External Hemorrhoids: Causes, Symptoms, and Treatment Options - Surgery

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External hemorrhoids, commonly referred to as external piles, are swollen veins located around the anus and lower rectum. They can be quite uncomfortable and are often associated with various symptoms, including pain, itching, and bleeding during bowel movements. Understanding the causes, symptoms, and treatment options for external hemorrhoids can help manage this condition effectively.


Causes of External Hemorrhoids
External hemorrhoids are primarily caused by increased pressure in the lower rectum. 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 excessive straining.

2. Pregnancy: The increased weight of the uterus can put pressure on the pelvic veins, leading to hemorrhoids.

3. Obesity: Excess body weight can increase pressure on the veins in the rectal area.

4. Prolonged Sitting: Sitting for long periods, especially on the toilet, can contribute to the development of hemorrhoids.

5. Heavy Lifting: Regularly lifting heavy objects can increase abdominal pressure, leading to hemorrhoids.


Symptoms of External Hemorrhoids
The symptoms of external hemorrhoids can vary, but common signs include:
- Pain or Discomfort: This is often felt during bowel movements or when sitting.

- Swelling: You may notice a lump near the anus, which can be sensitive or painful.

- Itching or Irritation: The area around the hemorrhoid may feel itchy or irritated.

- Bleeding: Bright red blood may appear on toilet paper or in the toilet bowl after a bowel movement.


Treatment Options
Treatment for external hemorrhoids can range from home remedies to medical procedures, depending on the severity of the condition:
1. Home Remedies:
- Warm Baths: Soaking in warm water can help relieve pain and discomfort.

- Over-the-Counter Creams: Creams containing hydrocortisone or witch hazel can reduce inflammation and itching.

- Dietary Changes: Increasing fiber intake can help prevent constipation and reduce straining during bowel movements.

2. Medical Treatments:
- Rubber Band Ligation: This procedure involves placing a rubber band around the base of the hemorrhoid to cut off its blood supply, causing it to shrink.

- Sclerotherapy: A chemical solution is injected into the hemorrhoid to shrink it.

- Hemorrhoidectomy: In severe cases, surgical removal of the hemorrhoids may be necessary.


Why Your Hemorrhoids Haven't Disappeared
In your case, the presence of two small, soft lumps at the anal opening suggests that you may have external hemorrhoids that have not resolved. This can happen for several reasons:
- Chronic Straining: If you continue to strain during bowel movements, the hemorrhoids may persist.

- Lifestyle Factors: Lack of dietary fiber, dehydration, or prolonged sitting can contribute to the persistence of hemorrhoids.

- Incomplete Treatment: If the initial treatment was not comprehensive, the hemorrhoids may not have fully resolved.


Classification of Hemorrhoids
Hemorrhoids are typically classified into four grades based on their severity:
- Grade I: Small, bulging hemorrhoids that do not protrude outside the anus.

- Grade II: Hemorrhoids that protrude during bowel movements but retract on their own.

- Grade III: Hemorrhoids that protrude and need to be manually pushed back in.

- Grade IV: Hemorrhoids that are permanently protruding and cannot be pushed back in.

Based on your description, if the lumps are soft and do not retract, they may be classified as Grade II or III.

Conclusion
To promote healing and potentially reduce the size of your external hemorrhoids, consider making dietary changes to increase fiber intake, stay hydrated, and avoid straining during bowel movements. If the symptoms persist or worsen, it is advisable to consult a healthcare professional for further evaluation and treatment options. They can provide a tailored approach based on your specific condition and needs.