anal area.

4. Swelling: A lump or swelling near the anus that can be painful to touch.

Causes
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.

- Low-fiber diet: A diet lacking in fiber can lead to constipation and straining.

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

2. Over-the-Counter Remedies: Creams and ointments containing hydrocortisone or witch hazel can help reduce inflammation and relieve itching.

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

4. Pain Relief: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain.

5. Avoid Straining: Try to avoid straining during bowel movements. If you find it difficult to pass stools, consider using a stool softener.

6. Medical Procedures: If symptoms persist and are severe, procedures such as rubber band ligation, sclerotherapy, or surgical removal may be necessary. However, these are typically considered when conservative treatments fail.

When to Seek Medical Attention
If you notice significant bleeding, severe pain, or if the lump does not improve with home treatment, it is essential to consult a healthcare provider. They can perform a physical examination and possibly recommend further treatment options.

Conclusion
Based on your description, it seems likely that you are dealing with external hemorrhoids, possibly accompanied by anal fissures due to straining. While many cases can resolve with conservative treatment, it is crucial to address dietary habits and avoid straining to prevent recurrence. If your symptoms do not improve or worsen, seeking medical advice is essential to rule out other conditions and discuss potential treatments.
Remember, while surgery is an option for severe cases, many individuals find relief through lifestyle changes and non-invasive treatments. Don't hesitate to reach out to a healthcare professional for personalized advice and support.

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