How to Differentiate Between External Hemorrhoids and Skin Folds - Surgery

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Anal issues


Thank you, doctor, for your response! I am still very confused about whether my folds are external hemorrhoids.
How can a doctor distinguish between external hemorrhoids and skin folds? My anxiety is affecting my sleep!

Lie Ren, 40~49 year old female. Ask Date: 2023/12/27

Dr. Zhang Shuhao reply Surgery


External hemorrhoids, in addition to containing vascular plexuses, are prone to congestion and swelling due to poor venous return.
They are located closer to the anal opening, and the skin in this area is more sensitive, making it prone to pain when swollen.
If symptoms are not significant or infrequent, no special treatment is necessary.
However, if discomfort is experienced, it is advisable to seek an outpatient examination to avoid excessive anxiety.

Reply Date: 2023/12/27

More Info


When it comes to differentiating between external hemorrhoids and skin folds, it’s essential to understand the anatomy and characteristics of each condition. External hemorrhoids are swollen veins located under the skin around the anus, while skin folds are simply the natural creases or folds of skin that can occur in the anal region.

Characteristics of External Hemorrhoids:
1. Appearance: External hemorrhoids typically appear as swollen, bluish lumps around the anal area. They may be tender to the touch and can vary in size.

2. Symptoms: They often cause discomfort, itching, and pain, especially during bowel movements. You may also notice bleeding during or after a bowel movement.

3. Texture: The surface of an external hemorrhoid may feel smooth or slightly bumpy, and it can be sensitive or painful when touched.

4. Location: They are located at the anal verge and can be seen or felt when you examine the area.

Characteristics of Skin Folds:
1. Appearance: Skin folds are typically not swollen or painful. They appear as natural creases in the skin and may be more pronounced in individuals with excess weight or skin laxity.

2. Symptoms: Skin folds usually do not cause any symptoms unless they become irritated or infected. They do not typically bleed unless there is a secondary issue.

3. Texture: Skin folds have a normal skin texture and do not feel tender or painful.

4. Location: They are usually found in the same area but are not raised or swollen like hemorrhoids.

How to Differentiate:
- Palpation: Gently feeling the area can help. If the lump is soft and painful, it is more likely to be an external hemorrhoid. Skin folds will feel like normal skin without tenderness.

- Observation: Look for signs of swelling, discoloration, or bleeding. If you notice these symptoms, it’s more likely to be an external hemorrhoid.

- Symptoms: Pay attention to any discomfort during bowel movements or if there is bleeding. These symptoms are more indicative of hemorrhoids.

When to Seek Medical Advice:
If you are experiencing significant discomfort, bleeding, or if the area appears to be changing, it is crucial to consult a healthcare professional. They can perform a physical examination and provide a definitive diagnosis.
Managing Anxiety:
It’s understandable to feel anxious about your symptoms, especially if they are affecting your sleep. Consider discussing your concerns with a healthcare provider who can offer reassurance and possibly recommend treatments for both your physical symptoms and anxiety. Techniques such as mindfulness, relaxation exercises, or cognitive behavioral therapy may also help manage anxiety.

In conclusion, while external hemorrhoids and skin folds can appear similar, their characteristics and associated symptoms can help you differentiate between the two. If you remain uncertain or if your symptoms persist, seeking medical advice is the best course of action.

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